Relación entre el estrés psicosocial y el síndrome de dolor miofascial: revisión sistemática narrativa de la literatura científica

• Autores: Andrea Fumanal Escartín, Patricia Costa Rodriguez, Ana María Lascorz Goicoechea, Teresa Sierra Pascual, Ignacio Conde Arias, Raquel Magaz Montaner
• Localización: Revista Sanitaria de Investigación, ISSN-e 2660-7085, Vol. 6, Nº. 9, 2025
• Idioma: español
• Enlaces
  • Texto completo
• Resumen
  • español

    Objetivo: sintetizar la relación entre el estrés psicosocial y el síndrome de dolor miofascial (SDM), describiendo mecanismos fisiopatológicos, evidencia clínica y consideraciones terapéuticas.

    Métodos: revisión sistemática narrativa (PRISMA 2020) de estudios publicados entre 2010–2025 en PubMed, Scopus y PsycINFO. Se incluyeron ensayos clínicos, estudios observacionales y revisiones sistemáticas que analizaron el vínculo entre estrés (psicológico o laboral), marcadores neuroendocrinos (p. ej., cortisol) y SDM, así como intervenciones multimodales que combinaron fisioterapia con estrategias de manejo del estrés.

    Resultados: los estudios observacionales muestran asociaciones consistentes entre altos niveles de estrés y mayor prevalencia o intensidad del dolor miofascial. La literatura mecanística indica que la activación crónica del eje hipotálamo‑hipófisis‑adrenal y del sistema simpático favorece hiperalgesia, hiperactividad muscular y sensibilización central. Los ensayos clínicos sugieren que el abordaje multimodal que integra fisioterapia (técnicas manuales, ejercicio, educación) con manejo del estrés (relajación, mindfulness o terapia cognitivo‑conductual) consigue mayores reducciones del dolor e incapacidad que la fisioterapia aislada, con mejoras concomitantes en ansiedad y calidad de vida.

    Conclusiones: el estrés actúa como factor precipitante y perpetuante del SDM. Un enfoque biopsicosocial e integrativo parece aportar beneficios clínicamente relevantes. Se requieren ensayos multicéntricos con protocolos estandarizados y seguimiento prolongado para precisar magnitud de efecto, biomarcadores de respuesta y coste‑efectividad.

  • English

    Objective: To synthesize the relationship between psychosocial stress and myofascial pain syndrome (MPS), covering pathophysiological mechanisms, clinical evidence and therapeutic implications.

    Methods: Narrative systematic review (PRISMA 2020) of studies published 2010–2025 in PubMed, Scopus and PsycINFO. Randomized trials, observational studies and systematic reviews were included if they assessed the link between stress (psychological/occupational), neuroendocrine markers (e.g., cortisol) and MPS, and/or multimodal interventions combining physiotherapy with stress‑management strategies.

    Results: Observational evidence consistently shows associations between higher stress and greater prevalence or intensity of myofascial pain. Mechanistic literature indicates that chronic activation of the hypothalamic‑pituitary‑adrenal axis and sympathetic system promotes hyperalgesia, muscle overactivity and central sensitization. Randomized trials suggest that multimodal approaches integrating physiotherapy (manual therapy, exercise, education) with stress‑management (relaxation, mindfulness, cognitive‑behavioral therapy) provide larger reductions in pain and disability than physiotherapy alone, alongside improvements in anxiety and quality of life.

    Conclusions: Stress operates as both a trigger and a perpetuating factor for MPS. A biopsychosocial, integrated approach appears clinically beneficial. Larger standardized RCTs with longer follow‑up are needed to refine effect sizes, biomarkers of response and cost‑effectiveness.

• Referencias bibliográficas
  • Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. Baltimore: Williams...
  • Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep. 2001,5(5):412‑420.
  • McEwen BS. Stress, adaptation, and disease. Allostasis and allostatic load. Ann N Y Acad Sci. 1998,840:33‑44.
  • Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009,5(7):374‑381.
  • Yunus MB. Central sensitivity syndromes: a new paradigm for fibromyalgia and overlapping conditions. Semin Arthritis Rheum. 2008,37(6):339‑352.
  • Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions....
  • Flor H, Turk DC. Chronic back pain and maladaptive pain‑related cognitions. Behav Ther. 1988,19(4):597‑607.
  • Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 2002,70(3):678‑690.
  • Tough EA, White AR, Richards S, Campbell J. Reliability of clinical examination in the diagnosis of myofascial trigger points: a systematic...
  • Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004,8(6):468‑475.
  • Sapolsky RM. Stress hormones: good and bad. Neurobiol Dis. 2000,7(5):540‑542.
  • Ulrich‑Lai YM, Herman JP. Neural regulation of endocrine and autonomic stress responses. Nat Rev Neurosci. 2009,10(6):397‑409.
  • Hubbard DR, Berkoff GM. Myofascial trigger points show spontaneous needle EMG activity. Spine. 1993,18(13):1803‑1807.
  • Shah JP, Phillips TM, Danoff JV, Gerber LH. Biochemicals associated with pain and inflammation are elevated near active myofascial trigger...
  • Nijs J, Torres‑Cueco R, van Wilgen CP, Girbes EL, Struyf F, Roussel N, et al. Applying modern pain neuroscience in clinical practice: criteria...
  • Fernández‑de‑las‑Peñas C, Dommerholt J, Gerwin RD. Manual therapies in myofascial trigger point treatment: a systematic review. J Bodyw Mov...
  • Hou CR, Tsai LC, Cheng KF, Chung KC, Hong CZ. Immediate effects of various physical therapeutic modalities on pain threshold of an active...
  • Moraska A, Pollini RA, Boulanger K, Brooks M. Physiological adjustments to stress measures following massage therapy: a review. Evid Based...
  • Sharan D, Ajeesh PS, Rameshkumar R, Manjula M. Effect of psychophysiological relaxation on chronic musculoskeletal pain: randomized controlled...
  • Busch AJ, Barber KA, Overend TJ, Peloso PMJ, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2007,(4):CD003786.
  • Koenig J, Jarczok MN, Ellis RJ, Hillecke TK, Thayer JF. Vagal activity and pain: association of reduced heart rate variability with impaired...
  • Dommerholt J, Fernández‑de‑las‑Peñas C. Trigger Point Dry Needling: An Evidence and Clinical‑Based Approach. 2nd ed. Philadelphia: Elsevier,...