Jay Shah and MTrPs

MYOFASCIAL PAIN: INTEGRATING OBJECTIVE PHYSICAL FINDINGS WITH TREATMENT STRATEGIES

Jay P.
Shah, MD

8:00
AM–4:00 PM (Break: 10:30–10:45 AM, Lunch: 12:00–1:30 PM, Break: 2:45–3:00 PM)

Chronic pain states are characterized by profound changes in neuronal excitability and architecture in the pain matrix. This workshop integrates emerging knowledge the pain sciences in a clinically accessible way. Attendees will learn to identify active myofascial trigger points (MTrPs) and common physical findings in neuro–anatomically related dermatomes, myotomes, and sclerotomes. These objective findings are ubiquitous in chronic musculoskeletal pain states and suggestive of spinal segmental sensitization. Participants will learn and apply dry needling
techniques and electrical stimulation modalities to deactivate MTrPs and desensitize affected spinal segments. Application of examination techniques before and after treatment provides reproducible findings that guide treatment outcomes.

Does Shah make any distinction between spinally vs trigeminally innervated pain, TPs, etc. ?

Quote: (docfm)

Have to look back at my notes, but he was primarily focusing on the peripheral issues of muscle pain. If I remember there was not too much on trigeminal if any.

and there in lies the problem.

Travell & Simons is the bible for myofascial pain. When one examines the evidence they cited, when it comes to “TMD” pain, one finds Morgan’s text from the 80’s. This book has an entire chapter on muscle “spasm” as it relates to facial pain. (Spasm is extremely rare, except in cases of dystonia.)

Lund spilled a lot of ink refuting Travell’s viscious cycle theory and brought forth the pain adaptation model. Stohler and others have shown the lack of association of EMG values with pain. When I look at our patient population, we rarely see TPs in trigeminally innervated musculature.

I would love to hear/read Shah’s thoughts on this.