Multimodal approach to managing patients with myofascial pain syndrome

Myofascial pain syndrome (MPS) is a common disorder involving localized or referred pain that originates from trigger points in muscles and fascia. In many cases, its treatment is either inappropriate or delayed, leading to a reduced quality of life for patients. This is due to incomplete comprehension of the mechanisms underlying myofascial pain, the lack of uniform diagnostic criteria, and the absence of standard treatment protocols. This review aims to summarize, systematize, and evaluate the available data on treatment and rehabilitation methods used in clinical practice for patients with MPS. Numerous systematic reviews, meta-analyses, and individual studies were analyzed revealing that pharmacological methods include the oral administration of nonsteroidal anti-inflammatory drugs, opioid analgesics, muscle relaxants, antidepressants, and antiepileptic drugs. Topical anesthetics are also used in these approaches, either in the form of patches or creams; as well as injections into trigger points. Among the physical methods are dry needling, acupuncture, manual therapy, kinesiotherapy, shockwave therapy, electrical muscle stimulation, magnetic stimulation, phototherapy, and ultrasound therapy. As first-line therapy, topical anesthetics combined with non-invasive physical methods can be considered. MPS treatment requires a comprehensive and personalized approach. Positive treatment results and patient recovery depend on rehabilitation measures, particularly regular exercise, psychological support, and a healthy lifestyle.

1. Urits I., Charipova K., Gress K., et al. Treatment and management of myofascial pain syndrome. Best Pract Res Clin Anaesthesiol. 2020; 34 (3): 427–48. https://doi.org/10.1016/j.bpa.2020.08.003.

2. Steen J.P., Jaiswal K.S., Kumbhare D. Myofascial pain syndrome: an update on clinical characteristics, etiopathogenesis, diagnosis, and treatment. Muscle Nerve. 2025; 71 (5): 889–910. https://doi. org/10.1002/mus.28377.

3. Lam C., Francio V.T., Gustafson K., et al. Myofascial pain a major player in musculoskeletal pain. Best Pract Res Clin Rheumatol. 2024; 38 (1): 101944. https://doi.org/10.1016/j.berh.2024.101944.

4. Cao Q.W., Peng B.G., Wang L., et al. Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases. 2021; 9 (9): 2077–89. https://doi.org/10.12998/wjcc.v9.i9.2077.

5. Giamberardino M.A., Affaitati G., Fabrizio A., Costantini R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2011; 25 (2): 185–98. https://doi.org/10.1016/j.berh.2011.01.002.

6. Galasso A., Urits I., An D., et al. A Comprehensive review of the treatment and management of myofascial pain syndrome. Curr Pain Headache Rep. 2020; 24 (8): 43. https://doi.org/10.1007/s11916-02000877-5.

7. Nasirzadeh Y., Ahmed S., Monteiro S., et al. A survey of healthcare practitioners on myofascial pain criteria. Pain Pract. 2018; 18 (5): 631–40. https://doi.org/10.1111/papr.12654.

8. Fricton J. Myofascial pain: mechanisms to management. Oral Maxillofac Surg Clin North Am. 2016; 28 (3): 289–311. https://doi. org/10.1016/j.coms.2016.03.010.

9. Appasamy M., Lam C., Alm J., Chadwick A.L. Trigger point injections. Phys Med Rehabil Clin N Am. 2022; 33 (2): 307–33. https://doi. org/10.1016/j.pmr.2022.01.011.

10. Henneman E., Somjen G., Carpenter D.O. Excitability and inhibitability of motoneurons of different sizes. J Neurophysiol. 1965; 28 (3): 599–620. https://doi.org/10.1152/jn.1965.28.3.599.

11. Gissel H. Ca[2+] accumulation and cell damage in skeletal muscle during low frequency stimulation. Eur J Appl Physiol. 2000; 83 (2–3): 175–80. https://doi.org/10.1007/s004210000276.

12. Simons D.G., Hong C.Z., Simons L.S. Endplate potentials are common to midfiber myofacial trigger points. Am J Phys Med Rehabil. 2002; 81 (3): 212–22. https://doi.org/10.1097/00002060-200203000-00010.

