Correlation between Cervical Spondylosis and Myofascial Pain Syndrome: A Retrospective Study

Authors

  • Sucha Kumnoonsup Department of Physical medicine and Rehabilitation, Saraburi Hospital, Saraburi, Thailand

Keywords:

cervical spondylosis, myofascial pain syndrome, pain, prevalence, risk factors

Abstract

Objectives: To determine the prevalence and characteristics of myofascial pain syndrome (MPS) in people diagnosed with cervical spondylosis and the correlation between these two conditions.

Study design: Retrospective study.

Setting: Outpatient Rehabilitation Clinic, Saraburi Hospital.

Subjects: Patients diagnosed with cervical spondylosis between March 1, 2019 and February 28, 2022.

Methods: Patient characteristics and general information were obtained from medical records. The level and severity of cervical spondylosis were determined from radiographic findings. Muscles of the neck, shoulder, arm, and hand areas diagnosed with MPS were used to determine the prevalence of MPS and to analyze correlations with cervical spondylosis and other related factors.

Results: Of the 281 patients with cervical spondylosis recruited, 71.5% were diagnosed with MPS and the average number of MPS-affected muscles was 2.29 per person. The severity of cervical spondylosis was statistically significantly associated with a diagnosis of MPS (p = 0.003). Those with a minimal degree of cervical spondylosis on radiographic study were approximately 13 times more likely to have a diagnosis of MPS than those with a gross degree; however, severity had a weak negative correlation with the number of MPS-affected muscles (r = -.224, p < 0.001). Multivariable logistic regression analysis demonstrated that less severe cervical spondylosis, female gender and lower body mass index were independent factors correlated with a diagnosis of MPS (p < 0.05). 

Conclusions: Patients diagnosed with cervical spondylosis have a high prevalence of concomitant MPS. Physicians need to be aware of the possibility of MPS when treating cervical spondylosis, especially if the patient is female, has a low BMI, and has less severe cervical spondylosis.

References

Kuo DT, Tadi P. Cervical Spondylosis. [Internet]. Treasure Island: StatPearls Publishing; 2022 [cited 2022 Mar 28]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK551557/

Bernabéu-Sanz Á, Mollá-Torró JV, López-Celada S, Moreno López P, Fernández-Jover E. MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression. Eur Radiol [Internet]. 2020 Jan [cited 2022 Apr 12];30(1):357-69. Available from: https://pubmed.ncbi.nlm.nih.gov/31350584/ doi:10.1007/s00330-019-06352-z

Shedid D, Benzel EC. Cervical spondylosis anatomy: pathophysiology and biomechanics. Neurosurgery [Internet]. 2007 Jan [cited 2022 Apr 12];60(1):7-13. Available from: https://pubmed.ncbi.nlm.nih.gov/17204889/ doi:10.1227/01.NEU.0000215430.86569.C4.

Kelly JC, Groarke PJ, Butler JS, Poynton AR, O’Byrne JM. The natural history and clinical syndromes of degenerative cervical spondylosis. Adv Orthop [Internet]. 2011 Nov [cited 2022 Apr 25]; 2012:393642. Available from: https://www.hindawi.com/journals/aorth/2012/393642/ doi:10.1155/2012/393642

Lu X, Tian Y, Wang SJ, Zhai JL, Zhuang QY, Cai SY, et al. Relationship between the small cervical vertebral body and the morbidity of cervical spondylosis. Medicine [Internet]. 2017 Aug [cited 2022 Apr 20];96(31):e7557. Available from: https://journals.lww.com/md-journal/Fulltext/2017/08040/Relationship_between_the_small_cervical_vertebral.8.aspx doi:10.1097/MD.0000000000007557

Kellgren JH, Ball J, Jeffrey MR. Atlas of standard radiographics, vol II. Oxford: Blackwell Scientific; 1963. p. 217.

Kellgren JH, Lawrence JS. Osteo-arthrosis and disk degeneration in an urban population. Ann Rheum Dis [Internet]. 1958 Dec [cited 2022 Apr 15];17(4):388–97. Available from: https://ard.bmj.com/content/17/4/388.long doi:10.1136/ard.17.4.388

McCartney S, Baskerville R, Blagg S, McCartney D. Cervical radiculopathy and cervical myelopathy: diagnosis and management in primary care. Br J Gen Pract [Internet]. 2018 Jan [cited 2022 Apr 12];68(666):44–6. Available from: https://bjgp.org/content/68/666/44.long doi:10.3399/bjgp17X694361

Conger A, Cushman DM, Speckman RA, Burnham T, Teramoto M, McCormick ZL. The effectiveness of fluoroscopically guided cervical transforaminal epidural steroid injection for the treatment of radicular pain; a systematic review and meta-analysis. Pain Med [Internet]. 2020 Jan [cited 2022 Apr 15];21(1):41-54. Available from: https://academic.oup.com/painmedicine/article/21/1/41/5513392 doi:10.1093/pm/pnz127

Manchikanti L, Nampiaparampil DE, Candido KD, Bakshi S, Grider JS, Falco FJ, et al. Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review. Pain Physician [Internet]. 2015 Jan [cited 2022 Apr 15];18(1):39-60. Available from: https://www.painphysicianjournal.com/linkout?issn=&vol=18&page=39

Travell D, Simons DG. Myofascial pain and dysfunction: the trigger point manual, upper half of the body. Baltimore, USA: Williams & Wilkins; 1999. p. 1038.

Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol [Internet]. 1985 Dec [cited 2022 Apr 17];60(6):615–23. Available from: https://www.sciencedirect.com/science/article/abs/pii/0030422085903640 doi:10.1016/0030-4220(85)90364-0

Cerezo-Tellez E, Torres-Lacomba M, Mayoral-Del Moral O, Sanchez-Sanchez B, Dommerholt J, Gutiérrez-Ortega C. Prevalence of myofascial pain syndrome in chronic non-specific neck pain: a population-based cross-sectional descriptive study. Pain Med [Internet]. 2016 Dec [cited 2022 Apr 17];17(12):2369–77. Available from: https://academic.oup.com/painmedicine/article/17/12/2369/2741181 doi:10.1093/pm/pnw114

Skootsky SA, Jaeger B, Oye RK. Prevalence of myofascial pain in general internal medicine practice. West J Med [Internet]. 1989 Aug [cited 2022 Apr 17];151(2):157–60. Available from: https://pubmed.ncbi.nlm.nih.gov/2788962/

Cakit BD, Taskin S, Nacir B, Unlu I, Genc H, Erdem HR. Comorbidity of fibromyalgia and cervical myofascial pain syndrome. Clin Rheumatol [Internet]. 2010 Jan [cited 2022 Apr 23];29(4):405–11. Available from: https://link.springer.com/article/10.1007/s10067-009-1342-5 doi:10.1007/s10067-009-1342-5

Rivera OLG. Prevalence of head and neck myofascial pain syndrome in a South American population. Revista Nacional de Odontologia [Internet]. 2020 Oct [cited 2022 Apr 23];16(1):1–13. Available from: https://revistas.ucc.edu.co/index.php/od/article/download/3975/3129/11629

Simons DG. Referred phenomena of myofascial trigger points. In: Vecchiet L, AlbeFessard D, Lindblom U, editors. New trends in referred pain and hyperalgesia. Amsterdam: Elsevier Science; 1993. p. 341–57.

Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician [Internet]. 2002 Feb [cited 2022 Jun 15];65(4):653–60. Available from: https://www.aafp.org/pubs/afp/issues/2002/0215/p653.html

Hong CZ. Muscle pain syndromes. In: Braddom RL, Chan L, Harrast MA, Kowalske KJ, Matthews DJ, Ragnarsson KT, et al., editors. Braddom’s Physical Medicine and Rehabilitation. 4th ed. Philadephia: Saunders; 2011. p. 971-1001.

Marcus NJ. Failure to diagnose pain of muscular origin leads to unnecessary surgery. Pain Med [Internet]. 2002 Jun [cited 2022 May 28];3(2):161–6. Available from: https://academic.oup.com/painmedicine/article/3/2/161/1940492 doi:10.1046/j.1526-4637.2002.02020.x

Ceneviz C, Maloney G, Mehta N. Myofascial pain may mimic trigeminal neuralgia. Cephalalgia [Internet]. 2006 Jul [cited 2022 May 28];26(7):899–901. Available from: https://journals.sagepub.com/doi/full/10.1111/j.1468-2982.2006.01123.x doi:10.1111/j.1468-2982.2006.01123.x

Facco E, Ceccherelli F. Myofascial pain mimicking radicular syndromes. Acta Neurochir Suppl [Internet]. 2005 Feb [cited 2022 May 28];92:147–50. Available from: https://link.springer.com/chapter/10.1007/3-211-27458-8_32 doi:10.1007/3-211-27458-8_32

Hou C, Tsai L, Cheng K, Chung K, Hong C. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil [Internet]. 2002 Oct [cited 2022 May 20];83(10):1406–14. Available from: https://www.archives-pmr.org/article/S0003-9993(02)00060-6/fulltext doi:10.1053/apmr.2002.34834

Hong C, Chen Y, Pon C, Yu J. Immediate effects of various physical medicine modalities on pain threshold of an active myofascial trigger point. J Musculoskelet Pain [Internet]. 2010 Jan [cited 2022 May 20];1(2):37–53. Available from: https://www.tandfonline.com/doi/abs/10.1300/J094v01n02_04 doi:10.1300/J094v01n02_04

Desai MJ, Saini V, Saini S. Myofascial pain syndrome: a treatment review. Pain Ther [Internet]. 2013 Jun [cited 2022 May 20];2(1):21–36. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107879/ doi:10.1007/s40122-013-0006-y

Kuncewicz E, Samborski W. Tender points and trigger points--differences and similarities. Chir Narzadow Ruchu Ortop Pol [Internet]. 2009 Nov [cited 2022 May 28];74(6):367–71. Available from: https://pubmed.ncbi.nlm.nih.gov/20201336/

