Cold sores – NHS

Cold sores are common and usually clear up on their own within 10 days. But there are things you can do to help ease the pain.

Check if it’s a cold sore

A cold sore usually starts with a tingling, itching or burning feeling.

Over the next 48 hours:

Small fluid-filled blisters appear.

Credit:

SCIENCE SOURCE/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/257566/view

The blisters can appear anywhere on the face.

Credit:

PAN XUNBIN/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/479137/view

The blisters burst and crust over into a scab.

Credit:

C0473050, DR P. MARAZZI / SCIENCE PHOTO LIBRARY https://www. sciencephoto.com/media/1051811/view/cold-sore-on-lip

Cold sores should start to heal within 10 days, but are contagious and may be irritating or painful while they heal.

Some people find that certain things trigger a cold sore, such as another illness, sunshine or menstrual periods.

When it’s not a cold sore

How long cold sores are contagious

Cold sores are contagious from the moment you first feel tingling or other signs of a cold sore coming on to when the cold sore has completely healed.

A pharmacist can help with cold sores

A pharmacist can recommend:

• creams to ease pain and irritation
• antiviral creams to speed up healing time
• cold sore patches to protect the skin while it heals

You can buy electronic devices from pharmacies that treat cold sores with light or lasers.

Some people find these helpful, but there have not been many studies to confirm if they work.

Information:

If you regularly get cold sores, use antiviral creams as soon as you recognise the early tingling feeling. They do not always work after blisters appear.

Things you can do yourself

Cold sores take time to heal and they’re very contagious, especially when the blisters burst.

Important

Kissing a baby if you have a cold sore can lead to neonatal herpes, which is very dangerous to newborn babies.

Do

• eat cool, soft foods

• wash your hands with soap and water before and after applying cream

• avoid anything that triggers your cold sores

• use sunblock lip balm (SPF 15 or above) if you’re outside in the sun

• take paracetamol or ibuprofen to ease pain and swelling (liquid paracetamol is available for children) – do not give aspirin to children under 16

• drink plenty of fluids to avoid dehydration

Don’t

• do not kiss anyone while you have a cold sore

• do not have oral sex until your cold sore completely heals as you could give your partner genital herpes

• do not touch your cold sore (apart from applying cream) – if you do wash your hands

• do not rub cream into the cold sore – dab it on instead

• do not eat acidic or salty food if it makes your cold sore feel worse

Non-urgent advice: See a GP if:

• the cold sore has not started to heal within 10 days
• you’re worried about a cold sore or think it’s something else
• the cold sore is very large or painful
• you or your child also have swollen, painful gums and sores in the mouth (gingivostomatitis)
• you have a weakened immune system – for example, because of chemotherapy or diabetes

Treatment from a GP

A GP may prescribe antiviral tablets if your cold sores are very large, painful or keep coming back.

Newborn babies, pregnant women and people with a weakened immune system may be referred to hospital for advice or treatment.

Why cold sores come back

Cold sores are caused by a virus called herpes simplex.

Once you have the virus, it stays in your skin for the rest of your life. Sometimes it causes a cold sore.

Most people are exposed to the virus when they’re young after close skin to skin contact, such as kissing, with someone who has a cold sore.

It does not usually cause any symptoms until you’re older. You will not know if it’s in your skin unless you get a cold sore.

Page last reviewed: 20 July 2020
Next review due: 20 July 2023

Causes, Symptoms, Treatment, Complications, and Prevention

Written by WebMD Editorial Contributors

Medically Reviewed by Poonam Sachdev on May 10, 2023

• What Is a Cold Sore?
• Cold Sore Symptoms
• Cold Sore Causes
• Cold Sore Risk Factors
• Cold Sore Diagnosis
• Cold Sore Treatment
• Cold Sore Complications
• Cold Sore Prevention
• More

A cold sore is a group of tiny, painful blisters caused by the herpes simplex virus (HSV). They’re also called fever blisters or herpes simplex labialis.

Up to 90% of people around the world have at least one form of HSV.

The symptoms are usually the most serious the first you time you get cold sores. A first-time cold sore can make a child seriously ill.

After the first outbreak, your body should make antibodies, and you may never have another infection. But many people get cold sores that come back.

