근육통의 진단과 치료 = Diagnosis and management of muscle pain

다국어 초록 (Multilingual Abstract)

Muscle pain is one of the most common, as well as elusive, clinical complaints. Pain can be experienced in muscles by any dysfunction of the muscle itself, peripheral nerves, or central nervous system. Persistent inflammation of the muscle increases nerve endings of the nociceptors and can develop allodynia or hyperalgesia. Myofascial trigger points are formed by perpetuating contraction of the sarcomeres and local ischemia and can result in regional pain.

Disorders of the peripheral nervous system can entail muscle pain in the innervated territory. The central nervous system can also modulate or generate muscle pain. Gate-control theory provides an explanation as to how pain can be affected by the nervous system. Fibromyalgia is believed to be related to a lowered pain threshold in the central nervous system. Clinicians,during their diagnostic approach, should not unduly attribute muscle pain to pathology confined to the muscle merely because pain is perceived and evoked from the muscle. Even in cases where abnormalities are confirmed in the muscle, such as myofascial trigger points, clinicians should seek the underlying etiology. In particular, diagnosis of myofascial pain syndrome does not rule out primary musculoskeletal disorders. Rather, arthropathies or radiculopathies are known to frequently involve myofascial pain syndrome, which would not improve unless they are resolved. After accurate diagnosis of muscle pain is obtained, appropriate treatment should be implemented. A multi-disciplinary, individualized approach, including physiotherapy, exercise,education, and behavioral modification, is recommended.

참고문헌 (Reference)

1 Chu J., "Twitch-obtaining intramuscular stimulation (TOIMS) in acute partial radial nerve palsy" 39 : 221-226, 1999

2 Wolfe F, "The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom sever-ity" 62 : 600-610, 2010

3 Kuncewicz E, "Tender points and trigger points: differences and similarities" 74 : 367-371, 2009

4 Hong CZ, "Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points" 79 : 863-872, 1998

5 Paintal AS., "Participation by pressure-pain receptors of mam-malian muscles in the flexion reflex" 156 : 498-514, 1961

6 Melzack R, "Pain mechanisms: a new theory" 150 : 971-979, 1965

7 Melzack R., "Myofascial trigger points: relation to acupuncture and mechanisms of pain" 62 : 114-117, 1981

8 Hancock M, "MRI findings are more common in selected patients with acute low back pain than controls?" 21 : 240-246, 2012

9 Gerwin RD, "Inter-rater reliability in myofascial trigger point examination" 69 : 65-73, 1997

10 Reinert A, "Inflammation-induced increase in the density of neuropeptide-immunoreactive nerve endings in rat skeletal muscle" 121 : 174-180, 1998

11 Russell IJ., "Future perspectives in generalised musculoskeletal pain syndromes" 25 : 321-331, 2011

12 Russell IJ., "Fibromyalgia syndrome: approaches to manage-ment" 45 : 1-4, 1996

13 Bohr TW, "Fibromyalgia syndrome and myofascial pain syndrome. Do they exist?" 13 : 365-384, 1995

14 Mense S, "Discharge behaviour of feline gamma-motoneurones following induction of an artificial myositis" 46 : 201-210, 1991

15 Marinus J, "Clinical features and pathophys-iology of complex regional pain syndrome" 10 : 637-648, 2011

16 Henry DE, "Central nervous system reor-ganization in a variety of chronic pain states: a review" 3 : 1116-1125, 2011

17 Shah JP, "Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points" 89 : 16-23, 2008

18 "1990 classification criteria of fibromyalgia from the American College of Rheumatology: report of the Multicenter Criteria Committee" Union Med Can 272-, 1990