Tender points/fibromyalgia (FM) vs. trigger points/myofascial pain syndrome (MPS): a need for clarity in terminology & diagnoses
January 5, 1995
OBJECTIVE: This study reviews the clinical distinctions
between fibromyalgia (FM) and myofascial pain syndrome (MPS),
which represent two separate and distinct soft-tissue
syndromes. The major aim of this article is to clarify the
terminology associated with these syndromes and clearly define
the parameters of differential diagnosis and treatment. DATA
SOURCES: Pertinent articles in the chiropractic and medical
literature are reviewed with an emphasis on the literature
published from 1985-1994.
STUDY SELECTION: Studies were
selected that emphasized differential diagnosis of FM and MPS,
as well as individual articles on either FM or MPS.
SYNTHESIS: The literature on fibromyalgia and myofascial pain
syndromes has grown considerably since 1985. It is now clear
that there are several important differences between FM and
MPS. The most important criteria for differential diagnosis
are the presence of tender points (TePs) and widespread,
nonspecific, soft tissue pain in FM, compared with regional
and characteristic referred pain patterns with discrete
muscular trigger points (TrPs) and taut bands of skeletal
muscle in MPS. The etiology of TePs is still unknown and it is
uncertain which specific soft tissues are tender in FM
patients. Myofascial TrPs are found within a taut band of
skeletal muscle and have a characteristic "nodular" texture
upon palpation. TrPs are thought to develop after trauma,
overuse or prolonged spasm of muscles. Local treatment applied
to TePs is ineffective, yet specific treatment of TrPs is
often dramatically effective.
CONCLUSION: FM and MPS are two
different clinical conditions that require different treatment
plans. FM is a systemic disease process, apparently caused by
dysfunction of the limbic system and/or neuroendocrine axis.
It often requires a multidisciplinary treatment approach
including psychotherapy, low dose antidepressant medication
and a moderate exercise program. MPS is a condition that
arises from the referred pain and muscle dysfunction caused by
TrPs, which often respond to manual treatment methods such as
ischemic compression and various specific stretching
techniques. Both of these conditions are seen routinely in
chiropractic offices; therefore, it is important for field
practitioners to understand these distinctions.
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