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Palliative Care432 papers

Myofascial pain syndrome of neck

Last edited: 4/14/2026

Overview

Myofascial pain syndrome (MPS) of the neck involves chronic pain associated with trigger points in muscles, often leading to significant disability and reliance on pain management strategies, including opioids 17.

Diagnosis

  • Presence of trigger points identified by palpable taut bands and referred pain patterns 12626.
  • Numeric Rating Scale (NRS) for pain assessment 1.
  • MRI findings may correlate with pain and disability, though clinical significance varies 614.
  • Exclusion of other pathologies through physical examination and imaging when necessary 27.

    • Management

  • First-line treatments:
    • - Trigger point injections (TPI) with local anesthetics for pain relief 12. - Ischemic compression, potentially performed by family caregivers, showing efficacy 11. - Botulinum toxin injections for managing trigger points 17.
  • Adjunctive treatments:
    • - Radiofrequency neurotomy for refractory cases 4. - Manual therapy techniques including ischemic compression 11. - Ergonomic interventions and exercise programs in occupational settings 19.

    Special Populations

  • Cancer Patients:
    • - TPI can reduce opioid dosage and improve nutritional status 1. - Early diagnosis and treatment are crucial to prevent pain chronification 7.
  • Elderly and Comorbidities:
    • - Specific considerations for managing pain in the context of multiple comorbidities are not extensively covered in the abstracts provided.

    Key Recommendations

  • Utilize trigger point injections for pain relief and potential opioid tapering in cancer patients (Evidence: Moderate 1).
  • Consider ischemic compression as an effective non-invasive treatment option, particularly when performed by knowledgeable caregivers (Evidence: Moderate 11).
  • Evaluate and treat myofascial pain syndrome early to prevent chronicity and increased opioid dependence, especially in oncologic patients (Evidence: Expert opinion 7).

