Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey

Johannes Fleckenstein, Daniela Zaps, Linda J Rüger, Lukas Lehmeyer, Florentina Freiberg, Philip M Lang, Dominik Irnich, Johannes Fleckenstein, Daniela Zaps, Linda J Rüger, Lukas Lehmeyer, Florentina Freiberg, Philip M Lang, Dominik Irnich

Abstract

Background: Myofascial pain is a common dysfunction with a lifetime prevalence affecting up to 85% of the general population. Current guidelines for the management of myofascial pain are not available. In this study we investigated how physicians on the basis of prescription behaviour evaluate the effectiveness of treatment options in their management of myofascial pain.

Methods: We conducted a cross-sectional, nationwide survey with a standardized questionnaire among 332 physicians (79.8% male, 25.6% female, 47.5 +/- 9.6 years) experienced in treating patients with myofascial pain. Recruitment of physicians took place at three German meetings of pain therapists, rheumatologists and orthopaedists, respectively. Physicians estimated the prevalence of myofascial pain amongst patients in their practices, stated what treatments they used routinely and then rated the perceived treatment effectiveness on a six-point scale (with 1 being excellent). Data are expressed as mean +/- standard deviation.

Results: The estimated overall prevalence of active myofascial trigger points is 46.1 +/- 27.4%. Frequently prescribed treatments are analgesics, mainly metamizol/paracetamol (91.6%), non-steroidal anti-inflammatory drugs/coxibs (87.0%) or weak opioids (81.8%), and physical therapies, mainly manual therapy (81.1%), TENS (72.9%) or acupuncture (60.2%). Overall effectiveness ratings for analgesics (2.9 +/- 0.7) and physical therapies were moderate (2.5 +/- 0.8). Effectiveness ratings of the various treatment options between specialities were widely variant. 54.3% of all physicians characterized the available treatment options as insufficient.

Conclusions: Myofascial pain was estimated a prevalent condition. Despite a variety of commonly prescribed treatments, the moderate effectiveness ratings and the frequent characterizations of the available treatments as insufficient suggest an urgent need for clinical research to establish evidence-based guidelines for the treatment of myofascial pain syndrome.

Figures

Figure 1
Figure 1
Prescription Rate. demonstrates the physician estimated prescription rate of different therapeutic options in the treatment of myofascial pain. Circles indicate the overall average; the prescription rates of three subgroups (Pain therapists, rheumatologists and orthopaedists) are shown by triangles or squares (please refer to legend). Data are expressed in percent (%). TENS: transcutaneous electrical stimulation.
Figure 2
Figure 2
Ratings of Treatment Options. demonstrates the physician estimated efficacy of different therapeutic options in the treatment of myofascial pain on a 6-fold scale (with 1 being "excellently effective" and 6 being "ineffective"). Ratings towards the lower ranks on the value axis indicate a higher estimated effectiveness. Data are expressed as mean ± SD. (*), (**) and (***) express the different levels of significance p < 0.05, 0.01 and 0.001. Between-group differences were examined with Kruskal-Wallis tests, using the Mann-Whitney U tests for post-hoc two-group comparisons. Stars are placed upon the confirmed group, respectively. TENS: transcutaneous electrical stimulation.

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