Myofascial Pain and Fibromyalgia
Myofascial pain and fibromyalgia are chronic painful conditions affecting the muscles of the body. Fibromyalgia patients by definition must also have at least 11 out of 18 predetermined tender points. These points are tender to the touch but the pain usually does not radiate out from the site of tenderness. Patients with fibromyalgia usually complain of fatigue, sleep disturbances and mood disorders. Patients with myofascial pain usually do not have any of these secondary symptoms.
The hallmarks of myofascial pain are trigger points. These trigger points are tender areas of muscle which you can often feel. Trigger points can occur at almost any site in the body. These trigger points are similar to the tender points of the patient with fibromyalgia. When palpating these areas, the pain may radiate out a distance from the original site. They may even mimic the radicular symptoms of a bulging disc or herniated disc. Symptoms associated with myofascial pain but not fibromyalgia may be; numbness in the extremities, popping or clicking of the joints, limited joint mobility, double or blurry vision and nausea. Symptoms associated with fibromyalgia but not myofascial pain may include; fatigue, panic attacks, allergies and sensitivities and periodic confusion or disorientation. Sometimes the difference between fibromyalgia and myofascial pain is subtle and hard to diagnose.
Although the causes of myofascial pain and fibromyalgia have not been clearly delineated, there are several possibilities. Clearly trauma of any kind can cause muscle damage. Some systemic disorders such as connective tissue disease can cause myofascial pain. Stress and depression may exacerbate the symptoms.
The main treatment for myofascial pain is injection of the trigger points. A doctor will identify the most painful muscle groups and insert a small needle into them. Through the needle, he will injection any number of therapeutic medications which may include local anesthetics, anti-inflammatories or corticosteroids. There are several physical therapy modalities which may be useful. These may include spray-and-stretch, heat, ice and ultrasound. There are several medications which can be useful and include non-steroidal anti-inflammatories, and tricyclic antidepressants.
The treatment for fibromyalgia is multi-disciplinary. It involves some of the same treatments as for myofascial pain syndrome. These include physical therapy, medications, acupuncture, biofeedback and psychological therapy. There have been some recent advances in medication management including newer antidepressants such as Cymbalta and Lyrica which may be useful. A consultation with a pain management specialist is crucial in obtaining an accurate diagnosis and treatment plan.