Pain book
Muscle Pain Clinic

Myofascial pain is pain coming from the body's soft tissues and muscles. The symptoms are those of localised pain, and stiffness, with specific tender areas known as Trigger... Read more.

Muscle Pain

Muscle Pain Clinic

Myofascial Pain Syndrome

Myofascial pain is pain coming from the body's soft tissues and muscles. The symptoms are those of localised pain, and stiffness, with specific tender points on palpation, known as Trigger Points. Trigger Points occur when nerves supplying these muscles become irritated, with the result that the muscles are continually stimulated giving rise to pain and tenderness. These areas can be identified on physical examination.

Trigger points and their associated pain sites




*Adapted from Travell & Simons (1983 & 1992)

The trigger point (site to be injected) is marked with an X, the dark and stippled areas are the areas where pain is usually experienced.

Some caused of Myofascial pain.

Sports injuries, road traffic accidents, falls, stress, degenerative changes and repetitive movements.

General Information

Treatment for Myofascial pain syndrome is done in the Muscle Pain Clinic, done in conjunction with physiotherapy. Patients usually attend a series of three clinic appointments at approximately one-week intervals, although exact timing does not seem to be crucial to success.

Most patients will be able to drive themselves to these appointments and should come to the hospital and report to outpatient department. For your comfort please wear clothing that is easily removable.

Treatment time is approximately 30 minutes, however this may be longer at certain times. After treatment we advise you to rest for 10-15 minutes in the main waiting area where tea and coffee is available.


You will be examined by a physiotherapist who identifies the painful Trigger Points in the affected muscle(s). A heated pad is then applied to the affected area. The Trigger Points are injected with a small volume of long acting local anaesthetic (bupivicane) and a slow release anti-inflammatory drug (DepoMedrone) by the clinical practitioner. Following the injections, the physiotherapist will use either a cold spray (vapocoolant) or ultrasound on the Trigger Points. This helps to relax the muscle(s) and increases the circulation to them. The physiotherapist will then stretch the muscles through a full range of movements and show you how to do the appropriate stretches regularly at home.

Main Side Effects

You may experience some pain and bruising around the injection site(s). Please inform the clinic staff prior to your appointment if you are taking drugs to thin your blood such as warfarin, as these may need to be altered during your treatment to prevent bruising and haematoma (collection of blood under the skin).


Many patients receive long lasting pain relief from this treatment. If the pain and muscle tenderness persists despite this treatment a follow up appointment will be arranged for you with Dr Dolin.

Botox Treatment

In some cases of chronic myofascial pain Botulinum toxin (Botox) may be used. This substance is injected into the Trigger Point sites where its action is one of relaxing the muscles for a period of weeks or months giving pain relief. This same drug is used by cosmetic surgeons to relax facial muscles.

After treatment with Botox patients will be required to rest for a minimum of 20 minutes before departing. Occasionally flu like symptoms may be felt.

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