Iliocostalis Thoracis-Lumborum Myofascial
Pain: Reviewing a Subgroup of a Prospective,
Randomized, Blinded Trial. A Challenging
Diagnosis with Clinical Implications
Authors: Roldan Carlos J. 
Published: February 2021

Background: Pain of myofascial origin is a well-recognized pathology characterized by the presence
of two components: referred pain; which is often distant from its source and specific to each muscle,
and the trigger point, a localized hyperirritable band present in the affected muscle and able to
reproduce the referred pain when stimulated. Myofascial pain (MP) commonly coexists in patients
with acute or chronic pain of other etiologies. The uniqueness of the clinical presentation of some MPs
and the lack of training of most specialties represent a clinical challenge. Thus, many patients with
MPS receive less than optimal management of this condition.
Objective: Pain at the anterior torso, originating at the posterior torso, can mimic common pathologies
that correlate with the same anatomical area such as cardiac and intra-abdominal conditions. These clinical
characteristics could be caused by MP of the iliocostalis thoracis-lumborum (ITL) muscle. However, this entity
has not been well addressed in the medical literature. In this report we characterize the manifestations,
diagnosis, and clinical implications of ITL MP.
Study Design: Observational assessment.
Setting: Two university-based academic emergency medicine departments (ED) in an urban setting
in the United States.
Methods: A convenience sample of 43 patients who presented to the ED with pain at the anterior aspect
of the torso (chest, abdomen, or pelvis) and clinical evidence of MP originated in the ITL muscle.
Of a clinical trial of patients with MP, we describe a subgroup of patients with MP of the ITL which was
clinically evident by the presence of a trigger point (TP) in its ability to reproduce the referred pain present at
the anterior aspect of the torso. Patients received a TP injection. In this trial we intend to demonstrate that
TP injections using particulate steroids mixed with a local are no more effective than saline alone to treat
MP. The primary outcome was pain control (decrease in intensity of 50% or more below baseline numeric
pain rating). A follow-up telephone interview was performed by third-party abstractors.
Results: Forty-three patients presented with pain of the anterior torso and ipsilateral back, both
correlating with the level of the TP of the ITL muscle. The pain had been present from 2 days to 7
years. The most common locations of pain were the right-lower quadrant and the left side of the
chest. In many of them a pattern of missed diagnosis was evident despite extensive workups and
consultations. Only 17 patients were able to identify the precipitating event; the most common was
coughing. Two weeks after TP injection, all patients still had satisfactory pain control. After treatment,
no missed pathology or returns to the ED were reported.
Limitations: This descriptive portion of the ongoing study does not affect the integrity of the
trial itself but could be subject to the introduction of subject selection and selective reporting bias.
Similarly, this convenience sample does not establish the incidence of this pathology and challenges
the external validity to other clinical settings.
Conclusions: Anterior torso pain often resulted in extensive workups before ITL myofascial pain was
diagnosed. TP injections were diagnostic and therapeutic of ITL myofascial pain.
Key words: Iliocostalis thoracis-lumborum muscle, myofascial pain, referred pain, trigger point injection