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 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.

CURRENT THOUGHT ON PAIN REDUCTION IN MYOFASCIAL PAIN SYNDROMES (Part 2)

In Part 1 of this discussion of myofascial pain syndromes (MPS), we talked about symptoms caused by trigger points (TP). While this type of pain syndrome is aggravating for the sufferer and complex for a physician to treat, it is actually fairly straightforward in comparison to those without trigger points. The TP generated pain conditions are caused by lesions that are local and readily identifiable once the symptom pattern and history are considered. Myofascial pain in the absence of TPs is a different matter.

Some people regard this as a completely separate condition but that may be splitting hairs. The results of both are similar in that there is muscle pain, joint pain, tenderness, and inflammation. In fact, the American Medical Association’s (AMA) coding manual used by almost every physician, insurance company and workers’ compensation organization uses the same code number for myofascial pain syndrome, myofascitis, myositis, fibromyositis and fibromyalgia. For clarity, we will refer to this form as Fibromyalgia and the pain caused by trigger points as TP Syndrome.

While the AMA, the National Institutes of Health (NIH) and the World Health Organization (WHO) recognize the existence of Fibromyalgia, some physicians do not. Consequently, many patients spend years and visit a number of physicians looking for an accurate diagnosis. Patients become frustrated with treatments that do little or nothing to address their complaints; some even undergo surgeries that are, at best, unnecessary.

There are clear differences, though, between Fibromyalgia and TP Syndromes. Fibromyalgia is more systemic than the localized TP Syndromes. Both cause and affect of Fibromyalgia are more widespread. Most recent research supports central nervous system (CNS) involvement. It is thought that the CNS is made overly sensitized to stimuli.

Defining the problem is necessary but is certainly not a solution. It is only a first step. What must follow are investigations into characteristics of the condition. Research has shown chemical, endocrine and hormonal differences between Fibromyalgia sufferers and the wider population. What findings differentiate the Fibromyalgia group from the “normal” population? What causes the changes in some patients? What can be done to alleviate the symptoms? What can be done to assist the patient in eliminating this painful and debilitating condition completely? These are complex questions I will attempt to address in the next part of our discussion.