%0 Journal Article
%A Fernández-de-las-Peñas, César
%A Nijs, Jo
%A Cagnie, Barbara
%A Gerwin, Robert D.
%A Plaza Manzano, Gustavo
%A Valera Calero, Juan Antonio
%A Arendt Nielsen, Lars
%T Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain
%D 2023
%@ 2075-1729
%U https://hdl.handle.net/20.500.14352/73313
%X Myofascial pain syndrome is featured by the presence of myofascial trigger points (TrPs).Whether TrPs are primary or secondary phenomena or if they relate to central or peripheral nervoussystem disorders is controversial. Referred pain, a cardinal sign of TrPs, is a central phenomenon drivenby peripheral input. In 2021, the InternationalAssociation for the Study of Pain (IASP) proposed a clinicalcriteria and grading system for classifying patients with pain on nociceptive, neuropathic, or nociplasticphenotypes. Myofascial TrP pain has been traditionally categorized as a nociceptive phenotype; however,increasing evidence supports that this condition could be present in patients with predominantlynociplastic pain, particularly when it is associated with an underlying medical condition. The clinicalresponse of some therapeutic approaches for managing TrPs remains unclear. Accordingly, the abilityto classify myofascial TrP pain into one of these phenotypes would likely be critical for producingmore successful clinical treatment outcomes by a precision medicine approach. This consensus paperpresents evidence supporting the possibility of subgrouping individuals with myofascial TrP pain intonociceptive, nociplastic, or mixed-type phenotype. It is concluded that myofascial pain caused by TrPs isprimarily a nociceptive pain condition, is unlikely to be classified as neuropathic or nociplastic, but can bepresent in patients with predominantly neuropathic or nociplastic pain. In the latter cases, managementof the predominant central pain problem should be a major treatment goal, but the peripheral drivefrom TrPs should not be ignored, since TrP treatment has been shown to reduce sensitization-associatedsymptomatology in nociplastic pain conditions, e.g., fibromyalgia.
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