Myofascial Pain Syndrome: An Update on Clinical Characteristics, Etiopathogenesis, Diagnosis, and Treatment.

Abstract

Myofascial pain syndrome (MPS) is a chronic regional pain condition characterized by trigger points-hyperirritable spots within taut bands of muscle fibers that cause both localized and referred pain. The pathogenesis, diagnostic criteria, and classification of MPS are still under investigation, which complicates the development of standardized treatment protocols. Although diagnostic tools have improved, MPS often remains underrecognized due to symptom overlap with other pain disorders, such as fibromyalgia, neuropathic pain, and joint disorders. Factors contributing to its onset and persistence include muscle overuse, postural imbalance, systemic conditions, and psychological and behavioral influences. This narrative review explores the primary risk factors, current hypotheses on pathogenesis, diagnosis and differential diagnosis, and both conventional and emerging treatments. Sufficient evidence supports the use of local anesthetic injections for MPS. Some evidence suggests that dry needling, acupuncture, magnetic stimulation, ultrasound therapy, laser therapy, extracorporeal shock wave therapy, and manual therapy may be effective, particularly compared to sham or placebo. However, non-steroidal anti-inflammatory drugs, diclofenac, botulinum toxin, and transcutaneous electrical nerve stimulation show insufficient evidence, while the effectiveness of muscle relaxants, antidepressants, gabapentin, opioids, topical lidocaine, capsaicin, EMLA cream, and kinesio taping remains inconclusive. Effective management of MPS requires a patient-centered approach that integrates empirically supported and evidence-based treatments tailored to individual needs. This review synthesizes the current understanding of MPS and highlights the need for high-quality research to improve clinical decision-making in managing this complex condition.