Academy of Chiropractic

MD Referral Program

#11 – Clinical Information, MRI and Diagnosis

Consultation #19

Interprofessional Spine Care Report

Spine Research Series #02

Myofascial Trigger Points and Chronic Pain

This flyer introduces the concept of myofascial trigger points and their relationship to chronic pain.  Trigger points have long history in pain management but since costlier procedures (epidurals and facet injections) have been embraced by the business side of the medical model, treatment of trigger points have been left in the dust.  That is unfortunate for patients, but it gives us a huge opportunity to get referrals from the medical community provided you keep them updated with the very latest research information.  Remember, you are simply keeping them informed on the best ways to IDENTIFY those patients, the next step is for them to refer to YOU for follow-up and management. You can then treat as you see fit and how you feel will best benefit the patient. 

This paper outlines the differences between Active and Latent Trigger Points and how they present clinically.  Continued activation of trigger points in the pain patient is one of the primary reasons the pain will persist over the log term.  If you need a refresher on the inflammatory response or inflammatory cascade there is a great video at the Khan Academy, here is the link.

This type of information is a great tool to build relationships with the mid-level providers such as Physician Assistants and Nurse Practitioners.  I would also recommend that you use a macro in your EMR notes to describe the trigger points in your patients.  Remember a well-documented patient encounter is a great tool to teach the MDs about what you do. 

When using this flyer, I would say “This is some research that shows how chronic pain can exist and persist in the absence of MRI findings.”  I would also ask the MD, “How do you currently diagnose a myofascial pain patient and ensure that you are getting the Active trigger point?”.  They will not be able to answer that which leaves them with the only one option, to send the patient to you!


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