Overview
Myofascial pain syndrome of the thoracic spine involves chronic pain arising from trigger points in the muscles of the thoracic region, often coexisting with low back and neck pain. 1Diagnosis
Key Diagnostic Criteria: Presence of chronic pain localized to the thoracic spine, reproducible pain on palpation of specific trigger points.
Recommended Tests: Self-reported pain assessment using validated questionnaires (e.g., Nordic questionnaire).
Grading: No specific grading system mentioned; diagnosis primarily clinical with exclusion of other causes.Management
First-Line Treatments:
- Physical Therapy: Including stretching, strengthening exercises, and manual therapy targeting trigger points.
- Trigger Point Injections: Local anesthetic or corticosteroid injections for refractory cases.
Adjunctive Treatments:
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief; specific dosing not detailed.
- Behavioral Therapies: Cognitive-behavioral therapy to address pain coping mechanisms.Special Populations
Elderly: Increased incidence with age, particularly in those ≥50 years (OR 6.0 [95% CI 2.1-17.3]). 1
Work-Related Factors: Tall stature and frequent/sustained trunk bending are risk factors, suggesting ergonomic adjustments may be beneficial. 1Key Recommendations
Screen for Thoracic Spine Pain in Older Workers: Given the higher incidence in those aged ≥50 years, routine screening is recommended for older working populations. (Evidence: Moderate 1)
Consider Ergonomic Interventions: Implement ergonomic modifications, particularly addressing trunk bending and recovery periods, to reduce risk factors in susceptible populations. (Evidence: Moderate 1)
Utilize Physical Therapy Early: Initiate physical therapy early in management to address muscle trigger points and improve function. (Evidence: Expert opinion)References
1 Roquelaure Y, Bodin J, Ha C, Le Marec F, Fouquet N, Ramond-Roquin A et al.. Incidence and risk factors for thoracic spine pain in the working population: the French Pays de la Loire study. Arthritis care & research 2014. link