The prognosis for myofascial pain syndrome (MPS) is good if treatment is started before symptoms become acute and aggravating factors, such as poor posture or excessive muscle overload, are eliminated. Other conditions, including many that are symptoms of or occur simultaneously with MPS (e.g., migraines, depression, anxiety, diabetes, fibromyalgia, insomnia) should be treated, as they may aggravate other MPS symptoms when uncontrolled.

Finding the right physician is crucial in treating MPS because not all physicians have experience treating this type of pain disorder. It is recommended that patients seek care with a physician specializing in pain management, a growing medical specialty incorporating anesthesia and physical medicine and rehabilitation.

Treatment of MPS centers on reducing the musculoskeletal pain and improving muscular function. All treatment options, including those the individual can do on their own, should be discussed with a physician. These may include:

• Physical therapy. Therapists focus on correction of muscle shortening by targeted stretching and strengthening of the affected muscles, and correction of aggravating factors (e.g., improper posture and ergonomics). Modalities such as diathermy and ultrasound therapy can be used to reduce pain.
  

Therapists may also perform a spray and stretch technique. This involves spraying a muscle with a topical anesthetic to numb the area and then stretch out the painful, contracted muscle to reduce pain and stiffness. Many therapists use ice instead of the spray, because the spray is costly and ice usually is just as effective.

• Manipulation therapy. Myofascial release therapy involves working on tight, contracted muscles and TrPs to release or stretch out the problem areas. Massage therapists generally work lightly and progress slowly in doing deep muscle work. The results of massage can last a considerable time.
  

• Occupational therapy. This type of therapy can be helpful in assessing and setting up ergonomically correct workstations to prevent exacerbation and/or recurrence of symptoms. Properly set-up work sites can help to decrease aggravating factors, such as poor posture. Occupational therapists can also offer expertise on home modifications, task simplification and energy conservation to reduce fatigue and pain.
  

• Cryotherapy (cold therapy). Therapy using a cold substance can reduce pain and inflammation; however, prolonged use can injure skin.
  
  
• Thermotherapy (heat therapy). Heat therapy is usually used in rehabilitation to relieve joint stiffness. Moist heat, done by combining hydrotherapy with thermotherapy, penetrates deeper into the muscle and offers more relaxation than dry heat. Too much heat can cause burns. Heat should not be used on sensitive skin and may need to be avoided when using analgesics.
  
  
• Cognitive behavioral therapy. This form of psychological treatment can help people replace negative thoughts with positive ones and provide coping strategies.
  
  
• Injection therapy. Physicians may inject medication directly into the TrPs to relieve pain.  A physician may recommend trigger point injections only when other, less invasive methods fail to eliminate the pain. These treatments can be very effective in individuals who have long standing pain.

Other complementary and alternative medicine techniques can be tried in some patients:

• Dental appliances. A mouth guard worn at night can help in cases caused or exacerbated by clenching or grinding of the teeth.
  
  
• Biofeedback. Information about typically unconscious bodily functions (e.g., muscle tension and blood pressure) is used to help gain conscious control over those functions. Electrodes are placed on the muscles to identify which are in use. People can then try to consciously lower muscle tension in that area.
  
  
• Acupressure. Pressure is used on target points of the body to control symptoms.
  
  
• Acupuncture. Thin needles are inserted into target points of the body to ease pain and improve sleep patterns. Controversy remains as to its effectiveness, but some studies show significant beneficial results.

When used in conjunction with active treatment therapies, the use of certain medications may help alleviate symptoms. These include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Usually used to treat inflammation, NSAIDs also help ease muscle aches and may help make patients more comfortable in exercising and returning to daily activities.
  
  
• Muscle relaxants. By reducing the ability of the muscles to contract, these drugs help alleviate muscle pain.
  
  
• Antidepressants. Used in lower doses when treating MPS than when treating depression unless the patient is also suffering with depression. Even at low doses, side effects are common, including dry mouth, weight gain, constipation and lack of concentration. Tricyclic antidepressants relax muscles and heighten the effects of endorphins and may be taken at bedtime to help promote restorative sleep. The U.S. Food and Drug Administration (FDA) has approved a  selective serotonin and norepinephrine reuptake inhibitor (SSNRI) to relieve some types of nerve pain.

Patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the U.S. Food and Drug Administration has advised that antidepressants may increase the risk of suicidal thinking in younger patients and all people being treated with them should be monitored closely for unusual changes in behavior.

For improvement to be significant, patients must adhere to an active medical treatment plan as outlined by their physician. In addition, patients should continue seeing their physician until symptoms have resolved or stabilized at maximum medical improvement.