Cold sores, or fever blisters, are groups of small blisters on the lip and around the mouth. The skin around the blisters is often red, swollen, and sore. Photo credit: Courtesy of the CDC

Cold sores are most likely to show up on the outside of your mouth and lips, but you can also get them on your nose and cheeks.

You may get cold sores as late as 20 days after you’re infected. The sore might appear near where the virus entered your body.

Cold sores happen in stages:

1. You have a tingling, burning, or itching feeling.
2. About 12-24 hours later, blisters form. The area becomes red, swollen, and painful.
3. The blisters break open and fluid comes out. This usually lasts 2 or 3 days.
4. A scab forms on the sore. It might crack or bleed.
5. The scab falls off.

You might also have red or swollen gums, swollen glands in your neck, fever, or muscle aches.

First-time infections can also cause:

• Burning and pain inside your mouth
• Sore throat
• Pain when you swallow
• Headache
• Upset stomach

You catch HSV when you come into contact with people or things that carry the virus. For instance, you can get it from kissing someone who has the virus or from sharing eating utensils, towels, or razors.

Two types of the virus can cause cold sores: HSV-1 and HSV-2. Both types can also cause sores on your genitals and can be spread by oral sex. 

Type 1 usually causes cold sores, and type 2 mostly causes genital herpes, but either can be found in both areas.

Certain things can trigger an outbreak, including:

• Some foods
• Stress
• Fever
• Colds
• Allergies
• Fatigue
• Sunburn or being in strong sunlight
• Dental work or cosmetic surgery
• Your period

Cold sores generally aren’t serious, but the infection may be life-threatening for someone who has a weakened immune system because of AIDS, another condition, or medications. 

If you have a serious case of the skin condition eczema, you may get cold sores over large parts of your body.

Your doctor might diagnose a cold sore just by looking at the blisters. They can also swab the blister and test the fluid for HSV.

There’s no cure for cold sores. Once you have the virus, it stays in your body. The sores themselves usually heal on their own in 1 or 2 weeks.

Antiviral medications can speed healing, especially if you take them at the first sign of an outbreak. Your doctor might tell you to use:

• Cream that you apply on the sores. Acyclovir (Zovirax) and penciclovir (Denavir) require a prescription, or you can get docosanol (Abreva) over the counter.
• Pills you swallow, like acyclovir (Sitavig, Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex). You need a prescription to get these.
• Medicine injected into your bloodstream (called intravenous or IV), such as cidofovir (Vistide) or foscarnet (Foscavir), if you have a serious case. Acyclovir can also be injected.

Some home remedies can help you feel better while you heal:

• Cold, damp compresses
• Over-the-counter pain medicines like acetaminophen and ibuprofen
• Cream painkillers with benzocaine or lidocaine
• Treatments with alcohol to dry out the blisters
• Lip balms and creams to keep moisture in

Complications from a cold sore are rare, but can happen if the virus spreads to another part of your body, including your:

• Fingers. This infection is called herpes whitlow.
• Genitals. You might have warts or ulcers on your genitals or anus.
• Other areas of skin. If you have eczema and get a cold sore, see your doctor right away to avoid a serious condition called eczema herpeticum. This painful rash covers large areas of skin.
• Eyes. HSV keratitis, an infection in your cornea, can cause blindness.
• Brain or spinal cord. The virus can cause dangerous inflammation called meningitis or encephalitis, especially in people who have weakened immune systems.

To lower your risk of another outbreak:

• Get plenty of rest. A lack of sleep weakens your immune system, so you get sick more easily.
• Wear lip balm with sunscreen. Look for SPF on the label.
• Talk with your doctor. If you get sores often, they might have you take an antiviral medicine every day.

To keep from spreading the virus, when you have cold sores, don’t:

• Kiss anyone
• Share eating utensils, glasses, towels, lipstick or lip balm, or razors
• Have oral sex

Keep in mind that you can spread the virus even if you don’t have symptoms.  

Top Picks

Tooth reacts to cold and hot: why and what to do

It’s great when the teeth do not make themselves felt at all. You can enjoy any drinks, dishes, not be afraid of awkward movements (“bite on the wrong side”), enjoy life and delight others with a snow-white smile.
However, all this applies only to healthy teeth. Any problems with the jaw immediately and dramatically reduce the quality of life, make you experience discomfort and pain. One of the most unpleasant and most common pathologies (according to some reports, occurs in 68% of the population) is the reaction of teeth to cold and hot.