13. Simons D.G. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004; 14 (1): 95–107. https://doi.org/10.1016/j.jelekin.2003.09.018.

14. Gautam M., Benson C.J., Sluka K.A. Increased response of muscle sensory neurons to decreases in pH after muscle inflammation. Neuroscience. 2010; 170 (3): 893–900. https://doi.org/10.1016/j. neuroscience.2010.08.003.

15. Stecco A., Gesi M., Stecco C., Stern R. Fascial components of the myofascial pain syndrome. Curr Pain Headache Rep. 2013; 17 (8): 352. https://doi.org/10.1007/s11916-013-0352-9.

16. Ero ǧ lu P.K., Yilmaz Ö., Bodur H., Ateş C. A comparison of the efficacy of dry needling, lidocaine injection, and oral flurbiprofen treatments in patients with myofascial pain syndrome: a double-blind (for injection, groups only), randomized clinical trial. Arch Rheumatol. 2013; 28 (1): 38–46. https://doi.org/10.5606/tjr.2013.2779.

17. Ma Y.T., Dong Y.L., Wang B., et al. Dry needling on latent and active myofascial trigger points versus oral diclofenac in patients with knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord. 2023; 24 (1): 36. https://doi.org/10.1186/s12891-022-06116-9.

18. Dalewski B., Kamińska A., Szydłowski M., et al. Comparison of early effectiveness of three different intervention methods in patients with chronic orofacial pain: a randomized, controlled clinical trial. Pain Res Manag. 2019; 2019: 7954291. https://doi.org/10.1155/2019/7954291.

19. Abbasi F., Moaddabi A., Beithardan G., et al. Comparing the effects of low-level laser therapy with ibuprofen in improving myofascial pain dysfunction syndrome. Dent Hypotheses. 2021; 12 (3): 124–7. https://doi.org/10.4103/denthyp.denthyp_112_21.

20. Alpaslan C., Kahraman S.A., Durmuslar C., Cula S. Comparative efficacy of four muscle relaxants on signs and symptoms of the myofascial pain syndrome associated with temporomandibular disorders: a randomized clinical trial. J Musculoskelet Pain. 2012; 20 (4): 310–6. https://doi.org/10.3109/10582452.2012.740181.

21. Malanga G., Gwynn M.W., Smith R., Miller D.A. Tizanidine is effective in the treatment of myofascial pain syndrome. Pain Physician. 2002; 5 (4): 422–32.

22. Manfredini D., Romagnoli M., Cantini E., Bosco M. Efficacy of tizanidine hydrochloride in the treatment of myofascial face pain. Minerva Med. 2004; 95 (2): 165–71.

23. Alencar F.G. Jr., Viana P.G., Zamperini C., Becker A. Patient education and self-care for the management of jaw pain upon awakening: a randomized controlled clinical trial comparing the effectiveness of adding pharmacologic treatment with cyclobenzaprine or tizanidine. J Oral Facial Pain Headache. 2014; 28 (2): 119–27. https://doi. org/10.11607/ofph.963.

24. Leite F.M.G., Atallah Á.N., El Dib R., et al. Cyclobenzaprine for the treatment of myofascial pain in adults. Cochrane Database Syst Rev. 2009; 2009 (3): CD006830. https://doi.org/10.1002/14651858. CD006830.pub3.

25. Plesh O., Curtis D., Levine J., McСall W.D. Jr. Amitriptyline treatment of chronic pain in patients with temporomandibular disorders. J Oral Rehabil. 2000; 27 (10): 834–41. https://doi. org/10.1046/j.1365-2842.2000.00572.x.

26. Bendtsen L., Jensen R. Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia. 2000; 20 (6): 603–10. https://doi.org/10.1046/j.1468-2982.2000.00087.x.

27. Haviv Y., Zini A., Sharav Y., et al. Nortriptyline compared to amitriptyline for the treatment of persistent masticatory myofascial pain. J Oral Facial Pain Headache. 2019; 33 (1): 7–13. https://doi. org/10.11607/ofph.1886.

28. Haviv Y., Rettman A., Aframian D., et al. Myofascial pain: an open study on the pharmacotherapeutic response to stepped treatment with tricyclic antidepressants and gabapentin. J Oral Facial Pain Headache. 2015; 29 (2): 144–51. https://doi.org/10.11607/ofph.1408.

