Fibromyalgia and Myofascial Pain

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Fascia is the dense, fibrous connective tissue that surrounds muscles. Normal fascia is able to relax and constrict in a painless manner, however when injury occurs the fascia can become tight and restricted in its movement. The fibers surrounding the area of injury “knot up” in effect, and create what are referred to as “trigger points.” When touched, these trigger points can be extremely painful, causing the pain to radiate throughout the muscle and even elsewhere into the body. Myofascial pain syndrome is a type of chronic muscle pain that centers around these trigger points.

 The symptoms of myofascial pain syndrome are akin to a deep, aching pain in a muscle that persists and worsens over time. Muscles may also be stiff, as may the joints near the affected muscle. Areas of tension within affected muscles may feel like knots and be exceptionally sensitive to touch. Some individuals with myofascial pain syndrome may have difficulty sleeping as a result of their pain.

 Myofascial pain syndrome differs from normal, everyday muscle pain in that it persists and worsens over time. Myofascial pain trigger points are common in headaches, the jaw, neck, lower back, pelvis, and arms and legs. Muscle overuse and injury can cause trigger points in muscles and lead to myofascial pain syndrome. In addition, under-use of muscles, such as the inability to use a particular muscle or group of muscles following surgery, can also spur the onset of trigger points once the muscle is used again. In addition, individuals who suffer from extreme stress and anxiety are more likely to develop muscular trigger points. Finally, middle-aged individuals are more prone to developing trigger points and women are more likely than men to experience myofascial pain syndrome.

Comorbidities and Association with Fibromyalgia

 Many of the symptoms associated with myofascial pain syndrome can have a substantial impact on an individual’s ability to live an active and fulfilling life, much like Fibromyalgia. Muscle weakness can lead individuals to become less active and promote social isolation. The pain associated with myofascial pain syndrome can also make sleeping difficult as it can be hard to find a comfortable position in which to sleep. The frequent overlapping symptoms can also take a toll on individuals who have both conditions. A 2010 study by Cakit et al. evaluated the frequency of Fibromyalgia symptoms in patients with chronic myofascial pain of the cervical (neck) region. Of the 93 patients studies, 22 had Fibromyalgia. The researchers also found that the number of tender points, degree of fatigue, depression, and presence of irritable bowel syndrome was higher among those with both cervical myofascial pain and Fibromyalgia.

 Due to their generalized pain presentation and many overlapping features, myofascial pain may on occasion be misdiagnosed in conjunction with Fibromyalgia, or misdiagnosed altogether as Fibromyalgia due to the common overlapping symptoms and similar demographic profiles of the conditions. The potential misunderstanding and confusion of trigger points (in myofascial pain syndrome) and tender points (in Fibromyalgia) also presents a problem in the diagnosis of these two conditions; it has been estimated that as many as 72% of patients with Fibromyalgia have active trigger points (Cakit 2010).

Treatments for Myofascial Pain Syndrome

 Myofascial pain syndrome is typically treated with physical therapy (primarily using massage and stretching exercises), injections of corticosteroids or numbing medications into the trigger points within muscles, and medications (such as Advil or Aleve) to relieve the muscle pain. In addition, certain antidepressant medications known as tricyclic antidepressants may also be of benefit to help relieve pain and improve sleep.

 As for complementary and alternative therapies, acupuncture has been anecdotally demonstrated to be effective for some individuals who suffer from chronic pain, however there is a lack of research to support its effectiveness in treating myofascial pain and most studies have been limited by flawed methodology or small numbers (Sun et al., 2010; Shen et al., 2009; Ga et al., 2007). Two studies have been conducted to investigate the effectiveness of L-tryptophan in treating myofascial pain, however neither demonstrated effectiveness (Stockstill et al., 1989; Seltzer et al., 1982).

 There is some evidence to support the use of myofascial release therapy as a treatment for Fibromyalgia. Myofascial release therapy is a type of massage therapy that uses sustained pressure on trigger points to help relieve tension in the fascia and muscles. A 2011 study by Castro-Sanchez et al. found that anxiety, sleep, pain, and quality of life were all significantly improved among those patients who received myofascial release therapy versus those in a control group who did not (Castro-Sanchez et al., 2011a). Another study also led by Castro-Sanchez and colleagues reported similar findings and found that the differences between those in the myofascial release therapy group and those in the control (non-intervention) groups persisted for up to one year after the end of the study (Castro-Sanchez et al., 2011b).

 In his lengthy and comprehensive review of myofascial pain syndrome and Fibromyalgia, Gerwin (2005) points to the need for research to better understand the causes of each condition in order to better design effective treatment plans for those who suffer from Fibromyalgia and myofascial pain syndrome.

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References

1.        Chandola HC, Chakroborty A. Fibromyalgia and myofascial pain syndrome – a dilemma. Indian J Anaesth. 2009;53(5):575-581.

2.        Cakit BD, Taskin S, Nacir B, Unlu I, Genc H, Erdem HR. Comorbidity of Fibromyalgia and cervical myofascial pain syndrome. Clin Rheumatol. 2010;29:405-411.

3.        Sun MY, Shieh CL, Cheng YY, Hung HC, Li TC, Yen SM, Huang IS. The therapeutic effects of acupuncture on patients with chronic neck myofascial pain syndrome: a single-blind randomized controlled trial. Am J Chin Med. 2010;38(5):849-859.

4.        Shen YF, Younger J, Goddard G, Mackey S. Randomized clinical trial of acupuncture for myofascial pain of the jaw muscles. J Orofac Pain. 23(4):353-389.

5.        Ga H, Choi JH, Park CH, Yoon HJ. Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients – a randomized trial. Acupunct Med. 2007;(25)4:130-136.

6.        Stockstill JW, McCall D Jr., Gross AJ. The effect of L-tryptophan supplementation and dietary instruction on chronic myofascial pain. J Am Dent Assoc. 1989;118:457-460.

7.        Castro-Sanchez, AM, Mataran-Penarrocha GA, Granero-Molino J, Aguilera-Manrique G, Quesada-Rubio JM, Moreno-Lorenzo C. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with Fibromyalgia. Evid Based Complement Alternat Med. 2011a;2011:561753.

8.        Castro-Sanchez AM, Mataran-Penarrocha GA, Arroyo-Morales M, Saavedra-Hernandez M, Fernandez-Sola C, Moreno-Lorenzo C. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with Fibromyalgia: a randomized controlled trial. Clin Rehabil. 2011b;25(9):800-813.

9.        Seltzer S, Dewart D, Pollack R, Jackson E. The effects of dietary tryptophan on chronic maxillofacial pain and experimental pain tolerance. J Psychiatr Res. 1982-83;17:181-186.

10.     Gerwin RD. A review of myofascial pain and Fibromyalgia – factors that promote their persistence. Acupunct Med. 2005;23(3):121-134.

11.  http://www.healingwell.com/library/fibro/webber3.asp

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