Indeed, the vast majority of people experience this unpleasant sensation. These unfortunates do not allow themselves to refresh themselves with ice cream in the heat – because the tooth reacts to the cold with a sharp, albeit short-term pain. They do not have the opportunity to warm up and enjoy a hot latte – the tooth reacts to the hot and gives out such an “impulse” that the whole body throws up as if from a current discharge.

Unfortunately, such a reaction rarely serves as a reason for an examination by a dentist – many perceive the problem as inevitable and try to cope on their own. They limit hot and cold, use various hygiene products to reduce tooth sensitivity.

However, this is a dead end path, which, moreover, can lead to consequences that are much more difficult to eliminate than a momentary attack of pain from a sip of an ice-cold cocktail. Therefore, the best way to deal once and for all with hypersensitivity of the teeth is to make an appointment with the dentist and get an examination by an experienced dentist. To understand why this is necessary, it is worth knowing why the tooth generally reacts to cold and hot.

Dental device

The human tooth is quite complex. The crown (outer protruding part) is covered with enamel – the hardest tissue in the body that protects the tooth from infections and mechanical damage. On the crown, just under the enamel, there is dentin – a strong tissue that makes up the bulk of the tooth. Dentin is pierced by dentinal tubules, which, in turn, are connected with the pulp – loose connective tissue in the tooth cavity. The pulp contains a huge number of blood and lymphatic vessels, many nerve endings that instantly respond to any external influence on the tooth.

Any, the most insignificant damage or even thinning of the enamel leads to the fact that the influence of external influences on the pulp and the nerves located in it increases. And the tooth, even at first glance quite healthy, treated and sealed, reacts with pain – for example, to hot and cold. This reaction is called hyperesthesia.

What is hyperesthesia

Hyperesthesia is not an independent disease, but a symptom that indicates the presence of problems with the teeth. The reason why a tooth hurts is any damage to hard tissues. Lesions may be carious, non-carious, mechanical, or caused by demineralization.

There are several degrees of hyperesthesia:

• Stage 1 is the same temperature reaction when the tooth gives out a portion of pain in response to cold or hot exposure.
• Stage 2 – the tooth hurts when exposed to temperature, plus a reaction to chemical irritants is added – salty, sweet, sour, spicy, and so on.
• Stage 3 – teeth already react to literally everything: sharp tastes, cold and hot, any tactile manipulations, including a painful reaction to a toothbrush or floss, and even to cold air.

It is impossible to establish the exact cause of the pathological condition on your own. The tooth looks quite safe, but the pain periodically appears. Why? Or, the painful syndrome manifested itself after dental treatment – a depulped tooth hurts with a removed nerve, which, in principle, cannot disturb. And if there is a reaction to hot and cold, you should immediately contact the dentist in order to prevent the aggravation of the process, which can lead to complete loss of the tooth.

What can cause hyperesthesia

Caries

Focal enamel demineralization and destruction of tooth tissue leads to the formation of a cavity in the dentin. This, in turn, opens access to external stimuli directly in the hypersensitive pulp. If you do not take up treatment in time, then the process naturally leads to periodontitis, pulpitis and ends with tooth loss.

Enamel thinning

Intense loss of enamel due to its rapid abrasion leads to exposure of dentin and a painful reaction of the tooth to any external influences. There are many reasons for enamel depletion: malocclusion, bruxism, fluorosis, incorrectly selected prosthesis, loss of teeth, leading to increased stress on the remaining dentition. Among the pathologies that thin the enamel, there may be some that are not directly related to the condition of the teeth. These are, for example, hormonal disorders.

Cracks in the enamel

Even micro cracks and micro chips in the tooth enamel can lead to the development of a painful reaction to cold and hot. Cracks facilitate the access of external irritants to the pulp.

Wedge-shaped defect

Like the previous reason, the wedge-shaped defect refers to non-carious pathologies of the hard tissue of the tooth. It is characterized by the fact that a wedge-shaped lesion is formed in the neck of the tooth. Most often, pathology occurs on the frontal teeth. Its causes are periodontitis, damage to the enamel by external factors (for example, the wrong toothbrush, toothpicks, etc. ), inadequate oral hygiene. A wedge-shaped defect is the most vulnerable spot in tooth enamel and dentin, facilitating the access of external factors to the pulp.

