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An additional group was treated with morphine in the trapezius muscle to evaluate the systemic effect of morphine that may reduce pain in the masseter muscle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was a significant difference in<jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content>scores between the morphine 5\u00a0mg group and the saline group favoring morphine, but not between the morphine 5\u00a0mg and lidocaine. Morphine 1.5 and 5\u00a0mg treatments led to consistently and significantly elevated<jats:styled-content style=\"fixed-case\">PPT<\/jats:styled-content>and<jats:styled-content style=\"fixed-case\">PP<\/jats:styled-content>tol measures in men, but not in women. Morphine administered in the trapezius muscle did not affect the outcome measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A single dose intramuscular morphine produced analgesic effects up to 48\u00a0hr in patients with myofascial pain. Intramuscular morphine elevated mechanical pain threshold and tolerance in the masseter only in male patients, suggesting sex differences in local morphine effects. 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