CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 6)

How Does This All Work?

Impressive sub-title, huh? The reality is that we don’t really know how it all works. Right now, research is snapping at the edges of what promises to be a very complex set of conditions. This is one good reason for legitimate scientific research funding from governments. Certainly, there is good and valuable research funded by private enterprise and non-governmental organizations (NGOs) but those entities often have specific agendas regarding the directions and results of research they fund. Those organizations, as the old adage states, “…have a dog in the race.” Their profits and/or organizational values are foremost in any decision to fund research. This profoundly affects the questions put forth in the investigation and in how the study is constructed.

Also, to dredge up another old adage, “When your only tool is a hammer, all problems begin to look like nails.” At risk of belaboring the point, let me explain. Private enterprise is most interested in research that promotes whatever product the company manufactures or sells. NGOs want to support investigations whose results closely align with their values. For example, pharmaceutical manufacturers want results that prove a recently developed drug is the best treatment for a problem and any solution other than use of that drug 2nd best. A NGO may want to prove the best solution to a problem is to follow the specific course of action advocated by the organization. Other, possibly better, solutions are ignored because the NGO wants to impose it’s value system on the target population to the exclusion of more efficient approaches.

Governmental support of basic science or health research is less likely to attempt to influence the direction of that investigation. As a result, much of the technological and scientific advancements that placed the United States at the vanguard of innumerable fields have come from government support of basic research. Many of these investigations offered no immediate benefit, only the opportunity to advance the general knowledge base of society. One example is the space program, out of which entire industries were created that did not exist even 30 years ago.

To say that we don’t know how it all works is true. But we have a pretty good idea how some of it works. There are a number of conditions or circumstances that seem to contribute to myofascial pain syndromes.

Sleep disorders may be closely associated with MPS. If you wake in the morning feeling that you are still tired, you may have a sleep disorder. Your body needs a particular sleep cycle sequence in order to heal and resupply with necessary hormones, biochemicals and anti-bodies. If your sleep cycle is disrupted, these critical tasks are not accomplished. Sleep is loosely divided between a phase called Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM). REM sleep is also considered the dreaming phase of sleep and its importance is not understood. This may be when memories are moved from short-term to long-term storage but that is only a guess. NREM sleep is more cogent to our discussion because it is during this phase that synthesis of necessary chemicals is done as is much of the healing and repair required to keep your body functioning.

Studies have shown that sleep disorders and MPS are closely associated. In fact, 70% of MPS patients recognize that poor sleep makes their symptoms significantly worse. This is an area that should be pursued by MPS patients in a complete approach to reducing symptoms.

Depression is also found in many MPS patients. Again, the specifics of this connection are not defined. Some believe there is a direct and intimate relationship between the two while others are firm that any depression in MPS patients is primarily due to sleep deprivation. Pharmaceutical solutions to sleep disorders and depression are not a cure. In fact, neither sleep disorders nor depression have shown to respond particularly well to drug treatment alone. Both, however, seem to diminish with an appropriate regimen of exercise, dietary modification and stress management. (I recommend discussing your desires and goals with your physician and working out a suitable program together.)

Cognitive Dysfunction is a decreased ability to think, learn, remember or reason. This is a common problem with MPS and may actually cause more trouble than any other symptom. I’ve seen this referred to as “fibro-fog” and is due to alterations in various types of memory storage and reasoning systems in your brain. Obviously, with moderate to severe cognitive dysfunction your school, career, personal relationships, emotional well-being and even your physical safety can be impaired.

CNS Imbalances, as mentioned in an earlier post, document a number of chemicals and neurotransmitters that can have a detrimental affect on your ability to think, do your job and even increase your perceived pain levels.

Physical and Emotional Stresses can have the unfortunate affect of making symptoms worse and then, as your functional abilities decrease, cause misunderstandings with your co-workers, friends and family. This, of course, further increases those same stressors, thus creating a vicious cycle that feeds on itself.

The last few parts of this topic have touched on a few aspects of MPS but I haven’t discussed much about what can be don to alleviate your symptoms. The next section (part 7) “Some Things That Seem To Help”, will address a few treatment considerations I have found helpful over the years.

CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 5)

What Else May Be Involved?

Fibromyalgia and TP syndromes have some similarities. Both, for instance, subject you to the discomfort of tender muscles, even with fairly light pressure. Pain from pressure on trigger points sends pain to other areas. This is called “referred pain”. But pain associated with fibromyalgia tends to be only where pressure is applied. This is “localized pain”. The important point to remember, though, is that you can have both!

Patients with TP syndromes can certainly experience other conditions at the same time. This situation is called “comorbidity”. But, by-and-large, comorbidity in TP syndromes is coincidental and you are just as likely to experience only the trigger points without other complicating circumstances.

Fibromyalgia, on the other hand, frequently occurs along with other conditions or diseases. The existence of these comorbidities makes diagnosis and treatment much more difficult. The exact nature of the relationship between fibromyalgia and one or more other conditions is poorly understood. Does one cause another? We simply do not know.

