Deep fascia as a potential source of pain: A narrative review

Background: The fascial component of the myofascial pain syndrome and the contribution of the deep fascia to various painful conditions has not been well-described and is still less understood. Objectives: The aims of this study were to evaluate the possible role of the deep fascia on musculoskeletal pain, focusing on findings from histological and experimental studies; and to assess the nociceptive and associated responses of the deep fascia to experimentally-induced irritation. Methods: Narrative review of the English scientific literature. Results and conclusions: Different components of the deep fascia, both in humans and animals are richly innervated, with some differences between body segments. These fascial components usually exhibit dense innervation, encompassing amongst others, nociceptive afferents. The application of different types of stimuli, i.e., electrical, mechanical, and chemical to these fascial components produces long-lasting pain responses. In some cases, the intensity and severity of pain produced by the stimulation of fascia were higher than ones produced by the stimulation of the related muscular tissue. These observations may denote that the deep fascia and its various components could be a source of pain in different pathologies and various pain syndromes.