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The Science

The Science

A reading list of published research on muscle and soft tissue as a source of chronic pain.

Clinical studies

  1. Failure to diagnose pain of muscular origin leads to unnecessary surgery

    Marcus NJ. Pain Medicine. 2002;3(2):161-166.

    Three case reports describe patients whose planned surgeries were canceled after muscle-directed treatment relieved their pain. Case reports cannot establish how often this outcome occurs.

    doi:10.1046/j.1526-4637.2002.02020.x

  2. A comprehensive protocol to diagnose and treat pain of muscular origin may successfully and reliably decrease or eliminate pain in a chronic pain population

    Marcus NJ, Gracely EJ, Keefe KO. Pain Medicine. 2010;11(1):25-34.

    doi:10.1111/j.1526-4637.2009.00752.x

  3. A preliminary study to determine if a muscle pain protocol can produce long-term relief in chronic back pain patients

    Marcus NJ, Shrikhande AA, McCarberg B, Gracely E. Pain Medicine. 2013;14(8):1212-1221.

    A retrospective analysis of 56 patients reported sustained improvement after a muscle pain protocol. Patients had persistent pain despite previous treatment, including surgery in some cases. The findings are preliminary and require controlled validation.

    doi:10.1111/pme.12144

Reviews, commentary, and history

  1. Is it time to consider soft tissue as a pain generator in nonspecific low back pain?

    Hansen AE, Marcus NJ. Commentary. Pain Medicine. 2016;17(11):1969-1970.

    A commentary on muscles and soft tissue as overlooked sources of chronic back pain, drawing on historical and modern evidence.

    doi:10.1093/pm/pnw204

  2. Muscle pain: pathophysiology, evaluation, and treatment

    Marcus NJ, Mense S. In: Bajwa ZH, Wootton RJ, Warfield CA, eds. Principles and Practice of Pain Medicine. 3rd ed. McGraw-Hill Education; 2017:535-554.

    A textbook chapter on the biological mechanisms behind muscle pain, including the role of sensitized nociceptors and entheses.

  3. Soft tissue: a possible source of pain pre and post minimally invasive spine surgery

    Marcus NJ, Schmidt FA. Global Spine Journal. 2020;10(2).

    doi:10.1177/2192568219879114

  4. The reintroduction of an exercise program to directly treat low back pain of muscular origin

    Kraus H, Marcus NJ. Journal of Back and Musculoskeletal Rehabilitation. 1997;8(2):95-107.

  5. How and why Hans Kraus, MD, helped President Kennedy's back pain

    Hansen AE, Marcus NJ. Letter to the editor. Journal of Neurosurgery: Spine. 2018;28(6):688-690.

    How Dr. Hans Kraus treated President Kennedy's back pain with a muscle-based rehabilitation program.

    doi:10.3171/2017.9.SPINE17838
Review the clinical evidence