Erosion of tooth enamel

The next non-carious lesion is erosion of tooth enamel and sometimes dentin. The definitive cause of this pathology has not been elucidated. There are versions about its mechanical origin or development due to hormonal and metabolic disorders.

Hypoplasia

Sometimes the cause of tooth hypersensitivity is the underdevelopment of tissues or the entire tooth during formation. This pathology is irreversible and leads to many problems, of which hypersensitivity is not the most unpleasant. As a rule, treatment consists in filling the affected tooth or placing it under a crown in order to eliminate the effect of external factors on the tissues.

Necrosis

Dental hard tissues can undergo necrosis due to a variety of reasons – from disorders of the central nervous system to exposure to acids and alkalis. Dead enamel does not protect the tooth well, which leads to pain and temperature reactions.

Periodontal pathologies

Any inflammation of the periodontal tissues (periodontium) also leads to painful manifestations and threatens with tooth loss. In addition, the periodontium is a tissue saturated with nerve endings, and excessive exposure to it is already unpleasant in itself.

Other causes

Other causes of enamel damage include a variety of external factors. These include:

• certain dental procedures, including prosthetics, whitening, fillings and nerve removal,
• improper care with unsuitable appliances and hygiene products,
• deficiency of minerals and vitamins in the body: calcium, fluorine, vitamins C and D, magnesium. The lack of active substances provokes the destruction of enamel. This is especially true for children, the elderly and pregnant women.

How to get rid of hyperesthesia

As you can see, the reaction of teeth to hot and cold is just the tip of the iceberg. And, of course, the removal of this discomfort should begin with a visit to the dentist and a dentist consultation. At home, it will not be possible to cope with the problem, and if you start it, it will lead to tooth loss.

Professional diagnosis of the cause of hyperesthesia is necessary to select the correct method of dental treatment – medication, hygiene, physiotherapy or surgery.

Depending on what led to the pathology, the doctor may choose one or more types of treatment:

• Mineralization is the saturation of the enamel with substances rich in potassium, fluorine, phosphorus and other minerals.
• Enamel fluoridation – its coating with fluorine-containing preparations.
• Fissure sealing – sealing the grooves on the chewing surface with a sealant.
• Installation of prostheses, crowns, veneers if necessary.
• Filling in the presence of a carious process.
• Treatment of periodontitis and surgical removal of gum pathology. Most often, this is its raising, if the onset of the disease was due to the prolapse of the gums and the exposure of the cervical region.

As a rule, if hyperesthesia is in the first stage, complex treatment is not required. Enough fluoridation of teeth and their mineralization. Most of the above procedures, dentists choose if the process has already moved to stages 2 and 3.

What should be done so that hyperesthesia does not occur at all

Timely prevention will reduce the likelihood of developing any pathological processes in the oral cavity and save you from serious and financially costly problems.

Prevention:

• Use suitable toothbrushes and toothpastes that do not contain abrasives. Brush your teeth at least twice a day, and do it right. Do not neglect dental floss, rinses.
• Do not forget – professional teeth cleaning in dentistry should take place at least once every 6-12 months.
• Strengthen your immune system, stop smoking, coffee, foods high in sugar and acids.
• “Vitaminize” the diet – in daily meals there should be a sufficient amount of vitamins and minerals. If this is not possible, use pharmacy vitamin-mineral complexes.

And, of course, keep an eye on the health of your teeth and the whole body, undergo medical examinations, regularly visit a general practitioner and a dentist. Timely noticed disease will save you from many troubles.

Myofascial pain – treatment, symptoms, causes, diagnosis

It has been estimated that almost 44 million Americans have myofascial pain. Clinical studies have shown that 30% of patients with pain complaints had active myofascial trigger points. Data from a clinic specializing in headache and neck pain indicate a myofascial etiology of pain in 55% of cases. Thus, it has been determined that active myofascial trigger points often play a role in symptomatology in patients with tension headaches, low back pain, neck pain, temporomandibular pain, shoulder and forearm pain, and pelvic pain.

