To the Editor.—
The report in TRENDS IN THERAPY by Burnell R. Brown, Jr, MD, PhD, "Diagnosis and Therapy of Common Myofascial Syndromes" (239:646-648, 1978), was interesting but also provocative. The author defines myofascial syndrome describing certain diagnostic criteria that also would apply equally to conversion reaction and malingering. Unfortunately, no method is presented to help differentiate these diagnostic categories from the myofascial syndrome.Dr Brown recommends injection with water-soluble steroid and indicates that repetitive injections are given into various parts of the body over a considerable period of time. Although certain complications such as toxic reaction and inadvertent block of cervical nerve are mentioned, Dr Brown does not indicate whether any reactions were seen from over-dosage with steroid (Cushing-like disorders). Unfortunately, I have seen several Cushing complications from repetitive steroid injections of "trigger areas."Also, since the author had the advantage of reviewing 500 cases, one wonders whether any
Bernstein J. Diagnosis and Therapy of Myofascial Syndrome. JAMA. 1978;239(24):2549. doi:10.1001/jama.1978.03280510033006
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