29. Tak M.M., Chalkoo A.H. To evaluate the pharmacotherapeutic efficacy of tizanidine hydrochloride and gabapentin in treating myofascial pain-in a stepwise treatment approach. J Evol Med Dent Sci. 2015; 4 (89): 15435–9. https://doi.org/10.14260/jemds/2015/2203.

30. Avrahami D., Hammond A., Higgins C., Vernon H. A randomized, placebo-controlled double-blinded comparative clinical study of five over-the-counter non-pharmacological topical analgesics for myofascial pain: single session findings. Chiropr Man Therap. 2012; 20: 7. https://doi.org/10.1186/2045-709X-20-7.

31. Affaitati G., Fabrizio A., Savini A., et al. A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds. Clin Ther. 2009; 31 (4): 705–20. https://doi.org/10.1016/j.clinthera.2009.04.006.

32. Lin Y.C., Kuan T.S., Hsieh P.C., et al. Therapeutic effects of lidocaine patch on myofascial pain syndrome of the upper trapezius: a randomized, double-blind, placebo-controlled study. Am J Phys Med Rehabil. 2012; 91 (10): 871–82. https://doi.org/10.1097/ PHM.0b013e3182645d30.

33. Iwama H., Ohmori S., Kaneko T., Watanabe K. Water-diluted local anesthetic for trigger-point injection in chronic myofascial pain syndrome: evaluation of types of local anesthetic and concentrations in water. Reg Anesth Pain Med. 2001; 26 (4): 333–6. https://doi. org/10.1053/rapm.2001.24672.

34. Navarro-Santana M.J., Sanchez-Infante J., Gómez-Chiguano G.F., et al. Dry needling versus trigger point injection for neck pain symptoms associated with myofascial trigger points: a systematic review and meta-analysis. Pain Med. 2022; 23 (3): 515–25. https://doi. org/10.1093/pm/pnab188.

35. Nouged E., Dajani J., Ku B., et al. Local anesthetic injections for the short-term treatment of head and neck myofascial pain syndrome: a systematic review with meta-analysis. J Oral Facial Pain Headache. 2019; 33 (2): 183–98. https://doi.org/10.11607/ofph.2277.

36. Ahmed S., Subramaniam S., Sidhu K., et al. Effect of local anesthetic versus botulinum toxin-a injections for myofascial pain disorders. Clin J Pain. 2019; 35 (4): 353–67. https://doi.org/10.1097/ AJP.0000000000000681.

37. Affaitati G., Fabrizio A., Savini A., et al. A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds. Clin Ther. 2009; 31 (4): 705–20. https://doi.org/10.1016/j.clinthera.2009.04.006.

38. Ketenci A., Basat H., Esmaeilzadeh S. The efficacy of topical thiocolchicoside (Muscoril[®] ) in the treatment of acute cervical myofascial pain syndrome: a single-blind, randomized, prospective, phase IV clinical study. Agri. 2009; 21 (3): 95–103.

39. Hammi C., Schroeder J.D., Yeung B. Trigger point injection. Treasure Island (FL): StatPearls Publishing; 2023.

40. Brinks A., Koes B.W., Volkers A.C., et al. Adverse effects of extraarticular corticosteroid injections: a systematic review. BMC Musculoskelet Disord. 2010; 11: 206. https://doi.org/10.1186/14712474-11-206.

41. Matak I., Bölcskei K., Bach-Rojecky L., Helyes Z. Mechanisms of botulinum toxin type a action on pain. Toxins. 2019; 11 (8): 459. https://doi.org/10.3390/toxins11080459.

42. Comella C.L., Jankovic J., Shannon K.M., et al. Comparison of botulinum toxin serotypes A and B for the treatment of cervical dystonia. Neurology. 2005; 65 (9): 1423–9. https://doi.org/10.1212/01. wnl.0000183055.81056.5c.

43. Soares A., Andriolo R.B., Atallah Á.N., da Silva E.M.K. Botulinum toxin for myofascial pain syndromes in adults. Cochrane Database Syst Rev. 2014; 2014 (7): CD007533. https://doi.org/10.1002/14651858. CD007533.pub3.