It is important to distinguish between active myofascial trigger points and latent myofascial trigger points in interpreting the results of myofascial pain prevalence studies. Latent myofascial trigger points are characterized by areas of tension in the muscles that are not accompanied by pain manifestations. Active myofascial trigger points are accompanied by pain, which is clearly reproduced when these points are pressed. Studies on the frequency of myofascial pain syndromes in rheumatological diseases have not been conducted. But some authors believe that they are often not diagnosed and not treated, but are present as a pain component in systemic rheumatological diseases (SLE, rheumatoid arthritis, osteoarthritis). Currently, myofascial pain syndrome (MBS) refers to any regional manifestations with referred pain emanating from soft tissues (muscles, ligaments, tendons). The name myofascial means that the main source of pain is a specific skeletal muscle. For the diagnosis of such a syndrome, a physical examination and palpatory determination of muscle seals (nodes), called trigger points in the location of ligaments of skeletal muscles, is necessary.

Myofascial trigger point is a hypersensitive, firm nodule that produces a characteristic referred pain when pressed. With deep palpation directly in the trigger area, pain manifestations in the patient are fully reproduced.

Theoretically, a person with a palpable trigger point will typically have vague pain at rest. But the definition with the help of palpation allows you to determine exactly which muscle has dysfunction. Trigger points are thought to be more common in postural muscles.

Researchers divide MBS into two types: Primary MBS, in which the main complaint is specific – muscle trigger pain and the absence of other musculoskeletal pathology; and secondary MBS, which is more common and is characterized by muscle pain and the presence of another underlying musculoskeletal disease (rheumatoid arthritis, spinal stenosis, disc herniation, spondylolisthesis, vertebral fractures).

Regardless of the interpretation of MBS, trigger points differ from the painful areas of fibromyalgia in that the patient experiences only local tenderness, with no referred pain.

MBS is often a diagnosis of exclusion meaning that other conditions have been excluded.

Risk factors

There are no specific risk factors for the development of MBS. Myofascial pain syndrome can be diagnosed by a doctor in any patient with soft tissue pain. MBS occurs at any age, but is more common in middle age, equally in both men and women. People with poor posture (rounded and sloping shoulders, and excessive head tilt) have a higher risk of discomfort in the axial postural muscles and the appearance of trigger points.

Etiology

An exact explanation of the trigger point phenomenon has not yet been received. There are certain results of electromyography of trigger points that revealed low-voltage activity of these points, reminiscent of action potentials. It is assumed that the myofascial trigger point is a cluster of numerous microscopic foci with intense activity throughout the nodule. These lesions are thought to arise from a focal metabolic disorder due to trauma or frequent exposure. Factors commonly thought of as predisposing to the formation of a trigger point include deterioration in the general condition of the body, poor posture, repetitive mechanical stress, sleep disturbance, vitamin deficiency.

Prognosis

In mild cases, myofascial pain syndromes can be cured by correcting the factors that caused the appearance of triggers and treating the myofascial syndrome. With ineffective treatment, myofascial syndrome can lead to persistent pain. In some cases, central sensitization leads to a widespread pain syndrome -. fibromyalgia.

Symptoms of MBS

Myofascial pain syndrome pain can occur due to only one trigger point, but there are usually several trigger points responsible for any pain in a given area. This is a very common occurrence that starts with a single trigger point followed by the development of satellite trigger points that develop over time due to mechanical imbalance resulting from reduced range of motion and muscle pseudo weakness. The constant presence of the trigger zone can lead to neuroplastic changes at the level of the dorsal horn, which result in an increase in pain sensation (central sensitization occurs), with a tendency to spread beyond the initially involved zone. In some cases, segmental central sensitization leads to mirror pain phenomena (i.e., pain on the opposite side of the body, in the same segmental location), and in other cases, the progressive spread of segmental central sensitization gives rise to the widespread pain that is characteristic of fibromyalgia. .

Low back pain

Low back pain has many causes. Some are quite serious, such as cancer metastases, osteomyelitis, massive disc herniations (such as in cauda equina syndrome), vertebral fractures, pancreatic cancer, and aortic aneurysms. However, a common cause of acute low back pain is the so-called lumbago. In 95% of cases, this problem is cured within three months. In cases where recovery does not occur, the development of chronic pain in the lumbar region is usually accompanied by the detection of active myofascial trigger points. Usually a muscle group, quadratus lumborum, is involved in this process; pain emanating from trigger points in these muscles is manifested by pain in the lower back, with rare irradiation along the sciatic nerve or in the groin. Trigger points, located in the iliopsoas muscle, are also a common cause of chronic low back pain. The typical distribution of pain from the iliopsoas muscle is the vertical ligament in the lumbar region and upper thigh. Trigger points emanating from the gluteus medius from the iliac crest are a common cause of pain in the lumbar region in the sacrum, with possible irradiation to the outer thigh.

