A review of comprehensive pain treatment textbooks finds no chapters dealing with muscle pain aside from sections on “Myofascial Pain Syndrome” discussing “trigger points” as the defining characteristic of syndromes with painful muscles. This points up a fundamental problem in discussing and understanding clinical muscle pain- the lack of agreed terminology to describe what is found when a painful muscle is examined. All muscle pain logically cannot be the result of trigger points. Treating every patient with tender muscles with injections will frequently result in failure to eliminate the pain. To better appreciate this lack of understanding, the history of muscle pain should be reviewed.

The same confusion encountered today is found as early as the 16th century when Guillaume de Baillou first referred muscular rheumatism, while describing diffuse soft tissue pain. Other clinicians subsequently offered their explanations, inventing new terms along the way. In the 19th century, many believed that muscle pains were a disease of the muscle itself (a “serous exudative process”). Tender nodules were thought to be a clinical manifestation of this disease, and were first reported during this period. In 1919, Schade also observed muscle nodules and coined the term myogelosen (muscle gelling) and in 1921, M Lange used the term Muskelhärten, meaning hardened muscle. Various other authors referred to some type of muscular or fibrous inflammation and used terms such as fibrositis and myofibrositis. These terms eventually lost favor because there was actually no obvious inflammation in the muscle even though it was tender to pressure. The debate on the importance of tender nodules in muscles, which began at the turn of the last century, continues, with some authors denying their importance and observing that patients who are otherwise without pain complaints also may have these tender areas.

I am sharing this somewhat dense information because it is generally not discussed or understood that although doctors have been aware of muscle pain for hundreds of years, it has been difficult to understand what causes it or what the findings on physical examination tell us about its nature.

I will continue to discuss the various factors that make muscle pain confusing. One of the most interesting factor and why it has been so difficult to understand the meaning of tenderness in muscles is the fact that muscles refer pain to adjacent and distant muscles. More on that in my next blog this week.

~ Norman Marcus, MD
Norman Marcus Pain Institute, New York NY
 
“Your New York City Doctor”
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