44. Abboud W.A., Hassin-Baer S., Joachim M., et al. Localized myofascial pain responds better than referring myofascial pain to botulinum toxin injections. Int J Oral Maxillofac Surg. 2017; 46 (11): 1417–23. https://doi.org/10.1016/j.ijom.2017.04.020.

45. De Venancio R.A., Alencar F.G.P. Jr., Zamperini C. Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2009; 27 (1): 46–53. https://doi.org/10.1179/ crn.2009.008.

46. Kamanli A., Kaya A., Ardicoglu O., et al. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int. 2004; 25 (8): 604–11. https://doi.org/10.1007/s00296-004-0485-6.

47. Graboski C.L., Shaun Gray D., Burnham R.S. Botulinum toxin A versus bupivacaine trigger point injections for the treatment of myofascial pain syndrome: a randomised double blind crossover study. Pain. 2005; 118 (1–2): 170–5. https://doi.org/10.1016/j.pain.2005.08.012.

48. Khalifeh M., Mehta K., Varguise N., et al. Botulinum toxin type A for the treatment of head and neck chronic myofascial pain syndrome: a systematic review and meta-analysis. J Am Dent Assoc. 2016; 147 (12): 959–73.e1. https://doi.org/10.1016/j.adaj.2016.08.022.

49. Borg-Stein J., Iaccarino M.A. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014; 25 (2): 357–74. https://doi. org/10.1016/j.pmr.2014.01.012.

50. Unverzagt C., Berglund K., Thomas J.J. Dry needling for myofascial trigger point pain: a clinical commentary. Int J Sports Phys Ther. 2015; 10 (3): 402–18.

51. Finnoff J.T., Hurdle M.F.B., Smith J. Accuracy of ultrasound-guided versus fluoroscopically guided contrast-controlled piriformis injections: a cadaveric study. J Ultrasound Med. 2008; 27 (8): 1157–63. https://doi.org/10.7863/jum.2008.27.8.1157.

52. Kietrys D.M., Palombaro K.M., Azzaretto E., et al. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013; 43 (9): 620–34. https://doi.org/10.2519/jospt.2013.4668.

53. Liu L., Huang Q.M., Liu Q.G., et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2015; 96 (5): 944–55. https://doi.org/10.1016/j.apmr.2014.12.015.

54. Navarro-Santana M.J., Sanchez-Infante J., Fernández-de-las-Peñas C., et al. Effectiveness of dry needling for myofascial trigger points associated with neck pain symptoms: an updated systematic review and meta-analysis. J Clin Med. 2020; 9 (10): 3300. https://doi. org/10.3390/jcm9103300.

55. Ramaswamy P., Saikiran C.H., Swathi M., et al. An evaluation of wet and dry needling techniques for treating myofascial pain in trapezius muscle a meta-analysis. Saudi J Oral Sci. 2024; 11 (2): 84–90. https://doi.org/10.4103/sjoralsci.sjoralsci_14_24.

56. Ga H., Koh H.J., Choi J.H., Kim C.H. Intramuscular and nerve root stimulation vs lidocaine: Injection to trigger points in myofascial pain syndrome. J Rehabil Med. 2007; 39 (5): 374–8. https://doi. org/10.2340/16501977-0058.

57. Ay S., Evcik D., Tur B.S. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol. 2009; 29 (1): 19–23. https://doi.org/10.1007/s10067-009-1307-8.

58. Lin J.G., Kotha P., Chen Y.H. Understandings of acupuncture application and mechanisms. Am J Transl Res. 2022; 14 (3): 1469–81.

59. Furlan A.D., van Tulder M.W., Cherkin D., et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev. 2005; 2005 (1): CD001351. https://doi.org/10.1002/14651858.cd001351.pub2.

60. Peloso P.M., Gross A., Haines T., et al. Medicinal and injection therapies for mechanical neck disorders. Cochrane Database Syst Rev. 2007; 3: CD000319. https://doi.org/10.1002/14651858.CD000319. pub4.

61. Zhang R., Wen S.Y., Zhan H.S., et al. Acupuncture for lumbar myofascial pain syndrome: systematic review and meta-analysis. Zhongguo Zhen Jiu. 2023; 43 (11): 1324–32. https://doi. org/10.13703/j.0255-2930.20221120-0002.

