Fibromyalgia and Myofascial Pain Syndrome

By: Michael Lam, MD, MPH


Graphic of a muscle experiencing pain in chronic myofascial pain syndromeWith continuing research, the conditions of fibromyalgia and myofascial pain syndrome (MPS) are becoming better recognised and understood. This is a reflection upon rising data highlighting the pathophysiology behind MPS. Myofascial pain syndrome is a condition or disorder that causes pain in the body, specifically in the skeletal muscles. With muscles taking up a large portion of our body weight, about 50% and about 400 muscles in the body, there is an opportunity for the condition to vastly affect the quality of life of an individual and cause chronic musculoskeletal pain. MPS can present as local pain that can be described as tight or tender, that is stiff or limits movement. When understanding the pathophysiology behind MPS, trigger points (TrP) are referred to pain in specific areas of functional muscle groups which restrict the range of motion of the affect muscles and promote a response of local twitching.

Muscles in our body have a relationship between the agonists and antagonist muscles, these pairs of muscles allow a muscle to cause a movement or inhibit it. Allowing for better control in specific movements and reversing motions. When a TrP occurs, it leads to the loss or inability for the antagonist and agonist inhibitory relationship, which then results with muscles that would normally be inhibited, leaving it in a state of perpetual contraction that ultimately leads to fatigue. When symptoms of pain become chronic, it is often found that there has been a spread of TrP throughout muscles in the body.

The spread of TrP throughout the body in muscles that are dysfunctional tends to affect both sides of the midline of the body as well as both superior and inferior compartments, thus the belief that MPS is more localised in its effect on muscle groups, while fibromyalgia being more of a widespread condition. MPS also shares co-morbidities, that is that individuals are often plagued with other conditions of health along with MPS. With individuals suffering from whiplash pain, the co-morbidity present is 100%, along with those who have facet joint injuries. Individuals with arthritis and spondylosis also share coexistence with MPS.

A graphic of pain throughout the body highlighting fibromyalgia is more generalized than chronic myofascial pain syndromeFibromyalgia is a condition of chronic pain being experienced in the body, often associated with high volumes of spinal fluids, serotonin deficiency and a general hypersensitivity along with disturbances in sleep and fatigue that is out of the ordinary. The general sense of widespread pain and tenderness is the identifier for fibromyalgia. It is often associated as arthritis related condition, but not truly one, as it does not affect joints, causing inflammation or damage to bones or joints. When diagnosing fibromyalgia, it comes in two steps, the identification of the muscle that is the origin of the pain and the clarification or area the muscle pain has spread to. With fibromyalgia there is no unique identifier, therefore making diagnosis more difficult, care must be taken to exclude other conditions from the differential diagnosis of widespread myalgia. A statistically significant detail shared by patients who have the condition of fibromyalgia, is tenderness. However, there is still a need for a more objective diagnostic tool that doesn’t depend only on the symptom of tenderness but also one that has correlation.

MPS is related to the taut bands in the muscle anatomy, there is a concentrated and intense muscle contraction of the muscle fibres known as sarcomeres that shortens the muscles and increases their diameter. When there are multiple activations of these contractions, it can lead to a trigger area or zone. Vecchiet along with their co-workers discovered an interesting approach to this problem of tenderness utilising stimulation of the skin and muscle with electricity. This provided the opportunity to examine responses from varying musculoskeletal pain conditions. Diagnosis of chronic fibromyalgia and chronic myofascial pain syndrome may improve with further understanding of physiological characteristics of the conditionsAnother significant diagnostic tool is the skin rolling test, Zohn and Clauw using a an examination of the skin planes stickiness to discover that decreased or increased levels of tissue stickiness could serve potentially as a tool of diagnosis for fibromyalgia.

The conditions of musculoskeletal pain, fibromyalgia and myofascial pain syndrome both share tenderness as a clinical sign or symptom. With this in mind, it has resulted in individuals experiencing bilateral and/or muscle pain that is all over the body that is diagnosed having fibromyalgia when in some instances they may actually have MPS.

© Copyright 2016 Michael Lam, M.D. All Rights Reserved.

A graphic of pain throughout the body highlighting fibromyalgia is more generalized than chronic myofascial pain syndrome

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You discussed how the ANS becomes imbalanced in response to adrenal fatigue having been diagnosed with Dysautonomia. I found this article very enlightening and a worth of knowledge especially since I have been researching and seeking answers to get better and back to living a full healthy life
 
Thank you,