Excerpted from Fibromyalgia and Chronic Myofascial Pain Syndrome: A Survival Manual by Devin J. Starlanyl and Mary Ellen Copeland and The Fibromyalgia Advocate by Devin J. Starlanyl © copyright, the authors. All rights reserved.
Please be aware that we cannot hope to put all the information from ours and several other books for patients on these disorders. Please get additional information from one of these sources. We have listed some in the bibliography.
 

 

Definitions
 

It's important for people with FMS and CMP to take on the responsibility of managing their own treatment.
It isn't easy, and it takes concentrated focus to change the habits of a lifetime. Getting as well as possible -- optimizing your quality of life -- takes commitment. What is done to or for you can help, but getting better is primarily a function of what YOU do.

The first step is gaining knowledge.

Sheet for Companions
This is a page of information about FMS and CMP for family, friends and co-workers.
 

Myofascia
The myofascia is the largest organ system of the body. It gives the body shape and texture, and connects one part to the other, allowing movement.
 

FMS
Fibromyalgia is a dysfunction of the biochemical informational substances (neurotransmitters, hormones, peptides, etc.) and is non-degenerative, non-progressive, non-inflammatory, pain amplification disorder. It is systemic and biochemical in nature.
 

Trigger Points (TrPs )
TrPs are extremely painful areas of tight myofascia, occurring in lumps and ropy bands, which refer pain and autonomic symptoms in characteristic patterns. It is neuromuscular and mechanical in nature.
 

Tender Points
Tender points are painful areas in FMS which do not refer pain elsewhere.
 

Chronic Myofascial Pain (CMP)
Chronic, body-wide TrPs of long duration, due to the development of secondary and satellite TrPs in a TrP cascade.
 

FMS and CMP
Interconnecting spiral of fibromyalgia and myofascial pain syndrome. These conditions perpetuate each other and feed on each other, and make treatment difficult. 

Chronic Myofascial Pain
Here is an example of how TrPs can spread:  You work at a desk alongside an air conditioning vent, and the cold air blows directly on your neck on your right side.  This constant chilling of your muscle stresses your scalene muscles (Chapter 8) on the right side of your neck.  TrPs in the scalenes cause you to tilt your head slightly, setting up stress on the left side of your neck trying to compensate for the unequal weight distribution.  This develops secondary TrPs on the left side of your neck, and may cause more TrPs on the right as well, as other muscles try to take up the slack caused by the weak scalenes.   Stresses caused by pain in the referral pattern of the right scalenes cause levator scapulae TrPs to develop on the right, causing a stiff neck on that side.  Your shoulder hitches up on that side, because it hurts to lengthen the muscles. The muscles on the left abdominal area under the ribs are compressed, and you develop secondary latissimus dorsi TrPs on that side.  These TrPs cause you to breath in a shallower pattern, setting up TrPs in the other respiratory muscles.  Your spine develops a twist to protect these painful muscles, as the lower spine twists one way and the upper spine twists the other way.   This is called rotoscoliosis, which activates a compensatory anterior rotation of your pelvis. This process can continue until your entire body is covered with TrPs.  

 

Sensitization of autonomic nerves in the myofascial TrP can be the cause of autonomic nervous system symptoms.  Autonomic dysfunctions include abnormal sweating, tearing of the eye, persistent runny nose, excessive salivation, and goose bumps on your skin.   TrPs may also have related  proprioceptive disturbances.  Proprioceptors are receptors that are concerned with your spatial awareness.  This includes where you are in relation to objects in the world around you, as well as the relationships between one part of your body and another.  Proprioceptor dysfunctions can include imbalance, dizziness, ringing in your ears, and a distorted weight perception of objects you pick up.  

 

Central TrPs are usually in the belly of muscle, where the motor endplates lie.  They cause local tenderness, referred pain, altered sensation, referred motor dysfunction, and referred autonomic changes due to sensitization of local nerves and induced central nervous system changes.

 

Attachment TrPs occur in areas of tenderness where the muscle attaches to other structures.  These result from the inability of the muscle attachment to withstand the sustained tension produced by the taut band.  In response, these tissues develop changes that are likely to produce irritants, which could sensitize local nociceptors (Simons, Travell and Simons, 1999, p 76).    Attachment TrPs are caused by the sustained tension of Central TrP-involved muscle fibers.  Dr. Hong feels that Attachment TrPs are tendon TrPs.  They often respond well to ice, whereas Central TrPs, unless there is nerve entrapment, often respond better to moist heat.

 

Remember, there is no such thing as a fibromyalgia trigger point.  TrPs are part of myofascial pain. Unlike FMS tender points, TrPs can and do refer pain to other parts of the body.  Referred pain is not unique to TrPs.  Most people have heard of the referred pain radiating down the arm during a heart attack.  Many women have experienced pain radiating down their thighs during painful menstrual periods.

 

When the myofascial nature of pain is unrecognized, such as the pain caused by TrPs in the pectoral muscles that mimics cardiac pain, the symptoms are likely to be diagnosed as neurotic, psychogenic, or behavioral.  This adds frustration and self-doubt to the patients misery and blocks appropriate diagnosis and treatment (Simons, Travell and Simons, 1999, p14).

 

In myofascial pain, local tissue changes are very similar to mechanically induced muscle damage.  In acute stages, they are accompanied by edema, and in chronic forms by local fibrosis (Pongratz and Spath, 1997).  Nonmyofascial TrPs are not caused by the same mechanism that causes myofascial TrPs. TrPs in the skin often cause sharp, moderately severe stinging, prickling or numbness.  TrPs that occur in scars can cause burning, prickling, or lightning-like jabs.  A considerable portion of the chronic pain due to myofascial TrPs could have been prevented by prompt diagnosis with appropriate treatment...When the myofascial nature of pain is unrecognized...the symptoms are likely to be diagnosed as neurotic, psychogenic, or behavioral. This adds frustration and self-doubt to the patients misery and blocks appropriate diagnosis and treatment.... The total cost is incalculable, but enormous, and most of it is unnecessary (Simons, Travell and Simons, 1999).

 

Some medical and dental practitioners use the term myofascial pain syndrome to refer to a TMJ dysfunction. This use is confusing and obsolete.   TMJ  Dysfunction may be caused by TrPs, but chronic myofascial pain can be body wide. When chronic myofascial pain develops, overlapping pain patterns may cause confusion even in care providers experienced in single muscle TrPs.  Since myofascial pain is no longer a syndrome, we prefer the term CMP rather than MPS  to indicate this widespread condition. 

 

Once doctors and therapists learn to recognize CMP, they are surprised to see how very common it is.  One reason CMP is that single TrPs have gone unrecognized and untreated!  Early, aggressive treatment of myofascial pain gives the patient a much better chance to get better (McClaflin, 1994).  Even with CMP, as progress is made in resolving the perpetuating factors, the involved muscles become increasingly treatable.

 

Within the International Myopain Society, a Special Interest Group for Certification in Myofascial Trigger Point Pain Diagnosis and Treatment has been formed this year (2000).  There is also a move underfoot to ensure we get separate special medical codes (for insurance and other purposes) for fibromyalgia and for myofascial pain.  Please urge your doctors to join this organization (Resources).  A subscription to the Journal of Musculoskeletal Pain comes with the membership.