By Celeste Cooper
Myofascial pain syndrome (MPS) is known as the great imitator because the symptoms that result from the tell tale myofascial trigger points mimic other conditions. It is also considered a peripheral nervous system disorder that contributes to pain. For instance, myofascial trigger points of the pelvic floor are associated with urological pain syndromes; the same is true for temporomandibular dysfunction, migraine, and other disorders often seen in those of us with fibromyalgia. Myofascial trigger points (TrPs), which cause myofascial pain, can develop in muscles anywhere in the body. So, when all four quadrants are affected, TrPs can seemingly cause the body-wide pain associated fibromyalgia (FM) leading to a misdiagnosis. When MPS and FM are both present, it makes it even more difficult to diagnose and treat.
Why does myofascial pain become chronic?
Like most chronic pain conditions, myofascial pain is considered chronic when the pain and dysfunction last for more than three months. However, most don’t like to put a number on pain duration. Instead, they define chronic pain as pain that persists beyond its usefulness as a warning sign. There are things that contribute to chronic myofascial pain, such as repetitive movement or forcing a muscle beyond its limits or capabilities. In most people, these injuries will heal on their own without specific myofascial therapies; however, others do not. Unfortunately, we really don’t know why.
What causes the chronic pain of fibromyalgia?
Many factors are thought to contribute to the body-wide pain and tenderness of fibromyalgia. Most all agree there is a mishap in the central nervous system, which helps explain immune, sleep, and other problems associated with it.
What is the difference between a trigger point and a tender point?
A myofascial trigger point is a knotted up piece of muscle fiber in a tight band of muscle that restricts motion and causes local and radiating pain. They can cause other symptoms if blood vessels or peripheral nerves are entrapped. The symptom pattern remains consistent in all patients. Trigger points can be felt by the examiner unless it is in deep muscle or beneath bone.
A tender point is a tender area on the body that causes pain when pressed. The tender points of fibromyalgia cannot be felt by an examiner. Knots in muscles are not present in the tender area unless the person has both MPS and FM.
Is myofascial pain syndrome associated with other disorders like fibromyalgia?
Yes, MPS is known as a peripheral pain generator that co-occurs with many disorders. According to my own pain specialist, MPS is a common cause of chronic pain. It can be the primary pain generator of pain, and at the same time, it can be an indicator of some other pain generator in the area. Doctors David J. Alvarez, D.O., and Pamela G. Rockwell, D.O. discuss the significance of MPS as a pain generator in their article Trigger Points Diagnosis and Management published in the peer-reviewed journal medical American Family Physician.
Are there any treatments available for chronic myofascial pain?
Treatments for myofascial pain syndrome include hands on therapy by a specialized therapist trained in myofascial therapy, electrical stimulation, ultrasound guided trigger point injections, needling and more. The goal is always the same: to return the muscle fiber affected to its normal resting state so it can function properly. Researchers continue to evaluate different types of treatments geared at releasing the trigger point.
Does myofascial pain sustain fibromyalgia pain?
According to Hong-You Ge, César Fernández-de-las-Peñas, and Shou-Wei Yue, "Active myofascial trigger points may play an important role in the transition from localized pain to generalized pain conditions via the enhanced central sensitization, decreased descending inhibition and dysfunctional motor control strategy."
Is there something I can do?
The most important thing you can do is to identify and manage perpetuating factors of myofascial pain syndrome and seek proper myofascial treatments. The same is true for managing fibromyalgia. When MPS and FM are both present, managing MPS is managing a perpetuating factor in fibromyalgia.
When trigger points are ignored, the more difficult they are to treat, which might lead you to think myofascial pain syndrome is a progressive illness. But, a progressive disease is one that continues to worsen and doesn’t respond to treatment. That is not the case when MPS is treated appropriately by a qualified doctor or therapist.