Chronic Neck Pain from Myofascial Pain Syndrome: A Case Study

Diagnostic Findings

An orthopaedic specialist had already seen the patient. A neck X-ray showed cervical spondylosis. This is a common condition where the discs and joints in the neck wear down slowly with age. There was no dislocation and no fracture. An MRI scan of the neck showed no pinched nerve and no slipped disc. The patient tried painkillers and physiotherapy. These did not help much.

In my assessment: When the patient came to me, I reviewed the X-ray and MRI results. These had already ruled out a spinal or nerve cause for the pain. On examination, I found no nerve damage and no muscle wasting. I felt the neck and shoulder muscles for a tight band within the muscle. I found spots that were clearly more tender than the tissue around them. Pressing on these spots brought back the patient’s usual pain. This pattern, along with the normal nerve and imaging findings, confirmed Myofascial Pain Syndrome. This diagnosis matters. It points treatment toward the muscle itself, not the spine or the nerves.

Treatment Approach

I took the following steps, in my own words:

1. I mapped the trigger points in the neck and shoulder muscles by feel. These points show up on examination, not on scans.
2. I gave a targeted injection into the trigger points. It combined a muscle relaxant with an anti-inflammatory. This aims to release the tight muscle and calm local inflammation.
3. I used a stepwise approach. If this first injection relieved the pain well, no further procedure was needed at that stage.
4. I replaced the patient’s regular painkiller with a specific muscle relaxant. This supports ongoing muscle relaxation and recovery.

 

Outcome

After the injection, the patient could stop regular oral painkillers. He moved to a targeted muscle relaxant to support recovery. Pain like this can sometimes come back. If that happens, the patient may need further muscle-directed treatment.

This outcome reflects one individual case. Treatment suitability and results depend on each patient’s specific diagnosis and clinical assessment.

Ask the Doctor

Q: How can I tell if my neck and shoulder pain is coming from a nerve, the spine, or the muscles?

A: Chronic neck and shoulder pain can have several causes. I first rule out spinal or nerve causes with imaging, such as an MRI or CT scan. If these show nothing that explains the pain, I examine the muscles directly. I feel for trigger points. These are small, tender knots in the muscle. Pressing them brings back the patient’s usual pain. This pattern is typical of myofascial pain syndrome. Many patients cannot recall a specific injury. In the neck and shoulders, the trigger can be something simple, like slouched computer posture, stress-related muscle tension, or holding the neck in one position for too long.

Q: What’s the right way to treat a muscle strain, and is muscle relaxant injection always the first step?

A: Most mild muscle, tendon, or neck strains settle within a day or two. Simple measures like paracetamol or ibuprofen usually help. When pain lasts longer, I inject the tight muscle knot. I use a mix of local anaesthetic, muscle relaxant, and anti-inflammatory medicine. These can be used alone or together, depending on the case. Patients should know that strong muscle relaxation can sometimes cause short-term dizziness, lip numbness, or ringing in the ears. I watch for this. In my experience, most myofascial pain responds well to one round of treatment. In a small number of cases, pain can return. If that happens, I reassess. I may then consider a platelet-rich plasma injection, known as PRP, as a further muscle-directed option to support healing.

Related Reading

• Understanding Myofascial Pain Syndrome
• Myofascia Pain Injection