By: Dr Alex Robber
Myofascial pain syndrome and fibromyalgia are two overlapping chronic pain conditions which display similar symptoms. If these conditions are ever misunderstood, they could be viewed as just one condition, and the pain that lingers from the other condition is not addressed; hence, it is important to seek guidance from a doctor in pain management. Of three main reasons, these are real problems:
- They require different treatment
- MPS’s trigger points can be eliminated
- MPS pain can exacerbate FMS, and lowering MPS pain can calm FMS symptoms considerably
Myofascial Pain Syndrome
The syndrome of myofascial pain is characterized by trigger points which are perceived as taut muscle bands. The trigger points apply to pain in the body at other (nearby) places. When pushed, trigger points elicit a twitch response, also known as a “jump sign.” One of the main features of myofascial pain syndrome is that the pain is localized or restricted to a small body area.
On the shoulders, spine, arms, nose, low back and/or legs, myofascial pain is generally found. The effect is most frequently a misaligned posture. People with myofascial pain and trigger points appear to have muscles tight and flexibility limited. Myofascial pain syndrome occurs in males to females, roughly1:1
Treatment of Myofascial Pain Syndrome
Since there is no cure for fibromyalgia, there is therefore no cure for MPS. Treatment objectives will ideally include pain relief, and mobility and functionality improvement/restoration. Identifying any other accompanying conditions is necessary and providing treatment to these.
Perhaps importantly, maybe the patient wants to be informed about how best to treat chronic pain, so life can be lived as normal as possible. Myofascial pain syndrome may be managed in a variety of ways, including injections, stretching with the use of a cooling spray (a procedure called spray and stretching), and complex manual or relaxation procedures that remove the trigger points.
To loosen the taut bands, the doctor sticks a needle directly into a TrP or at multiple points around it. The doctor can inject a medicine that relieves the pain, such as corticosteroids or lidocaine. (Note: some doctors think corticosteroids can worsen symptoms of fibromyalgia.) If no medicine is used, it’s called dry needling.
A kind of spray-and-stretch treatment is commonly used to treat MPS. A physical therapist directs you through the stretching exercises while rubbing on your skin a numbing agent. Also, the therapist may use other massage techniques to relax the muscles and TrPs. A therapist can also work with you on issues such as poor posture which can lead to MPS.
What is the difference between fibromyalgia and myofascial pain syndrome?
Both conditions you list are chronic pain disorders, which means they cause long-term and difficult to manage pain. Myofascial pain syndrome mainly involves muscle pain; while fibromyalgia causes more frequent body pain along with other symptoms such as headaches, trouble with the stomach, weakness, and changes in mood.
Myofascial pain is a phenomenon associated with trigger point tenderness which is more localized or regional pain (along the muscle and underlying fascia tissues). A trigger point is a localized small lump (nodule) which elicits a reproducible pattern of local referred pain when pressed on. This pain often causes twitching of surrounding muscles often “triggering.”
Trigger points and myofascial pain may be managed with a variety of methods (sometimes in combination) including stretching, ultrasound, stretching ice sprays, workouts, and anesthetic injections. Fibromyalgia is felt to be a more systemic mechanism that triggers tender points in traditional areas of the body (local tender areas in normal-appearing tissues) and is also associated with irregular sleep pattern and stressful environment.
Diagnosing Myofascial Pain
Your doctor can diagnose myofascial pain after having discovered trigger points in a physical examination. To the diagnostics it is important to locate the trigger points. X-rays are not suitable for myofascial pain treatment. The onset of myofascial pain may be acute after injury, or chronic after poor posture or muscle overuse. This is a prevalent disorder.
Considering that 14.4% of the general U.S. population has chronic musculoskeletal pain, it was reported that 21% to 93% of patients who complain of regional pain actually have myofascial pain.
How Does Fibromyalgia Relate to MPS?
Fibromyalgia and MPS are both conditions in the musculoskeletal system which cause pain. Nevertheless, the pain is associated with MPS. The discomfort is thought to be centralized with fibromyalgia. Early treatment of MPS and other chronic pain can prevent fibromyalgia from developing later.
Why people with MPS frequently develop FMS isn’t yet clear, but a growing body of evidence shows that, in some people, chronic pain can make changes to the central nervous system, resulting in central sensitization. If theories are correct, early treatment of MPS may help prevent FMS. An emerging umbrella term for FMS, MPS, and other conditions involving central sensitization is central sensitivity syndromes.
Education is the most important component of the treatment regimen
Yet I think the most important part of the treatment regimen is schooling. Patients should be trained and encouraged to do exercises at home. Patients must be cautious about correct posture to ensure the best ergonomics are accessible in the workplace. Patients often benefit greatly from the use of biofeedback strategies that help to reduce stress, which in turn reduces muscle tension, which significantly contributes to the pain experienced by a patient.
Unfortunately, there is often a misdiagnosis of both MPS and fibromyalgia. It in effect leaves those with chronic pain that isn’t being adequately treated. In a way I don’t really know if a doctor gets fibromyalgia confused with MPS, or vice versa.
What I care about is that we have doctors who recognize the significance and urgency of providing all the support available to these patients with widespread pain, just as those with regional pain deserve all the necessary treatment to relieve their suffering. There is always chronic pain, but that doesn’t mean it must always be present with the same severity.
- Myofascial Pain Overview Is It Different From Fibromyalgia? By Carol Eustice via VeryWell Health
- Myofascial Pain. Disease Center. Arthritis Foundation.
- Myofascial Pain Syndrome. Merck Manual. November 2005.