62. Birch S., Jamison R.N. Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. Clin J Pain. 1998; 14 (3): 248–55. https://doi. org/10.1097/00002508-199809000-00012.

63. Wang R., Li X., Zhou S., et al. Manual acupuncture for myofascial pain syndrome: a systematic review and meta-analysis. Acupunct Med. 2017; 35 (4): 241–50. https://doi.org/10.1136/acupmed-2016-011176.

64. Lim S. WHO standard acupuncture point locations. Evid Based Complement Alternat Med. 2010; 7 (2): 167–8. https://doi.org/10.1093/ ecam/nep006.

65. de Melo L.A., Bezerra de Medeiros A.K., De Fátima M., et al. Manual therapy in the treatment of myofascial pain related to

66. temporomandibular disorders: a systematic review. J Oral Facial Pain Headache. 2020; 34 (2): 141–8. https://doi.org/10.11607/ofph.2530.

67. Lew J., Kim J., Nair P. Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis. J Man Manip Ther. 2021; 29 (3): 136–46. https://doi.org/10.1080/10669817.2020. 1822618.

68. Müggenborg F., de Castro Carletti E.M., Dennett L., et al. Effectiveness of manual trigger point therapy in patients with myofascial trigger points in the orofacial region a systematic review. Life. 2023; 13 (2): 336. https://doi.org/10.3390/life13020336.

69. Zhang X.F., Liu L., Wang B.B., et al. Evidence for kinesio taping in management of myofascial pain syndrome: a systematic review and meta-analysis. Clin Rehabil. 2019; 33 (5): 865–74. https://doi. org/10.1177/0269215519826267.

70. Cheng J.H., Wang C.J. Biological mechanism of shockwave in bone. Int J Surg. 2015; 24 (6): 143–6. https://doi.org/10.1016/j.ijsu.2015.06.059.

71. Ramon S., Gleitz M., Hernandez L., Romero L.D. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia. Int J Surg. 2015; 24: 201–6. https://doi. org/10.1016/j.ijsu.2015.08.083.

72. Király M., Bender T., Hodosi K. Comparative study of shockwave therapy and low-level laser therapy effects in patients with myofascial pain syndrome of the trapezius. Rheumatol Int. 2018; 38 (11): 2045–52. https://doi.org/10.1007/s00296-018-4134-x.

73. Zhang Q., Fu C., Huang L., et al. Efficacy of extracorporeal shockwave therapy on pain and function in myofascial pain syndrome of the trapezius: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2020; 101 (8): 1437–46. https://doi.org/10.1016/j. apmr.2020.02.013.

74. Jun J.H., Park G.Y., Chae C.S., Suh D.C. The effect of extracorporeal shock wave therapy on pain intensity and neck disability for patients with myofascial pain syndrome in the neck and shoulder: a metaanalysis of randomized controlled trials. Am J Phys Med Rehabil. 2021; 100 (2): 120–9. https://doi.org/10.1097/PHM.0000000000001493.

75. Avendaño-López C., Megía-García Á., Beltran-Alacreu H., et al. Efficacy of extracorporeal shockwave therapy on pain and function in myofascial pain syndrome a systematic review and meta-analysis of randomized clinical trials. Am J Phys Med Rehabil. 2024; 103 (2): 89–98. https://doi.org/10.1097/PHM.0000000000002286.

76. Azatcam G., Atalay N.S., Akkaya N., et al. Comparison of effectiveness of transcutaneous electrical nerve stimulation and kinesio taping added to exercises in patients with myofascial pain syndrome. J Back Musculoskelet Rehabil. 2017; 30 (2): 291–8. https://doi.org/10.3233/ BMR-150503.

77. Ardiç F., Sarhus M., Topuz O. Comparison of two different techniques of electrotherapy on myofascial pain. J Back Musculoskelet Rehabil. 2002; 16 (1): 11–6. https://doi.org/10.3233/BMR-2002-16103.

78. Smania N., Corato E., Fiaschi A., et al. Repetitive magnetic stimulation: a novel therapeutic approach for myofascial pain syndrome. J Neurol. 2005; 252 (3): 307–14. https://doi.org/10.1007/s00415-005-0642-1.

