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Abstract
Objective
Discuss recent cytokine findings in myofascial trigger points (MTrPs) in the context of known kinase cascades and other transduction pathways to determine what pharmacological and/or other manual therapy strategies might be useful to treat myofascial pain, and identify key biochemical entities to target future research.
Methods
Search of the PubMed, Scopus, and Google databases for relevant key studies published since 1980 in English and German languages.
Results
One hundred and thirteen articles were identified for inclusion into this narrative review.
Discussion
Recent biochemical findings indicate a significant decrease in pH in active MTrPs compared to latent MTrPs or normal muscle, and large significant increases in cytokines, catecholamines, and neurotransmitters. The findings support Simons’ hypothesis, and it is possible that changes in bradykinin levels might in part be responsible for the pain experienced by patients with active MTrPs. There is also sufficient evidence to suggest that mitogen-activated protein kinases (MAPK) pathways might be involved with regard to myofascial pain and the development of MTrPs. MK2, a kinase downstream in p38 pathway has also been shown to be a point of convergence for multiple signaling processes activated during inflammation and has so far been targeted for various chronic inflammatory diseases. The potential efficiency of MK2 inhibitors is high because they may not only inhibit the production of inflammatory cytokines but also their actions. Finally, and most importantly, we still do not yet understand how latent MTrPs develop from normal muscle tissue and how latent MTrPs become active MTrPs. This must be an additional area of active research.
Acknowledgments
The authors want to thank Prof Dr Matthias Gaestel (Hanover Medical School, Institute of Biochemistry) for critically reading the manuscript.