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How do myofascial pain syndrome & trigger points relate to fibromyalgia? Experts debate

  [ 3 votes ]   [ 1 Comment ] • July 6, 2011

Leading rheumatologists Dr. Robert M Bennett and Dr. Don L Goldenberg have published a research-based “point-counterpoint” debate on how fibromyalgia and myofascial trigger points may be related. (“Fibromyalgia, myofascial pain, tender points and trigger points: Splitting or lumping? - Arthritis Research & Therapy, Jun 30, 2011)

“Myofascial trigger points (MTPs) have long been a contentious issue in relation to fibromyalgia, and poorly defined pain complaints in general,” the two experts explain – and the occasion for their debate is “a recent paper reporting that manual palpation of active MTPs elicits the spontaneous pain experienced by fibromyalgia patients.”

Issues this paper raised for them are:

1. Can MTPs be reproducibly identified?

2. Do MTPs have valid objective findings, such as spontaneous electromyographic activity, muscle microdialysis evidence for an inflammatory milieu or visualization with newer ultrasound techniques?

3. Is fibromyalgia a syndrome of multiple MTPs, or is focal muscle tenderness a manifestation of central sensitization?

The gist of Dr. Bennett’s argument is that:
“Currently FM is envisaged to be a pain syndrome related to dysfunctional central pain processing; however, increasingly evident is that peripheral pain generators such as painful joints and MTPs now need to be incorporated into this model.”

And the gist of Dr. Goldenberg’s response is that:
“There is no convincing evidence that the MTP can be clinically or pathophysiologically distinguished from a FM tender point….. MTPs will eventually be discounted as discrete pathologic abnormalities in the muscle….Identifying and treating any peripheral pain is a noble pursuit in the management of central pain disorders, such as FM. However, it is unlikely that the MTP is a specific peripheral pain phenomenon.”

To read the free full text of their point-by-point debate, click HERE >

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Article Comments Post a Comment

Trigger points
Posted by: KerryK
Jul 6, 2011
Trying to prove trigger points as being a condition of the muscles is like trying to prove the existence of God. So far, that notion is only an article of faith. I personally believe Travel and Simon did humanity a great injustice by promulgating muscles as the culprit. My belief is that all this debate over trigger points will be resolved by looking at the skin as the culprit, with any muscle spasms and tightness as a response to the noxious pain in the skin. See recent research on Trpv1 ion channels, mast cells, and keratinocytes as they relate to pain.
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