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Prognosis for Treating Trigger Points

Dr. Travell, "Acute myofascial pain due to TPs caused by clearly identifiable strain of one muscle is, as a rule, easily relieved. If the patients pain has increased as the range of motion decreased, the therapeutic results are still likely to be good. If the pain has decreased as the range of motion also decreased, which may indicate increasing fibrosis, achieving relief of pain and return of function becomes more challenging. Patients who have had a stable pattern of referred TP pain for months or longer, without extension to other muscles, are likely to respond well to treatment. When the pain has spread and is gaining momentum with successively more muscles becoming involved, multiple perpetuating factors must be eliminated before specific myofascial therapy will give sustained relief."
Paraphrase = The simpler, fewer and shorter duration trigger points have a faster and easier recovery. Multiple sites, long duration, increasing number and higher and longer severity trigger points take much longer to resolve or reduce and may not end completely.
Goals of treatment are:
1. Decreased pain
2. Increased mobility and ROM
3. Increased function
4. Better patient control of environment/self/precipitating factors

Depending on the severity, patient's commitment and a broad treatment approach most patients can recover significantly or fully within a reasonable time.
Estimates of treatment duration are:

  Acute Short term (<6mo.) Constant Chronic Long term (>6mo.) Recurring Chronic Long term (> 1 yr)
Single or Localized Mild- moderate 3 » 1/wk 1 - 3 wks 3 » 1 /wk 3 - 8 wks 3 » 1 /wk 3 - 8 wks
Severe 3 » 1 /wk 3 - 8 wks 3 » 1 /wk 3 - 8 wks 3 » 1 /wk 3 - 8 wks
Multiple <9 MPS Mild - moderate 3 » 1 /wk 3 - 8 wks 3 » 1 /wk 6 - 12 wks 3 » 1 /wk 10 - 20 wks
Severe Daily » 3/wk 6-12 wks Daily » 3/wk 6-12 wks Daily » 3/wk 10-20 wks
Multiple 9+ FMS Mild - moderate N/A Daily » 3/wk 4-12 mos Daily » 3/wk 4-12 mos
Severe N/A Daily » 3/wk 6-12 mos Daily » 3/wk 6-12 mos

» = "down to" - i.e. 3 » 1/wk 1 - 3 wks = 3 down to 1 time per week for 1 to 3 weeks
MPS = Myofascial Pain Syndrome = TPs in 8 or fewer of the 16 regions of the body
FMS = Fibromyalgia Syndrome = TPs in 9 or more of the 16 regions of the body

Sample Patients
#1. Recent documented injury with grade 4 trigger points in only one body region (neck/shoulders)
= Single or Localized / Severe / Acute - 3 per week x 1 to 3 weeks, 2 per week x 1 to 3 weeks until TP is gone and then a final exam 1 or 2 weeks later for a total of 3 to 8 weeks.

#2. Long term recurring chronic fibromyalgia. Daily for 4 to 12 weeks, 3 to 4 times per week for 2 to 6 months, 1 to 2 times per week for 6 to 12 weeks, etc. = total 6 to 12 months

Reasons for Failure
Lack of patient commitment
Misunderstanding / lack of doctor-patient education
Continuation of precipitating and/or perpetuating factors
Excessive patient zeal
Lack of familial support
Lack of doctor technique
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