Signs and symptoms of myofascial pain syndrome: an international survey of pain management providers, comparing results from the 1999 and 2012 surveys

Myofascial Pain Syndrome (MPS) is a highly prevalent pain diagnosis, yet there are no validated diagnostic criteria. This study compares the opinions of clinicians to a similar survey sent to members of the American Pain Society in 1999, and members of the International Association for the Study of Pain and American Academy of Pain Medicine in 2012. Clinicians were asked about the vitality of the MPS diagnosis, and to select which symptoms, signs, and response to treatment are essential, associated, irrelevant, or exclusionary to the diagnosis. These surveys will serve to guide a consensus conference and ultimately formal empirical validation of diagnostic criteria. Response rates were 403/1663 and 214/4143, respectively. Most believe MPS is a distinct clinical entity: 88% in 1999 and 76% in 2012. “Regional pain location,” “presence of trigger points,” and “normal neurologic examination” in 1999, and “tender spot causing local pain” and “recognition of symptoms upon palpation” in 2012 were endorsed as essential by over 50% of respondents. Over 90% of respondents believed “trigger points,” “decreased pain with local injection,” “taut bands,” “decreased pain with spray/stretch,” “dull, achy or deep pain,” “regional pain,” and “tender points” were essential to or associated with MPS in 1999; while “local muscle pain,” “soft tissue pain,” “pain/dyesthetic referral,” “recognition of symptoms upon palpation,” “taut band,” “tender nodule,” improvement with “PT,” “manual therapy,” and “injection of local anesthetic” were in 2012. There remains general agreement that MPS is a distinct clinical entity. Tender/trigger points, regional pain, and response to injection and manual therapy are reported essential/associated in both surveys. This study lays the groundwork for developing formal consensus-based diagnostic criteria and subsequent empirical validation. Funded through the RG Addison, MD and ER Blonsky, MD Research Grant from the Midwest Pain Society.