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Quintner & Cohen’s 1994 critique of the trigger point hypothesis

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Tags: muscle pain, trigger points doubts, etiology, classics, chronic pain, massage, muscle, pain problems, pro, manual therapy, treatment

Seven articles on PainSci cite Quintner 1994: (1) The Complete Guide to Trigger Points & Myofascial Pain(2) The Complete Guide to Chronic Tension Headaches(3) Basic Self-Massage Tips for Myofascial Trigger Points(4) Why Do Muscles Feel Stiff and Tight?(5) Trigger Point Doubts(6) Complete Guide to Frozen Shoulder(7) Trigger Points on Trial

PainSci summary of Quintner 1994: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

Quintner and Cohen’s 1994 paper is a historically significant critique of the “traditional” (Travell & Simons) explanation for the phenomenon of trigger points, known today as the “integrated hypothesis.” They propose that peripheral nerve pain is a better explanation. More specifically, they proposed that irritated or injured peripheral nerve trunks may be the cause of pain, rather than lesions in muscle tissue. This hypothesis has advantages and problems, just like the idea it is intended to replace. Its main problem is that there’s no obvious plausible mechanism for ubiquitous nerve irritation. I review the hypothesis more thoroughly in my book, The Complete Guide to Trigger Points & Myofascial Pain.

An updated version of this paper was published in 2015 in Rheumatology (Oxford).

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

The theory of myofascial pain syndrome (MPS) has been constructed around the trigger point (TrP), a region within a muscle from which local and remote pain can be evoked by palpation. Although their pathophysiology is obscure, TrPs have been regarded as the cause of myofascial pain. Spread and chronicity of pain are attributed to the activation of latent, secondary, and satellite TrPs. Although it lacks internal validity, this tautological concept has given rise to a system of empirical treatment that has been uncritically accepted by many. However, not only does the anatomical distribution of pain referred from TrPs bear a close relationship to the course of peripheral nerves, but the pain of MPS is also similar to nerve trunk pain, which is an example of somatic referred pain. Pain of peripheral nerve origin can be present without neurological deficit and with normal findings on conventional electrodiagnostic examination. In contrast to the theory of MPS, which considers the TrPs to be sites of primary hyperalgesia, this article argues that all MPS phenomena are better explained as secondary hyperalgesia of peripheral neural origin.

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