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

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.