Objective: To compare cervical dystonia (CD) and cervical myofascial pain syndrome (cMPS) and evaluate whether these conditions represent distinct disorders or points along a shared neurological spectrum.

Background: CD and cMPS are causes of neck pain that often present with overlapping clinical features, creating diagnostic challenges. CD is characterized by involuntary muscle contractions producing abnormal postures and movements, whereas cMPS is defined by regional muscle pain associated with myofascial trigger points. Although traditionally viewed and managed as separate entities, our clinical experience in the neurological subspecialties of movement disorders and pain management suggests a potential overlap in presentation and mechanisms.

Method: A systematic review of the literature was performed using PubMed, ScienceDirect, Wiley Online Library, SpringerLink, Oxford Academic, and Taylor & Francis. Studies published since 1990 discussing CD, cMPS, or both were screened. Of 120 articles identified, 78 met inclusion criteria and 65 were selected for analysis, including reviews, observational studies, meta-analyses, and randomized trials.

Results: CD is a well-defined movement disorder, whereas cMPS is diagnostically heterogeneous. The literature demonstrates that both conditions share key features including chronic neck pain, increased muscle activity on electromyography, and restricted movement. CD is characterized by involuntary muscle contractions leading to dystonic postures, sensory tricks and sometimes tremor, whereas cMPS is defined by localized trigger points and regional pain. Mechanistically, CD is considered to be a motor network dysfunction involving the basal ganglia, cerebellum, and sensorimotor pathways, whereas cMPS is often considered a disorder of peripheral nociception. Comparatively, cMPS remains less well characterized in terms of diagnostic criteria and mechanism.

Conclusion: Despite differing diagnostic frameworks, CD and cMPS share clinical and neurophysiologic features suggesting they may represent related manifestations along a spectrum of neurological dysfunction rather than entirely separate disorders. Recognizing this potential overlap may improve diagnostic accuracy and inform integrated treatment approaches. Further research is needed to clarify this relationship and to identify biomarkers to distinguish overlapping phenotypes of chronic cervical pain.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/rethinking-the-divide-are-cervical-dystonia-and-myofascial-pain-two-sides-of-the-same-coin/