Workshop description

This workshop explores the dynamic roles that myofascial trigger points (MTrPs), central sensitization, limbic system dysfunction, and objective physical findings play in the evaluation and management of chronic myofascial pain.

Spinal Segmental Sensitization (SSS) is a hyperactive state of the dorsal horn caused by bombardment of nociceptive impulses. Painful MTrPs are a common source of persistent nociception that leads to SSS and facilitated segments. Maladaptive changes in subcortical structures (e.g., the limbic system) and dysfunctional descending inhibition may contribute to somatic tissue abnormalities (e.g., tissue texture changes, tenderness, and stiffness).

Typical physical manifestations of SSS include dysesthesias such as allodynia / hyperalgesia, sclerotomal tenderness, expansion of receptive fields and painful MTrPs within the affected myotomes. Patients usually exhibit increased wind-up within the affected dermatome which can be quantified clinically though Quantitative Sensory Testing (QST) techniques such as weighted pinprick analysis to determine mechanical pain threshold (MPT) and wind-up ratio (WUR).

Participants will learn to recognize these objective and reproducible physical findings to identify the dysfunctional spinal segment(s) that should be treated and the application of QST techniques in the assessment of central sensitization.

Participants will also be shown therapeutic techniques to deactivate painful MTrPs and their associated sensitized spinal segments, in order to effectively alleviate chronic myofascial pain. The clinical application and interpretation of MPT and WUR outcomes will be discussed and demonstrated as objective measures of improvement in pain sensitivity post-treatment.

Learning Objectives

Upon completion of this workshop, participants will have learned:

1)  The unique neurobiology of muscle pain and the dynamic interplay of muscle nociceptors and endogenous biochemicals in the initiation, amplification, and perpetuation of peripheral and central sensitization.

2)  That persistent nociceptive bombardment, neurogenic inflammation,wide dynamic range neurons, subcortical structures (e.g., the limbic system) and dysfunctional descending inhibition all play a pivotal role in muscle sensitization, pain chronification, somato-visceral interactions and the objective, reproducible physical findings of allodynia, hyperalgesia and referred pain patterns.

3)  How to determine the reproducible physical manifestations of spinal segmental sensitization (involving dermatomes, myotomes, and sclerotomes) observed in chronic myofascial pain and dysfunction.

4)  How to assess central sensitization via QuantitativeSensoryTesting(QST),including measurement of mechanical pain thresholds (MPT) and windup ratios (WUR) using weighted pinprick technique.

5)  Novel applications of ultrasound imaging are able to visualize MTrPs, measure their stiffness properties and local blood flow.

6)  That MTrPs in the upper trapezius are stiffer than surrounding tissue and that active MTrPs can be distinguished from latent MTrPs by their high-resistance blood flow and greater surface area.

7)  Therapy techniques that desensitize the involved segments, deactivate painful MTrPs, and alleviate chronic myofascial pain and dysfunction.