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¹ Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia jqu33431@bigpond.net.au.

² Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia.

¹ Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia jqu33431@bigpond.net.au.

² Rheumatology and Pain Medicine, Mount Claremont, Perth, Western Australia, University of New England, College of Osteopathic Medicine, Biddeford, Maine, USA and Pain Medicine and Rheumatology, St Vincent's Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia.

The theory of myofascial pain syndrome (MPS) caused by trigger points (TrPs) seeks to explain the phenomena of muscle pain and tenderness in the absence of evidence for local nociception. Although it lacks external validity, many practitioners have uncritically accepted the diagnosis of MPS and its system of treatment. Furthermore, rheumatologists have implicated TrPs in the pathogenesis of chronic widespread pain (FM syndrome). We have critically examined the evidence for the existence of myofascial TrPs as putative pathological entities and for the vicious cycles that are said to maintain them. We find that both are inventions that have no scientific basis, whether from experimental approaches that interrogate the suspect tissue or empirical approaches that assess the outcome of treatments predicated on presumed pathology. Therefore, the theory of MPS caused by TrPs has been refuted. This is not to deny the existence of the clinical phenomena themselves, for which scientifically sound and logically plausible explanations based on known neurophysiological phenomena can be advanced. Quintner J, et al. Rheumatology (Oxford). 2015 Jun;54(6):1127-8. doi: 10.1093/rheumatology/kev095. Epub 2015 Mar 31. Rheumatology (Oxford). 2015. PMID: 25832608 Rathbone A, et al. Rheumatology (Oxford). 2015 Jun;54(6):1126-7. doi: 10.1093/rheumatology/kev028. Epub 2015 Mar 31. Rheumatology (Oxford). 2015. PMID: 25832612 Chaitow L. J Bodyw Mov Ther. 2015 Apr;19(2):191-2. doi: 10.1016/j.jbmt.2015.01.008. Epub 2015 Jan 31. J Bodyw Mov Ther. 2015. PMID: 25892371 Dommerholt J, et al. J Bodyw Mov Ther. 2015 Apr;19(2):193-204. doi: 10.1016/j.jbmt.2015.01.009. Epub 2015 Feb 4. J Bodyw Mov Ther. 2015. PMID: 25892372 Quintner JL, et al. J Bodyw Mov Ther. 2015 Jul;19(3):394-5. doi: 10.1016/j.jbmt.2015.02.008. Epub 2015 Feb 27. J Bodyw Mov Ther. 2015. PMID: 26118507 Bron C, et al. Curr Pain Headache Rep. 2012 Oct;16(5):439-44. doi: 10.1007/s11916-012-0289-4. Curr Pain Headache Rep. 2012. PMID: 22836591 Free PMC article. Review. Fernández-de-Las-Peñas C, et al. Pain Manag. 2016 May;6(4):401-8. doi: 10.2217/pmt-2016-0013. Epub 2016 Jun 14. Pain Manag. 2016. PMID: 27296946 Schneider MJ. J Manipulative Physiol Ther. 1995 Jul-Aug;18(6):398-406. J Manipulative Physiol Ther. 1995. PMID: 7595112 Fernández-de-Las-Peñas C. Curr Pain Headache Rep. 2015 Jul;19(7):28. doi: 10.1007/s11916-015-0503-2. Curr Pain Headache Rep. 2015. PMID: 26049772 Quintner JL, et al. Clin J Pain. 1994 Sep;10(3):243-51. doi: 10.1097/00002508-199409000-00012. Clin J Pain. 1994. PMID: 7833584 Quintner J, et al. Korean J Pain. 2025 Apr 1;38(2):213-214. doi: 10.3344/kjp.25007. Korean J Pain. 2025. PMID: 40159941 Free PMC article. Ameloot B, et al. Chiropr Man Therap. 2016 Jul 4;24:20. doi: 10.1186/s12998-016-0101-3. eCollection 2016. Chiropr Man Therap. 2016. PMID: 27379178 Free PMC article. Wada JT, et al. Biomed Res Int. 2020 Jan 22;2020:9240581. doi: 10.1155/2020/9240581. eCollection 2020. Biomed Res Int. 2020. PMID: 32076620 Free PMC article. Bo K, et al. Int Urogynecol J. 2017 Feb;28(2):191-213. doi: 10.1007/s00192-016-3123-4. Epub 2016 Dec 5. Int Urogynecol J. 2017. PMID: 27921161