Myofascial Pain and Fibromyalgia: Trigger Point Management, 2nd ed.

Rachlin E.S., Rachlin I.S., eds. St Louis, MO 63146, Mosby Inc, 2002, hardcover, 624 pp, illus, ISBN: 0-323-01155-1, $75.

The editors of this text present a multi-disciplinary approach to the management of myofascial pain syndromes, fibromyalgia, and trigger points. Current research findings and empirical knowledge are provided by experts in orthopedics, physical therapy, anesthesiology, endocrinology, dentistry, ergonomics, and psychology. The book provides the theoretical background as well as a laboratory guide on how to perform interventions designed to remedy myofascial pain syndromes. Both invasive techniques, such as injections, and noninvasive techniques, such as manual trigger point work, are described.

Part I, "General Considerations," includes updated information about fibromyalgia. According to the authors, the fibromyalgia syndrome is characterized by chronic, widespread musculoskeletal aching, pain, and stiffness with tenderness on palpation at multiple, specific sites. The role of central sensitization, an enhanced response of the central nervous system, is described, and current research studies are reviewed. Chapter 3, "Diagnostic Challenges in the Pediatric Patient With Musculoskeletal Pain," and chapter 4, "Metabolic and Endocrine Causes of Muscle Syndromes," are new to the second edition. Updated chapters on the evaluation of disability and the tests used to quantify clinical findings will help clinicians document their diagnoses. Management of orofascial pain, is thoroughly covered, including a description of the relevant musculature and interventions such as injection, medications, physical therapy, and behavioral modification. This chapter would be particularly relevant to physical therapists with an interest in temporomandibular joint disorders.

Part II, "Trigger Point Management," includes chapters on examination techniques and interventions, both invasive and noninvasive. The book defines myofascial trigger points as small, circumscribed hyper-irritable foci in muscle and fascia, often found within a firm or taut band of skeletal muscle. Epidemiology, histopathology, and the examination techniques are described. Specific injection techniques are described and illustrated, including differential diagnoses and postinjection treatment plans. New injection techniques, which are based on the concept that spinal segmental sensitization is the pathophysiologic basis for a majority of myofascial pain syndromes, also are covered. The role of nerve blocks in treating myofascial pain is discussed, along with descriptions of specific blocks.

Part III, "Physical Therapy and Rehabilitation," contains several chapters on manual therapy (including soft-tissue mobilization, neurosensorimotor re-education, and joint mobilization), with an emphasis on massage and trigger-point work. A chapter on modalities (chapter 19) discusses electrical stimulation, ultrasound, and cold laser. Prevention and management of myofascial pain with ergonomic interventions are outlined in chapter 20.

The theory updates and current research presented in parts I and II are the strengths of this second edition. Part III, on physical therapy interventions, was not as well organized, although it presents valuable information. Some of the chapters presented redundant and outdated information, without referring to research that has been done on the topic. Chapter 18 on the noninvasive techniques for triggerpoint work was well written, as was chapter 17 on manual therapy for myofascial pain.

I would recommend this book to clinicians who are interested in expanding their knowledge of myofascial pain syndromes. In particular, I would hope that reading this text will spur physical therapists to provide evidence of what does and does not facilitate function and recovery in patients with myofascial pain syndromes.

Maggie Fillmore, PT, OCS 

Kaiser Permanente

Oakland, Calif

Ms Fillmore is Clinical Specialist in orthopedics at Kaiser Permanente, and a member of the clinical faculty for the Kaiser Fellowship in Advanced Orthopedic Manual Therapy.