What is the pathogenesis of myofascial pain (MP) and trigger points (TrPs) in low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

The pathogenesis of MP and TrPs remains unproven. To date, research suggests that myofascial dysfunction with characteristic TrPs is a spinal segmental reflex disorder. Animal studies have showed that TrPs can be abolished by transecting efferent motor nerves or infusing lidocaine; however, spinal transection above the level of segmental innervation of a TrP-containing muscle does not alter the TrP response. Simons postulates that abnormal, persistently increased, and excessive acetylcholine release at the neuromuscular junction generates sustained muscle contraction and a continuous reverberating cycle. This cycle has been postulated to result in painful and dysfunctional extrafusal muscle contraction that forms the basis for MP and possibly the actual structural substrate of the TrP.


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