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Variability of Criteria Used to Diagnose Myofascial Trigger Point Pain Syndrome—Evidence From a Review of the Literature

Tough, Elizabeth A. MSc; White, Adrian R. MD; Richards, Suzanne PhD; Campbell, John MD

doi: 10.1097/AJP.0b013e31802fda7c
Review Article

Objectives The aim of the literature review was to investigate the criteria adopted by “experts” to diagnose myofascial trigger point (MTrP) pain syndrome. Experts were defined as being either researchers investigating MTrP pain syndrome or the “authority” the researchers cited as a source of reference for MTrP pain syndrome diagnosis.

Methods We searched electronic databases to identify relevant empirical research (excluding studies not in English and those relating to dental pathology). Of 607 possibly relevant publications 93 met our inclusion criteria. We recorded (1) the individual criterion and criteria combinations used to diagnose MTrP pain syndrome; (2) the cited “authoritative” publications and (3) the criteria recommended by the authoritative publications as being essential for MTrP pain syndrome diagnosis.

Results The review identified 19 different diagnostic criteria. The 4 most commonly applied criteria were: “tender spot in a taut band” of skeletal muscle, “patient pain recognition,” “predicted pain referral pattern,” and “local twitch response.” There was no consistent pattern to the choice of specific diagnostic criteria or their combinations. However, one pair of criteria “tender point in a taut band” and “predicted or recognized pain referral” were used by over half the studies. The great majority of studies cited publications by Travell and more recently Simons as a principal authoritative source for MTrP pain syndrome diagnosis, yet most of these studies failed to apply the diagnostic criteria as described by these authorities.

Discussion We conclude that there is as yet limited consensus on case definition in respect of MTrP pain syndrome. Further research is needed to test the reliability and validity of diagnostic criteria. Until reliable diagnostic criteria have been established, there is a need for greater transparency in research papers on how a case of MTrP pain syndrome is defined, and claims for effective interventions in treating the condition should be viewed with caution.

Peninsula Medical School, Universities of Exeter and Plymouth, UK

Elizabeth A. Tough and Adrian R. White are supported by the DH-National Co-ordinating Centre for Research Capacity Development (NCC RCD).

Reprints: Elizabeth A. Tough, MSc, Peninsula Medical School, Room N32; ITTC Building. Tamar Science Park. Plymouth PL6 8BX (e-mail:

Received for publication July 12, 2006; accepted November 22, 2006

The authors have no financial or other relationships leading to a conflict of interest.

© 2007 Lippincott Williams & Wilkins, Inc.