Myofascial Pain and Fibromyalgia: Trigger Point Management.

This instructional textbook provides a comprehensive approach to theory and clinical technique for muscle pain. More specifically, the textbook clarifies the present-day relationship between the diagnosis and management of myofascial pain syndrome, fibromyalgia, trigger points, and referred pain. The most appropriate accolade for this compilation of articles from 17 different contributors is that it would be of value for all professionals who are involved in the clinical management of muscle pain. The three-part textbook has 16 highly referenced and well-illustrated chapters.

Part 1, entitled General Considerations, includes pathophysiologic mechanisms of fibromyalgia and myofascial treatment, metabolic and psychological considerations, disability management, and a very unique chapter on differential diagnosis using pressure algometry (dolorimetry).

Part 2 is written largely by the textbook's editor, Edward Rachlin, MD. Rachlin's contribution is specific to trigger-point management, with 187 of the book's 542 pages dedicated to detailed injection techniques for regional myofascial pain syndrome, which is defined as local and referred muscle pain arising from trigger points.

The section on diagnosis and management of trigger points that are related to facial pain is written by two dentists and can be found in chapter 11. Hand-drawn figures for 59 spine and extremity muscle groups and their respective trigger points are reinforced by subheadings such as anatomy, noninvasive therapy, injection technique, differential diagnosis, exercise and home programs. The orthopedic physical therapists may find the subheadings on noninvasive therapy and exercise protocol understated.

Part 3, entitled Physical Therapy and Rehabilitation, has five chapters and eight authors, three of whom are physical therapists. Topics in this section include an overview of muscle deficiency, manual therapy, massage, electrical modalities, and ergonomics. This particular section may be somewhat simplistic and subjective for the experienced physical therapist. Chapter 12, Muscle Deficiency, for example, provides a subjective validation toward exercise prescription for treating diminished muscle strength and flexibility. The author supports the use of specific exercises based on their particular use in a clinic for many years. The clinical point is made that "any treatment for muscle pain and deficiency which is not exercise specific and lacks lifestyle alteration will yield temporary results." Unfortunately, there is no unified literature that implies exercise specifically for muscle deficiency.

In conclusion, this textbook is a significant compilation of current research, theory, and clinical techniques for myofascial pain, fibromyalgia, and trigger points. The orthopedic physical therapist would find the text useful as a reference source for treating muscle pain.

Randy Brown, PT Petersburg, NJ

Mr Brown is director of rehabilitation services for RCS Rehab Inc in Smithville, NJ.