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Myofascial pain in dogs (Proceedings)

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Aug 01, 2010

Myofascial Pain is a rarely recognized pain generator for both acute and chronic pain in dogs. It is both defined by and diagnosed by the presence of muscle pain originating from myofascial trigger points (MTrPs) within the muscles.1 Only a handful of articles and conference presentations have addressed MTrPs in dogs, some of which are out of date in regard to current theories and findings accepted in human medicine. A better understanding of Myofascial pain is needed by both the primary care veterinarian and specialist to better manage many commonly seen pain patients.

Writings concerning muscle pain in poeple date back to the 1500's when the French physician Guillaume de Baillou (1538-1616) published "Liber de Rheumatismo" and referred to it as "muscular rheumatism. Thomas Sydenham (1624-1689) considered the "Father of English Medicine" published "Observations Medicae" in 1676 and referred to muscle pain as "Rheumatism". In 1816 the British physician Balfour described "patients as having a large number of nodular tumors and thickenings which were painful to the touch, and from which pains shot to neighboring parts". Numerous other references to muscle pain can be found however most current day knowledge of myofascial pain is based on the works of Janet Travell, MD (1901-1997).

Dr. Travell was a fascinating woman who was both a cardiologist and researcher. Some of her other accomplishments were serving as White House physician to both Presidents Kennedy and Johnson. In her early medical career, Dr. Travell served simultaneously on pulmonary, cardiology and general medical services, in all services she observed, even with dying patients, the major complaint was pain.2 When patients were asked how they were doing they would respond with varying complaints of pain, "I have a terrible pain in my shoulder. I can't sleep. I can't lay on that side." While different medical services would often have explanations for pain none had objective evidence of disease to account for the patient's pain. Dr. Travell, on the other hand, would examine patients and find that all groups had isolated tender spots in the muscles which, when compressed, reproduced the patient's pain. The common problem was myofascial pain syndrome due to myofascial trigger points.

Dr. Travell's observations and research in the area of myofascial pain led to numerous publications and in collaboration with David Simons, MD, wrote Volume 1 Upper Half of Body, Myofascial Pain and Dysfunctions – The Trigger Point Manual in 1983, and Volume 2 Lower half, in 1993. An updated second edition of Volume 1 was released in 1999, two years following the death of Dr. Travell. Review of most every publication regarding myofascial pain in human medicine will show reference to Doctors Travell and Simons' work and publications.

Janssens was perhaps the first to describe MTrPs in dogs in 1991 with his paper describing Myofascial Pain Syndrome in 48 dogs.3 In 1992 he published an additional paper on trigger point therapy.4 In 1999, Frank published a paper using the human model to establish diagnostic criteria in the dog.5 With the exception of these publications and the occasional conference proceedings lecture, little mention of myofascial pain in dogs exists.