Myofascial Pain Syndromes: Controversies and Suggestions for Improving Diagnosis and Treatment

SYNOPSIS: Myofascial pain syndromes (MPSs) affect a significant portion of the population. However, they remain controversial because their etiology, diagnostics, and effect mechanisms rely on theoretical frameworks with limited scientific rigor. This Viewpoint highlights 3 main challenges and proposes solutions: First, diagnosis lacks consistent criteria and is at risk of verification and incorporation biases. Tightened diagnostic criteria and differentiating myofascial pain syndrome from competing conditions will improve accuracy in research and clinical practice. Second, the etiology/pain mechanisms are poorly understood, with symptoms overlapping other conditions. We recommend recording of standardized assessments in national registries including psychological stress and systemic factors to identify distinct phenotypes. Third, the mechanisms behind treatments such as myofascial release and acupuncture are unclear. We advocate for mechanistic clinical trials to uncover how these treatments exert effects. Addressing these challenges will enhance understanding, diagnosis, and treatment of MPS and guide policymakers to fund appropriate research. J Orthop Sports Phys Ther 2025;55(4):231-234. Epub 10 February 2025. doi:10.2519/jospt.2025.13072