Cervical myofascial pain originates from neck muscle and surrounding fascia and is characterized by the presence of trigger points [hyperirritable areas located in a palpable, taut band of muscle]
Myofascial pain syndrome is said to constitute the largest group of unrecognized and among the most commonly overlooked causes of chronic pain and disability.
Often, the Cervical myofascial pain is described as steady, deep, and aching in quality, although it is not uncommon for patients to use words like burning or crushing.
The pain patterns are not limited to a specific dermatome or peripheral nerve segment. The pain of myofascial origin is essentially a diagnosis of exclusion, as the character of the pain may mimic other cervical pathology.
The muscles most often implicated in cervical myofascial pain are the trapezius, levator scapulae, rhomboids, supraspinatus, and infraspinatus.
Myofascial pain has predominance among women.
Causes of Cervical Myofascial Pain
Overuse of the muscles by repetitive use of the upper limb or trauma to muscles may lead to cervical myofascial pain. Lack of proper furniture in desk jobs, endocrine dysfunction, chronic infections, nutritional deficiencies, poor posture, and psychological stress may also be responsible.
Cervical myofascial pain may be abrupt in onset (after an injury) or of more gradual onset (from chronic overutilization of muscles).
Psychogenic stress, viral illness, visceral disease, exposure to cold or damp weather, strenuous exercise, or prolonged tension of the involved muscle may precipitate or exacerbate a myofascial pain syndrome.
Trigger points commonly responsible for pain referred to the cervical area are located within several muscle groups.
Cervical Myofascial Pain Trigger Points
| Muscle | Area of referred pain |
| Trapezius | Neck, shoulder, and temporal region |
| Splenius capitis and cervicis | Head, occiput, shoulder, and neck; vision may be blurred |
| Posterior neck muscles, semispinalis capitis and cervicis and multitifidi | Suboccipital area, neck, and shoulders |
| Levator scapulae | Angle of the neck and along the vertebral body of the border of the scapula |
| Scalene | Chest, the upper-central border of the scapula, and along the arm. |
| Supraspinatus | Posterior neck and suboccipital area of the deltoid, deep in the shoulder joint, and the front and lateral aspects of the arm. |
Presentation and Diagnosis of Cervical Myofascial Pain
The patient may give a history of trauma or repetitive activity but cervical myofascial pain can also be associated with poor posture, stress, or cold weather. Pain in the neck can be associated with a bump in the trapezius or cervical paraspinal muscles.
Pain may radiate into the upper extremities and may be accompanied by numbness and tingling in the upper extremity. Pain may be accompanied by dizziness or nausea.
The pain may be relieved by massage or heat therapy.
Patients with cervical myofascial pain often present with poor posture. Trigger points or taut bands may be noted in trapezius, supraspinatus, infraspinatus, rhomboids, and levator scapulae muscles.
The diagnosis of cervical myofascial pain is clinical. There are no confirmatory laboratory tests available.
However, investigations to rule out any serious conditions may be needed. In the case of trauma cervical, x rays may be done to rule out cervical instability.
Magnetic resonance imaging may be a help to rule out problems in the cervical spine and spinal canal. Common differential diagnoses of cervical myofascial pain are
- Cervical Disc Disease
- Cervical Spondylosis
- Cervical Sprain and Strain
- Fibromyalgia
- Rheumatoid Arthritis
- Thoracic Outlet Syndrome
Treatment of Cervical Myofascial Pain
Physical Therapy
Myofascial release techniques, massage, cervical stretch, and stabilization are integral parts of this approach. The primary goal of physical therapy is to restore the balance between muscles working as a functional unit. Postural retraining is crucial.
Trigger Point Injection
One of the most accepted means of treating myofascial pain besides physical therapy and exercise. Injection is performed most commonly with local anesthetic, although dry needling is equally effective.
Stretch and spray
This technique is performed using a vapocoolant spray applied to the affected muscle after it has been placed in the passive stretch.
Ischemic Compression
Ischemic compression involves the application of sustained pressure on the trigger point. With muscle in a fully stretched position, press firmly on the trigger point with a thumb. Gradually increase the pressure as the pain lessens.
Drug Therapy
Analgesics
Nonsteroidal anti-inflammatory drugs are the drugs of choice for the initial treatment of myofascial pain. Ibuprofen, Indomethacin, naproxen, diclofenac, and ketoprofen are commonly used drugs.
Opioid analgesics like tramadol can also be used.
Tricyclic Antidepressants
Tricyclic antidepressants like amitriptyline are commonly used for chronic pain. They also help to treat associated insomnia.
Muscle Relaxants
Cyclobenzaprine, baclofen, carisoprodol, tizanidine are commonly used muscle relaxants.
Anticonvulsants
Gabapentin has been shown to be effective in treating myofascial and neuropathic pain.
Prognosis
With appropriate treatment, the prognosis is generally good. Outcomes is better when treatment is initiated early.
Cervical myofascial pain is a treatable condition if the patient is educated on the condition and takes an active role in the recovery process. However, recurrence is a problem.
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C.O'Halloran says
August 22, 2012 at 11:59 pmI identify myself as having many of the symptoms detailed here. I've suffered from what I have always labeled 'tension headaches' for ten years now, starting in my late teens, however the pain is not actually in my head at all. The tension begins at the bottom of my cranium, spreading through the back and sides of my neck and slightly under the ears, right down to the most tender points along the tops of my shoulders. I also have a great deal of tension at the top of my shoulder blades. I experience an episode every 10-14 days which generally last 2-3 days a time. 9 times out of 10 I actually wake up with pain having gone to bed ok. The only relief I get is by applying a heat pack but the pain returns within hours. I have been able to continue to attend work but with a great deal of discomfort. I have had both physio and osteopathy treatment over the years where I have experienced some relief with soft tissue massage and adjustments but the muscle tension returns again within days.
I have had countless eye/dental tests, changed my pillows/matresses, changed my birth control and cut possible food triggers out of my diet. All to no avail. I have not suffered any trauma to my neck and do not suffer from stress or depression. I try not to take pain relief medication as I do not want to become addicted or develop rebound headaches. I have been taking magnesium phosphate tablets for six months but have not noticed any improvement.
I can only assume that the cause is either my sleeping position itself or my posture so I am working on improving this. My doctor has simply advised that I need to explore what the causes of my 'tension' are by myself.
Can anyone offer any suggestions or shed any light on what else I should explore? My chiropractor has mentioned fybromyalgia but from what I've read this appears to be a more severe pain and much wider spreading muscle issue throughout the body than I experience.
Thank you in advance for any feedback you are able to offer.
Dr Arun Pal Singh says
September 13, 2012 at 10:43 pm@C.O'Halloran,
Has your neck been examined and investigated?