Neck and shoulder pain

Latent trigger points are a common finding in many muscles in the back of the neck and back. Active trigger points are usually located in the upper part of the trapezius muscle, the levator scapula muscle. Referred pain from the trapezius muscle usually goes to the back of the neck and to the angle of the jaw. Trigger points of the levator scapula muscle cause pain in the angle of the neck and shoulder; this pain is often described as sharp, especially with heavy use of this muscle. Since many of the muscles in this area are involved in postural function, their development is not uncommon in office workers who have posture problems. Since the superior trapezius and levator scapulae act synergistically with several other muscles (levator and latitudinalis scapulae), the occurrence of a single trigger point initiates the appearance of satellite points through adjacent muscles involved in the same movement mechanism.

Pain in the hip

Pain resulting from dysfunction of the hip joint is usually located in the lower part of the front of the thigh and in the groin. This localization is not typical for myofascial pain syndrome from the iliopsoas muscle. In most cases, patients complain of pain in the outer part of the thigh. In some patients this is due to trochanteric bursitis, but in most cases it is associated with myofascial trigger points in adjacent muscles. Of course, the usual trigger points that give rise to pain in the outer thigh come from the muscles of the gluteus medius and minimus in the greater trochanter.

Pelvic pain

Pelvic smooth muscle is a common location for myofascial trigger points. Currently, gynecologists and urologists have become more likely to suspect myofascial trigger points in the genesis of pain syndromes, which are usually associated with prostatitis, coccygodynia, vulvodynia. The most indicative in this regard is the levator ani muscle. Trigger points in this muscle may be accompanied by pain in the lower buttocks.

Headaches

Active myofascial trigger points in the muscles of the neck, shoulder, and face are a common source of headaches. In many cases, the headache has features, the so-called tension headache, but there is increasing evidence that myofascial trigger points can initiate migraine headaches or be an integral part of the headache mechanism in tension headaches and migraine. For example, trigger points in the mastoid region the process can give pain in the face and in the supraorbital region. Trigger points in the upper trapezius muscle can give pain in the forehead or temple. Trigger points in the muscles of the neck can cause pain in the occipital and orbital region..

Jaw pain

There is a complex relationship between temporomandibular joint disorders and myofascial trigger points. The most common trigger points responsible for jaw pain are located in the massetters, pterygoid, superior trapezius, and superior sterno-cleido mastoid.

Pain in the upper extremities

The muscles attached to the shoulder blade are often the site of trigger points that can cause pain in the upper extremities. These muscles include the subscapularis, infraspinatus, teres, and serratus. This very common localization of trigger points in these muscles can cause referred pain in the arm and hand. Often, excessive flexion of the neck muscles leads to the formation of trigger points and pain in the elbow and little finger. Myofascial pain syndromes of the upper extremities are often diagnosed as humeroscapular periarteritis, cervical radiculopathy, or anterior chest syndrome.

Pain in the lower extremities

Trigger points in the muscles of the leg and thigh may be responsible for lateral thigh pain and lateral knee pain, respectively. Anterior knee pain may result from trigger points in various areas of the quadriceps. Back knee pain may result from trigger points in the popliteus and hamstring muscles. Trigger points in the anterior tibialis and peroneus longus muscles can cause pain in the front of the leg and lateral malleolus, respectively. Myofascial pain syndrome originating from these muscles is usually caused by ankle injuries or excessive rotation of the leg. Pain in sciatica may be similar to pain caused by trigger currents from the back of the gluteus minimus muscle.

Chest pain and abdominal pain

Diseases affecting the chest and abdominal organs are common problems encountered in internal medicine units. For example, pain in the anterior part of the chest is a common reason for hospitalization with suspected myocardial infarction, but then it turns out that there is no heart attack. In some cases, chest pain is caused by trigger points in the muscles of the anterior chest. Trigger points in the pectoralis major muscle can cause pain in the anterior chest and radiate to the elbow of the arm and thus simulate an attack of myocardial ischemia. Trigger points in the sternalis tend to cause chest pain. Trigger points in the upper and lower rectus abdominis may be similar to gallbladder dysfunction or bladder infections, respectively. It is important to note that myofascial trigger points can accompany diseases of the chest and abdominal organs, and the diagnosis of pure myofascial syndrome should be based only on an adequate examination.

