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 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.