Myofascial trigger point perpetuating factor: psychological stress

In today’s achievement oriented society, stress can be used as a motivating factor to achieve goals, but when excessive, this can result in a multitude of somatic, visceral or psychological complaints. These manifest complaints can be diffused and obscure leading to excessive diagnostics as well as frustration and dismissal of validity on behalf of the practitioner.

Tension related myalgia, while initially a gender specific diagnosis for females experiencing pelvic related pain, has been broadened to incorporate both genders and anomalies not only of the pelvic but abdominal, pectoral and cervical regions as well as headaches. This constant storing of emotion or tension of muscles can either perpetuate or activate trigger point pain, paresthesia or autonomic phenomenon.

Undoubtedly, it is the most common source of trigger point activation within our respective patient populations. Like all conditions that yield hypertonicity or muscle rigidity, it has the potential to deviate structure or create biomechanical segmental dysfunction.  As this SD can result in a radiculopathy, clinical definition between radicular pattern and trigger point referral pattern or zone can be bewildering.

Thus, one of the most highly responsive conditions to manual medicine can be overlooked, be treated inappropriately, and result in unnecessary time expenditure and lost confidence on behalf of the individual towards the practitioner. This negative situation encourages hopelessness and doctor swapping. The practitioner frequently assigns this condition to somatization, or if the patient becomes emotional, as a conversion hysteria.

While it is true that somatization and histrionic behavior are frequently observed within the healthcare community, the savvy practitioner can only delineate between psychological manifestation and somatic manifestation through the art of palpation and the knowledge of respective referral patterns.

Clinical depression is frequently observed within the primary care setting. Secondary to depressive states we frequently observe generalized myalgia. Individuals that have a standing diagnosis of bipolar disorder usually have depleted serotonin levels. Serotonin, aside from being a mood elevator, modulates sensory perception, especially for pain.

Fibromyalgia, while not a psychological syndrome, is exacerbated by stress. According to Dr. Travell, fibromyalgia is not a form of a myofascial pain syndrome. However, it does possess the ability to develop TrP’s and frequently is accompanied with depression.  Therefore persistent psychological stress effects the production of several neurotransmitters such as serotonin, dopamine, endorphin and L Dopa. These neurotransmitters, in addition to well over a hundred others, affect our mood and ability to deal with pain.

Dr. Travell also references a condition known as “Good Sport Syndrome”. This condition is the opposite of hypochondria. These “good sports” are individuals that push on with their daily living activities while enduring significant pain. Therefore the practitioners’ ability to render health care is not only dependent upon their comprehensive understanding of conditions, but their perception of the individuals’ needs or agenda.

Frequently, the medications used to manage these and other disorders affect the metabolic and endocrine system, which can result in muscle pain. Recreational drug usage also affects serotonin and endorphin levels. As the brain produces both of these chemicals, depletion of one or the other effects our ability to cope with pain. 

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