title: A critical evaluation of the trigger point phenomenon.
abstract: The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) seeks to explain the phenomena of muscle pain and tenderness in the absence of evidence for local nociception. Although it lacks external validity, many practitioners have uncritically accepted the diagnosis of MPS and its system of treatment. Furthermore, rheumatologists have implicated TrPs in the pathogenesis of chronic widespread pain (FM syndrome). We have critically examined the evidence for the existence of myofascial TrPs as putative pathological entities and for the vicious cycles that are said to maintain them. We find that both are inventions that have no scientific basis, whether from experimental approaches that interrogate the suspect tissue or empirical approaches that assess the outcome of treatments predicated on presumed pathology. Therefore, the theory of MPS caused by TrPs has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced.
authors.affiliation: Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia jqu33431@bigpond.net.au.
authors.forename: John L
authors.initials: JL
authors.lastname: Quintner
authors.affiliation: Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Bove
authors.affiliation: Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Milton L
authors.initials: ML
authors.lastname: Cohen
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004576:Electromyography; D006801:Humans; D009209:Myofascial Pain Syndromes / Q000209:etiology* / Q000503:physiopathology*; D059225:Nociception / Q000502:physiology; D010147:Pain Measurement; D061028:Trigger Points / Q000503:physiopathology*
keywords: muscle; nerve; pain mechanisms; philosophy of science; referred pain