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This article examines the economic and human costs of muscle pain and the role of biofeedback in treating chronic muscle pain. The article reviews the physiology of the musculature and the myofascial mantle and the contributions of physiological dysfunction to pain. The article critiques the relaxation model as an inadequate foundation for biofeedback treatment of pain and calls for more comprehensive education for biofeedback practitioners in muscle physiology yet emphasizes the promise of surface electromyographic treatment for chronic pain and for opioid abuse, when the muscle biofeedback intervention is well informed by medical and physiological knowledge. Medical factors that commonly contribute to pain are examined, along with a number of preventable sources for poor outcomes for muscle biofeedback treatment.