    • References

    1 Shimazaki Y, Iwasaki Y, Takasugi A, Miyabe T, Yokota T, Kurihara H et al.. Retrospective Study of Trigger Point Injections for Myofascial Pain Syndrome in Cancer Patients: Impact on Pain Relief and Opioid Tapering. Journal of pain & palliative care pharmacotherapy 2025. link 2 Hasuo H, Ishiki H, Matsuda Y, Matsuoka H, Kosugi K, Xing M et al.. Trigger point injections for myofascial pain in terminal cancer: a randomized trial. Pain medicine (Malden, Mass.) 2025. link 3 Kang X, Qian M, Qin T, Liu M, Xu H, Xu B. Increased Expression of Inflammatory Cytokines and Discogenic Neck Pain. Orthopaedic surgery 2024. link 4 Vilims BD, Block JE. Effective Management of Recurrent Trauma-Induced Neck Pain With Radiofrequency Neurotomy Using the Nimbus Electrosurgical Radiofrequency Multitined Expandable Electrode: A Case Report. Pain medicine case reports 2024. link 5 Cao J, Sun D, Guo L, Wang R, Liu P. A novel radiological index for the evaluation of cervical posterior subcutaneous fat tissue thickness and cervical spine degeneration: A retrospective study. Medicine 2023. link 6 Jensen RK, Dissing KB, Jensen TS, Clausen SH, Arnbak B. The association between cervical degenerative MRI findings and self-reported neck pain, disability and headache: a cross-sectional exploratory study. Chiropractic & manual therapies 2023. link 7 Arce Gálvez L, Buitrago Martín CL, Guauque Marcelo CV, Valencia Gómez RE. Myofascial pain syndrome in the oncologic patient: general considerations. Medical oncology (Northwood, London, England) 2023. link 8 Chang L, Wang H, Guo Y, Cai Z, Zhan H. Experimental and numerical analysis of biomechanical effects in cervical spine positioning rotation manipulation. International journal for numerical methods in biomedical engineering 2022. link 9 Muth-Seng C, Huneidi M, Heidsieck C, Laporte S, Le Coz JY, Gille O et al.. Personalised gravitational loading of the cervical spine from biplanar X-rays for asymptomatic and clinical subjects in neutral standing position. Clinical biomechanics (Bristol, Avon) 2022. link 10 Siag K, Mazzawi S, Paker M, Biener R, Ghanayim R, Lumelsky D. Acute longus colli tendinitis and otolaryngology. Brazilian journal of otorhinolaryngology 2022. link 11 Hasuo H, Hashimoto K, Iwamoto H, Miwa N, Kawashima T, Oda A et al.. Effect of ischemic compression performed by family caregivers on myofascial pain syndrome and the care burden of the families of patients: a multicenter open-label randomized comparative study. Annals of palliative medicine 2022. link 12 Bifarini B, Gori F, Russo D, Mammucari M, Maggiori E, Di Marzo R et al.. Intradermal therapy (mesotherapy): the lower the better. La Clinica terapeutica 2022. link 13 Louis CJ, Herrera CS, Garrity BM, McDonough CM, Cabral H, Saper RB et al.. Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain. Archives of physical medicine and rehabilitation 2020. link 14 Jensen RK, Jensen TS, Grøn S, Frafjord E, Bundgaard U, Damsgaard AL et al.. Prevalence of MRI findings in the cervical spine in patients with persistent neck pain based on quantification of narrative MRI reports. Chiropractic & manual therapies 2019. link 15 Liu R, Kurihara C, Tsai HT, Silvestri PJ, Bennett MI, Pasquina PF et al.. Classification and Treatment of Chronic Neck Pain: A Longitudinal Cohort Study. Regional anesthesia and pain medicine 2017. link 16 Steinmetz A, Claus A, Hodges PW, Jull GA. Neck muscle function in violinists/violists with and without neck pain. Clinical rheumatology 2016. link 17 Soares A, Andriolo RB, Atallah AN, da Silva EM. Botulinum toxin for myofascial pain syndromes in adults. The Cochrane database of systematic reviews 2014. link 18 Couto C, de Souza IC, Torres IL, Fregni F, Caumo W. Paraspinal stimulation combined with trigger point needling and needle rotation for the treatment of myofascial pain: a randomized sham-controlled clinical trial. The Clinical journal of pain 2014. link 19 Johnston V, O'Leary S, Comans T, Straker L, Melloh M, Khan A et al.. A workplace exercise versus health promotion intervention to prevent and reduce the economic and personal burden of non-specific neck pain in office personnel: protocol of a cluster-randomised controlled trial. Journal of physiotherapy 2014. link 20 Kim TH, Lee HM, Moon SH, Kwak DK, Oh JK, Kim YC et al.. Joint laxity negatively correlates with lumbar disc degeneration in young adults. Spine 2013. link 21 Rahmani N, Amiri M, Mohseni-Bandpei MA, Mohsenifar H, Pourahmadi MR. Work related neck pain in Iranian dentists: an epidemiological study. Journal of back and musculoskeletal rehabilitation 2013. link 22 Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM et al.. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC musculoskeletal disorders 2010. link 23 Bird S. A pain in the back case. Australian family physician 2004. link 24 Smythe HA. Rheumatologists and neck pain. Scandinavian journal of rheumatology 2000. link 25 Pawl RP. Chronic neck syndromes: an update. Comprehensive therapy 1999. link 26 Borg-Stein J, Stein J. Trigger points and tender points: one and the same? Does injection treatment help?. Rheumatic diseases clinics of North America 1996. link70274-x) 27 Wilson PR. Chronic neck pain and cervicogenic headache. The Clinical journal of pain 1991. link 28 Hicks NA. An efficient method for constructing a soft interocclusal splint. The Journal of prosthetic dentistry 1989. link90107-8) 29 Lance JW, Anthony M. Neck-tongue syndrome on sudden turning of the head. Journal of neurology, neurosurgery, and psychiatry 1980. link