The following is a list of conditions frequently associated with fibromyalgia:
Irritable Bowel Syndrome, Headaches (various types), Dysmenorrhea (painful menstruation), Unexplained Skin Sensations, TMJ, Mitral Valve Prolapse, Restless Leg Syndrome, Allergies, Chemical Sensitivity, Disorders of Muscular or Ligamentous Attachments to Bones, Disorders of the Esophagus, Vision Disturbances, Anxiety, Lung or Breathing Problems, Reynaud’s Phenomenon, Thyroid Dysfunction, Lyme’s Disease, Silicone Breast Implant Syndrome, Rheumatoid Arthritis, Systemic Lupus Erythematosus, Frequent Infections, Osteoarthritis, Chronic Fatigue Syndrome, Carpal Tunnel Syndrome, Hyperventilation, PMS, Depression, Cognitive Dysfunction, Sleep Disorders, Others I did not list.

If you have fibromyalgia, one or more of the conditions above can aggravate your symptoms and make treatment significantly more difficult. It has been suggested that the causes of comorbid conditions and the causes of fibromyalgia may be similar or even the same. Much more research is required to sort out this complex situation.

As you can see, it is all too easy to treat one or more of the above conditions without recognizing there is a concomitant fibromyalgia that also requires treatment. It is little wonder that many MPS sufferers spend years, spend money and change doctors often; without achieving the pain relief they seek.

Next I will look more closely at some of the conditions in the above list. This will be the topic of my next post: Current Thought on Pain Reduction in Myofascial Pain Syndromes (part 6) How Does This All Work?

CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 4)

Who Gets MPS?

Myofascial Pain Syndromes don’t appear to affect everyone equally. While the U.S. population seems to have only a 2% to 8% rate of MPS, this translates to a minimum of 8 million people at any given time. The condition, for reasons unknown, affects women more than men. Women are more likely to suffer from MPS by a ratio of about 7:1. Interestingly, though, the difference in incidence between girls and boys is negligible. Obviously, a lot more research must be done on this issue because by explaining this difference may point to better ways to treat the condition.

MPS can affect people of all ages but the diagnosis usually happens between the ages of 20 and 55 years. There is some speculation that younger people aren’t diagnosed as often because their muscles and fascia are better able to cope with stresses.

Race appears to have no affect upon the likelihood of contracting this condition. It seems to occur equally in all races and cultures. MPS has been found worldwide with very similar rates as noted for the U.S.

How does this affect the broader society? With some form of MPS experienced by as many as 1/10th of the population, there must be immeasurable consequences to all aspects of social structure. MPS patients are not the only victims of the condition. Family, friends and co-workers are also affected. Studies have shown that about 1/3 of patients must alter their work habits to accommodate for disabilities related to job requirements. These alterations may result in a slower work pace and/or may require co-workers to do extra work to compensate.

Family may suffer due to the patient’s need to work fewer hours thus bringing home smaller paychecks. Some patients are forced to exchange their jobs for less strenuous ones that pay less. Interpersonal relationships can suffer due to depression, frustration or impatience. Financial commitments due to medical treatments may increase as income decreases, thus further increasing stress levels.

It is estimated, based upon a number of reports that long-term disability awards have been made to 15% to 45% of MPS patients. Considering disability payments and loss of productivity, the cost to society must be truly significant. One study found that MPS costs the U.S. economy an estimated $9 billion annually.

Another aspect of MPS is that it rarely occurs alone. It is frequently accompanied by one or more other conditions or diseases. We’ll discuss this topic in the next post, Part 5: Current Thought On Pain Reduction In MPS: What Else Might Be Involved?

CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 3)

Despite having a long history (as far back as the 1600s), fibromyalgia was not recognized as an actual medical issue until the 1980s. Some physicians still do not accept fibromyalgia as a distinct condition in spite of its inclusion in the official list of diagnoses since 1987.

Fibromyalgia is complex to diagnose and to treat. There is no defining orthopedic or laboratory test that is diagnostic for fibromyalgia. The physician must look for a combination of exam findings and correlate those with pertinent information from a detailed history. If certain criteria are met, then the doctor can assume you have fibromyalgia.

Treating fibromyalgia can be complicated and, sometimes, frustrating for you and your doctor. Although inflammation is frequently present with fibromyalgia, it seems unconnected with the condition. There may be a connection, either as a cause or an affect, but recent research shows no demonstrable relationship. This is unfortunate because it precludes treating an inflammatory condition and having pain go away. Treating inflammation when you have concurrent fibromyalgia may decrease or eliminate some pain but the fibromyalgia and associated symptoms remain.

What causes fibromyalgia is not clear. As studies continue, more information emerges. Currently, it appears that fibromyalgia is associated with changes to the central nervous system (CNS). More specifically, there seems to be a change in how your body processes pain messages. It is unclear at this point whether this change is due to a previously minor pain message being “multiplied” by your nervous system or because your CNS has become hypersensitive to pain stimuli. This is similar to hearing a radio more loudly but not being sure if the cause was someone turning up the volume or that your ear is working better.

Most recent studies suggest that the problem may lie with alterations in normal chemical activity in your body. A number of CNS chemicals are frequently found to be outside normal ranges in fibromyalgia patients. I will gladly forward more specific information on these imbalances to those who are interested.

There also appears to be a familial component to fibromyalgia. In other words, there may be a genetic predisposition toward fibromyalgia because it seems prevalent in some families but not in others. Remember, though, that a genetic predisposition is like a gun. If the trigger isn’t pulled, the gun doesn’t fire. Similarly, if you don’t do a sequence of activities or behaviors that might initiate the fibromyalgia, it is unlikely to occur.

I will discuss other findings and selected treatment considerations in part 4 of our discussion.