Diagnosis

The clinical diagnosis of myofascial pain depends in principle on the physician, who can suggest this cause as a possible explanation for the nature of the pain. Myofascial pain syndromes pain can be similar to a large number of other diseases, so it is necessary to conduct an adequate examination. Myofascial pain is characterized as a non-intense deep sensation of pain that is aggravated by the work of the muscles concerned and stress, which increases muscle stiffness. A characteristic clinical feature of myofascial pain is the detection of a trigger point. This is a clear focus of local pain within the muscle. Sometimes pain on palpation can spread and reproduce symptoms in the patient. But as a rule, the irradiation of pain does not follow the same paths as the cutaneous innervation of the root. Palpation usually reveals a rope-like compaction of the muscle fibers, often referred to as a “tight ligament”. Sometimes, a quick flick on this ligament or a trigger point piercing with a needle results in a spasmodic contraction of the muscle concerned. This convulsive reaction can only be detected in superficial muscles. Myofascial pain often follows muscle injury or repetitive stress. Often, numerous costly examinations were performed in modern clinics before a diagnosis of myofascial pain was made. Some patients with a clear cause of musculoskeletal pain (such as rheumatoid arthritis) may develop a myofascial pain syndrome that is not diagnosed as there is an underlying disease. Myofascial pain has certain clinical features that help in making this diagnosis. Pain is usually described as a deep pain sensation, often with a feeling of stiffness in the area involved; this is sometimes seen as stiffness in the joints. Myofascial pain is exacerbated by exertion of the muscle concerned, stress, exposure to cold, or postural imbalance. Irradiation from the trigger point can be described as paresthesia, thus being similar to the symptoms of radiculopathy (lumbar or cervical). Muscle weakness resulting from its low load can lead to symptoms such as fatigue, impaired coordination of movements, and sleep disturbances. Patients with myofascial pain involving the muscles of the neck and face may experience symptoms of dizziness, tinnitus, and static disturbances.

Characteristic features of the myofascial trigger point:

1. Focus of tenderness on palpation of the muscle concerned
2. Reproduction of a complaint of pain on palpation of the trigger point (with a force of about 3 kg)
3. Palpation reveals induration (hardening) of the adjacent muscle
4. Limited range of motion in the affected muscle
5. Often pseudoweakness of the muscle concerned (no atrophy)
6. Often referred pain with prolonged (~5 seconds) pressure on the trigger point.

Treatment

Improving posture and ergonomics

Changing the ergonomics of the workplace and posture removes one of the possible trigger points. And the ability of muscle tissue to avoid increased and inadequate load allows in some cases to avoid the actual treatment.

exercise therapy

Muscles involved in myofascial pain syndrome are in a state of constant contraction, which leads to an energy imbalance, especially the level of ATP in the muscle, which ultimately leads to a reduction in the number of myomers due to excess consumption of ATP. Effective stretching is achieved using ethyl chloride followed by passive stretching of the muscle concerned. Another method is post-isometric relaxation. Strengthening the muscles is necessary because there is a secondary weakening of the muscles due to pain manifestations. But the load on the compacted muscles should be gentle and not cause the appearance of satellite triggers in adjacent muscles.

Trigger point blockade

Trigger point blockade is the most effective direct intervention and inactivation of these points. Careful blockade technique is the main key to the success and effect of the blockade. The exact localization of the trigger zone is confirmed if it was possible to obtain a local convulsive reaction; however, this may not be obvious if the needle is piercing deeper-lying muscles. Successful elimination of the trigger point usually results in relaxation of the tight area. Dry needle piercing is also possible, but the introduction of a local anesthetic (lidocaine or novocaine) is more effective. The introduction of a local anesthetic allows you to get an instant effect on the patient. The introduction of corticosteroids did not justify itself and did not allow to obtain a more stable effect than the anesthetic. The possibility of using botulinum toxin is still being studied.

Medications

Currently, there is no evidence that any medications are effective enough for myofascial syndrome.