Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan; Emirates speciality hospital, Dubai healthcare city, Dubai 505240, UAE.
Med Hypotheses. 2018 Feb;111:55-57. doi: 10.1016/j.mehy.2017.12.026. Epub 2017 Dec 22.
Despite the accumulating neuro-physiological evidence of myofascial pain, many clinicians are skeptical about its existence as a separate disease entity. No single theory can fully explain the four cardinal features of MPS; taut bands, local tenderness, local twitching and the characteristic pattern of referred pain. Bridging the gap between basic and clinical knowledge mandates coupling the local trigger point changes with the clinically seen distant somatically innervated referred pain. The main question addressed by the present theory is why do trigger points behave differently in comparison to the surrounding muscle tissue and are trigger points the primary problem or secondary to a primary pathology. We propose that trigger points have an extra-innervation system that connect them with other spinal structures such as the facet, the annulus and other trigger points with a role for the subcutaneous fascia as part of trigger points pathogenesis or passage for the extra-innervation. The extra-innervation system is Subcutaneous accessory pain system (SAPS). The novel SAPS system connecting trigger points to the spinal segments via dorsal rami is presented. Individuals with this accessory pathway are prone to myofascial pain, trigger point activation and segmental referred somatic pain similar to other axial spinal structures. Despite the high prevalence of myofascial pain, the mechanism is not universally agreed upon. Why do the trigger points act differently from surrounding muscle tissue and are almost constant in location in different individuals is controversial. Why does myofascial pain and its two components, trigger points and referred pain, exist or are more prevalent in some individuals than in others is unexplained. The correlation between axial spinal structures pathology and the trigger points is not explored well. The existing theories about trigger point formation and referred pain is scientifically credible for each separate component and the SAPS novel system can provide the link between the two.
尽管有越来越多的神经生理学证据表明肌筋膜疼痛的存在，但许多临床医生仍然对其作为一种独立的疾病实体存在持怀疑态度。没有单一的理论可以完全解释 MPS 的四个主要特征；紧张带、局部压痛、局部抽搐和特征性的牵涉痛模式。将基础和临床知识联系起来，需要将局部触发点变化与临床上所见的远处躯体传入牵涉痛联系起来，这是弥合两者之间差距的关键。目前的理论主要解决的问题是为什么触发点的行为与周围肌肉组织不同，以及触发点是主要问题还是继发于主要病理。我们提出，触发点具有一个额外的神经支配系统，将它们与其他脊柱结构（如关节突、纤维环）以及其他触发点连接起来，皮下筋膜作为触发点发病机制的一部分或作为额外神经支配的通道。这个额外的神经支配系统就是皮下辅助疼痛系统（SAPS）。我们提出了一个新的 SAPS 系统，通过背侧支连接触发点和脊柱节段，提出了一个新的 SAPS 系统。具有这种附加途径的个体容易出现肌筋膜疼痛、触发点激活和节段性躯体牵涉痛，类似于其他轴向脊柱结构。尽管肌筋膜疼痛的患病率很高，但其机制尚未得到普遍认可。为什么触发点的行为与周围肌肉组织不同，并且在不同个体中几乎固定在同一位置是有争议的。为什么肌筋膜疼痛及其两个组成部分，触发点和牵涉痛，在某些个体中存在或更为普遍，而在其他个体中则不常见，这是无法解释的。轴向脊柱结构病理学与触发点之间的相关性尚未得到很好的探讨。关于触发点形成和牵涉痛的现有理论，对于每个单独的组成部分都是具有科学可信度的，而 SAPS 新系统可以为两者之间提供联系。