79. He P., Fu W., Shao H., et al. The effect of therapeutic physical modalities on pain, function, and quality of life in patients with myofascial pain syndrome: a systematic review. BMC Musculoskelet Disord. 2023; 24 (1): 376. https://doi.org/10.1186/s12891-023-06418-6.

80. Toopchizadeh V., Izadseresht B., Eftekharsadat B., et al. Effectiveness of transcutaneous electrical nerve stimulation (TENS) modality for treating myofascial pain syndrome: a systematic review and metaanalysis. J Res Clin Med. 2024; 12 (1): 14. https://doi.org/10.34172/ jrcm.32240.

81. Farina S., Casarroto M., Benelle M., et al. A randomized controlled study on the effec myofascialt of two different treatments (FREMS and TENS) in pain syndrome. Eura Medicophys. 2004; 40 (4): 293–301.

82. Pujol J., Pascual-Leone A., Dolz C., et al. The effect of repetitive magnetic stimulation on localized musculoskeletal pain. Neuroreport. 1998; 9 (8): 1745–8. https://doi.org/10.1097/00001756-19980601000014.

83. Dompe C., Moncrieff L., Matys J., et al. Photobiomodulation underlying mechanism and clinical applications. J Clin Med. 2020; 9 (6): 1724. https://doi.org/10.3390/jcm9061724.

84. Zamani A.R.N., Saberianpour S., Geranmayeh M.H., et al. Modulatory effect of photobiomodulation on stem cell epigenetic memory: a highlight on differentiation capacity. Lasers Med Sci. 2019; 35 (2): 299–306. https://doi.org/10.1007/s10103-019-02873-7.

85. Gomes Fagundes M., dos Santos Albuquerque J.R., Santos Silva E.J., et al. The effects of low-level laser in the treatment of myofascial pain syndrome: systematic review. Br J Pain. 2023; 6 (s1): 83–9. https://doi. org/10.5935/2595-0118.20230014-en.

86. Tehrani M.R., Nazary-Moghadam S., Zeinalzadeh A., et al. Efficacy of low-level laser therapy on pain, disability, pressure pain threshold, and range of motion in patients with myofascial neck pain syndrome: a systematic review and meta-analysis of randomized controlled trials. Lasers Med Sci. 2022; 37 (9): 3333–41. https://doi.org/10.1007/s10103022-03626-9.

87. Magri L.V., Carvalho V.A., Rodrigues F.C.C., et al. Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain. Lasers Med Sci. 2017; 32 (2): 419–28. https://doi.org/10.1007/s10103-016-2138-x.

88. Lai C.H., Leung T.K., Peng C.W, et al. Effects of far-infrared irradiation on myofascial neck pain: a randomized, double-blind, placebocontrolled pilot study. J Altern Complement Med. 2014; 20 (2): 123–9. https://doi.org/10.1089/acm.2013.0122.

89. Lai Y.T., Chan H.L., Lin S.H., et al. Far-infrared ray patches relieve pain and improve skin sensitivity in myofascial pain syndrome: a doubleblind randomized controlled study. Complement Ther Med. 2017; 35: 127–32. https://doi.org/10.1016/j.ctim.2017.10.007.

90. Hashish I., Hai H.K., Harvey W., et al. Reduction of postoperative pain and swelling by ultrasound treatment: a placebo effect. Pain. 1988; 33 (3): 303–11. https://doi.org/10.1016/03043959(88)90289-8.

91. Ilter L., Dilek B., Batmaz I., et al. Efficacy of pulsed and continuous therapeutic ultrasound in myofascial pain syndrome: a randomized controlled study. Am J Phys Med Rehabil. 2015; 94 (7): 547–54. https://doi.org/10.1097/PHM.0000000000000210.

92. Baltazar M.C.D.V., Russo J.A.O., De Lucca V., et al. Therapeutic ultrasound versus injection of local anesthetic in the treatment of women with chronic pelvic pain secondary to abdominal myofascial syndrome: a randomized clinical trial. BMC Womens Health. 2022; 22 (1): 325. https://doi.org/10.1186/s12905-022-01910-y.