Akoglu H. User’s guide to correlation coefficients. Turk J Emerg Med [Internet]. 2018 Aug [cited 2022 Jun 4];18(3):91–3. Available from: https://www.researchgate.net/publication/326885374_User%27s_guide_to_correlation_coefficients doi:10.1016/j.tjem. 2018.08.001

Rudy IS, Poulos A, Owen L, Batters A, Kieliszek K, Willox J, et al. The correlation of radiographic findings and patient symptomatology in cervical degenerative joint disease: a cross-sectional study. Chiropr Man Therap [Internet]. 2015 Feb [cited 2022 Jun 18];23:9. Available from: https://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0052-0 doi:10.1186/s12998-015-0052-0

Yap EC. Myofascial pain--an overview. Ann Acad Med Singap [Internet]. 2007 Jan [cited 2022 May 28];36(1):43-8. Available from: https://pubmed.ncbi.nlm.nih.gov/17285185/

Teresi LM, Lufkin RB, Reicher MA, Moffit BJ, Vinuela FV, Wilson GM, et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology [Internet]. 1987 Jul [cited 2022 Jun 15];164(1):83–8. Available from: https://pubs.rsna.org/doi/10.1148/radiology.164.1.3588931 doi:10.1148/radiology.164.1.3588931

Sabeh AM, Bedaiwi SA, Felemban OM, Mawardi HH. Myofascial pain syndrome and its relation to trigger points, facial form, muscular hypertrophy, deflection, joint loading, body mass index, age and educational status. J Int Soc Prev Community Dent [Internet]. 2020 Nov [cited 2022 Jun 15];10(6):786–93. Available from: https://pubmed.ncbi.nlm.nih.gov/33437714/ Doi:10.4103/jispcd.JISPCD_328_20

Severino SK, Moline ML. Premenstrual syndrome. Obstet Gynecol Clin North Am [Internet]. 1990 Dec [cited 2022 Jun 15];17(4):889–903. Available from: https://pubmed.ncbi.nlm.nih.gov/2092248/

Page P. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. Int J Sports Phys Ther [Internet]. 2011 Mar [cited 2022 Jun 20];6:51–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105366/

Agung I, Murdana N, Purba H. The relationship between the body mass index and the pain threshold in myofascial pain syndrome: a cross-sectional study. Indones J Phys Med Rehabil [Internet]. 2017 Jun [cited 2022 Jun 15];6(1):8–17. Available from: http://indojournalpmr.org/IJPMR/article/view/147 doi:10.36803/ijpmr.v6i01.147

Michels KB, Greenland S, Rosner BA. Does body mass index adequately capture the relation of body composition and body size to health outcomes. Am J Epidemiol [Internet]. 1998 Jan [cited 2022 Jun 15];147(2):167–72. Available from: https://academic.oup.com/aje/article/147/2/167/183304 doi:10.1093/oxfordjournals.aje.a009430

Etchison WC, Bloodgood EA, Minton CP, Thompson NJ, Collins MA, Hunter SC, et al. Body mass index and percentage of body fat as indicators for obesity in an adolescent athletic population. Sports Health [Internet]. 2011 May [cited 2022 Jun 15];3(3):249–52. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445161/ doi:10.1177/1941738111404655

Kanehisa H, Fukunaga T. Association between body mass index and muscularity in healthy older Japanese women and men. J Physiol Anthropol [Internet]. 2013 Mar [cited 2022 Jun 15];32(1):1-4. Available from: https://jphysiolanthropol.biomedcentral.com/articles/10.1186/1880-6805-32-4 doi:10.1186/1880-6805-32-4

Akazawa N, Harada K, Okawa N, Tamura K, Moriyama H. Low body mass index negatively affects muscle mass and intramuscular fat of chronic stroke survivors. PLoS One [Internet]. 2019 Jan [cited 2022 Oct 12];14(1):e0211145. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone. 0211145 doi:10.1371/journal.pone.0211145

Jafri MS. Mechanisms of myofascial pain. Int Sch Res Notices [Internet]. 2014 Aug [cited 2022 Aug 15];2014:523924. Available from: https://www.hindawi.com/journals/isrn/2014/523924/ doi:10.1155/2014/523924

Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber LH. Myofascial trigger points then and now: a historical and scientific perspective. PM R [Internet]. 2015 Jul [cited 2022 Aug 12];7(7):746-61. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508225/ doi:10.1016/j.pmrj.2015.01.024

Hong CZ, Simons DG. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil [Internet]. 1998 Jul [cited 2022 Aug 12];79(7):863-72. Available from: https://www.archives-pmr.org/article/S0003-9993(98)90371-9/pdf doi:10.1016/s0003-9993(98)90371-9

Wang C, Tian F, Zhou Y, He W, Cai Z. The incidence of cervical spondylosis decreases with aging in the elderly, and increases with aging in the young and adult population: a hospital-based clinical analysis. Clin Interv Aging [Internet]. 2016 Jan [cited 2022 Jun 10];11:47–53. Available from: https://www.dovepress.com/the-incidence-of-cervical-spondylosis-decreases-with-aging-in-the-elde-peer-reviewed-fulltext-article-CIA doi:10.2147/CIA.S93118

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2023-03-08

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