    Original source

    1. [1]
      Retrospective Study of Trigger Point Injections for Myofascial Pain Syndrome in Cancer Patients: Impact on Pain Relief and Opioid Tapering. — Shimazaki Y, Iwasaki Y, Takasugi A, Miyabe T, Yokota T, Kurihara H et al. Journal of pain & palliative care pharmacotherapy (2025)
    2. [2]
      Trigger point injections for myofascial pain in terminal cancer: a randomized trial. — Hasuo H, Ishiki H, Matsuda Y, Matsuoka H, Kosugi K, Xing M et al. Pain medicine (Malden, Mass.) (2025)
    3. [3]
      Increased Expression of Inflammatory Cytokines and Discogenic Neck Pain. — Kang X, Qian M, Qin T, Liu M, Xu H, Xu B Orthopaedic surgery (2024)
    4. [4]
      Effective Management of Recurrent Trauma-Induced Neck Pain With Radiofrequency Neurotomy Using the Nimbus Electrosurgical Radiofrequency Multitined Expandable Electrode: A Case Report. — Vilims BD, Block JE Pain medicine case reports (2024)
    5. [5]
      A novel radiological index for the evaluation of cervical posterior subcutaneous fat tissue thickness and cervical spine degeneration: A retrospective study. — Cao J, Sun D, Guo L, Wang R, Liu P Medicine (2023)
    6. [6]
      The association between cervical degenerative MRI findings and self-reported neck pain, disability and headache: a cross-sectional exploratory study. — Jensen RK, Dissing KB, Jensen TS, Clausen SH, Arnbak B Chiropractic & manual therapies (2023)
    7. [7]
      Myofascial pain syndrome in the oncologic patient: general considerations. — Arce Gálvez L, Buitrago Martín CL, Guauque Marcelo CV, Valencia Gómez RE Medical oncology (Northwood, London, England) (2023)
    8. [8]
      Experimental and numerical analysis of biomechanical effects in cervical spine positioning rotation manipulation. — Chang L, Wang H, Guo Y, Cai Z, Zhan H International journal for numerical methods in biomedical engineering (2022)
    9. [9]
      Personalised gravitational loading of the cervical spine from biplanar X-rays for asymptomatic and clinical subjects in neutral standing position. — Muth-Seng C, Huneidi M, Heidsieck C, Laporte S, Le Coz JY, Gille O et al. Clinical biomechanics (Bristol, Avon) (2022)
    10. [10]
      Acute longus colli tendinitis and otolaryngology. — Siag K, Mazzawi S, Paker M, Biener R, Ghanayim R, Lumelsky D Brazilian journal of otorhinolaryngology (2022)
    11. [11]
      Effect of ischemic compression performed by family caregivers on myofascial pain syndrome and the care burden of the families of patients: a multicenter open-label randomized comparative study. — Hasuo H, Hashimoto K, Iwamoto H, Miwa N, Kawashima T, Oda A et al. Annals of palliative medicine (2022)
    12. [12]
      Intradermal therapy (mesotherapy): the lower the better. — Bifarini B, Gori F, Russo D, Mammucari M, Maggiori E, Di Marzo R et al. La Clinica terapeutica (2022)
    13. [13]
      Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain. — Louis CJ, Herrera CS, Garrity BM, McDonough CM, Cabral H, Saper RB et al. Archives of physical medicine and rehabilitation (2020)
    14. [14]
      Prevalence of MRI findings in the cervical spine in patients with persistent neck pain based on quantification of narrative MRI reports. — Jensen RK, Jensen TS, Grøn S, Frafjord E, Bundgaard U, Damsgaard AL et al. Chiropractic & manual therapies (2019)
    15. [15]
      Classification and Treatment of Chronic Neck Pain: A Longitudinal Cohort Study. — Liu R, Kurihara C, Tsai HT, Silvestri PJ, Bennett MI, Pasquina PF et al. Regional anesthesia and pain medicine (2017)
    16. [16]
      Neck muscle function in violinists/violists with and without neck pain. — Steinmetz A, Claus A, Hodges PW, Jull GA Clinical rheumatology (2016)
    17. [17]
      Botulinum toxin for myofascial pain syndromes in adults. — Soares A, Andriolo RB, Atallah AN, da Silva EM The Cochrane database of systematic reviews (2014)
    18. [18]
      Paraspinal stimulation combined with trigger point needling and needle rotation for the treatment of myofascial pain: a randomized sham-controlled clinical trial. — Couto C, de Souza IC, Torres IL, Fregni F, Caumo W The Clinical journal of pain (2014)
    19. [19]
      A workplace exercise versus health promotion intervention to prevent and reduce the economic and personal burden of non-specific neck pain in office personnel: protocol of a cluster-randomised controlled trial. — Johnston V, O'Leary S, Comans T, Straker L, Melloh M, Khan A et al. Journal of physiotherapy (2014)
    20. [20]
      Joint laxity negatively correlates with lumbar disc degeneration in young adults. — Kim TH, Lee HM, Moon SH, Kwak DK, Oh JK, Kim YC et al. Spine (2013)
    21. [21]
      Work related neck pain in Iranian dentists: an epidemiological study. — Rahmani N, Amiri M, Mohseni-Bandpei MA, Mohsenifar H, Pourahmadi MR Journal of back and musculoskeletal rehabilitation (2013)
    22. [22]
      Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. — Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM et al. BMC musculoskeletal disorders (2010)
    23. [23]
      A pain in the back case. — Bird S Australian family physician (2004)
    24. [24]
      Rheumatologists and neck pain. — Smythe HA Scandinavian journal of rheumatology (2000)
    25. [25]
      Chronic neck syndromes: an update. — Pawl RP Comprehensive therapy (1999)
    26. [26]
      Trigger points and tender points: one and the same? Does injection treatment help? — Borg-Stein J, Stein J Rheumatic diseases clinics of North America (1996)
    27. [27]
      Chronic neck pain and cervicogenic headache. — Wilson PR The Clinical journal of pain (1991)
    28. [28]
      An efficient method for constructing a soft interocclusal splint. — Hicks NA The Journal of prosthetic dentistry (1989)
    29. [29]
      Neck-tongue syndrome on sudden turning of the head. — Lance JW, Anthony M Journal of neurology, neurosurgery, and psychiatry (1980)
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