After reading my book Living Well With Chronic Fatigue Syndrome and Fibromyalgia," she wrote to me express her concerns that the medical community is still misinformed regarding the issue of trigger points, and some of the symptoms that are part of co- existing myofasical pain. She felt that these misunderstandings in the medical community -- some of which are also reflected in the various thoughts and theories presented by various practitioners and researchers featured in my book -- deserve to be clarified, for the benefit of patients.
In the interest of ensuring that people with fibromyalgia and chronic myofascial pain get the best possible information, I invited Devin to share her expert perspective on these issues. In this article, she explores and clarifies some key issues she feels are especially important for patients and practitioners, and I welcome her expertise. -- Mary Shomon
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There is general confusion and lack of information concerning chronic myofascial pain (CMP). Many of the symptoms mistaken for fibromyalgia syndrome (FMS) may actually be due to myofascial trigger points (TrPs) instead. TrPs are easily treated if they caught early. Understanding the differences between FMS and CMP and how they can interact may be necessary before the most effective therapies for your symptom control can be chosen. There is no such thing as a fibromyalgia trigger point. You may have read about them in articles and even books written by respected physicians, but they do not exist. FMS tender points and myofascial trigger points (TrPs) are different in fundamental and significant ways. (1, 4, 7, 11, 14 p 18) Failure to differentiate myofascial pain from TrPs may lead to unnecessary tests and procedures that may cause harm as well as unnecessary expense. (9)
Fibromyalgia is not progressive. (4) If FMS is getting worse, there is at least one perpetuating factor that is out of control. This factor is often co-existing myofascial pain. Medical case reports indicate that even if a patient has been diagnosed only with FMS, identification and treatment of coexisting myofascial TrPs and adequate FMS support can provide considerable symptom relief (3) and restore function. Yet many people have never heard of myofascia or of TrPs.
One type of myofascia, the fascia (a type of connecting tissue) you can see is the thin, translucent material that covers chicken breasts at the grocery. You have myofascia too. Imagine "...a gauze-like network that shapes the entire body. Make that network three-dimensional, covering all of the interior, and then fill the gauze with structures including blood vessels, nerves, and lymph." (15) That's one form of fascia. Your muscles are infiltrated with fascia down to the cellular level. Myofascia tightens in response to stressors like trauma or infection. It can entrap blood and lymph vessels or nerves, causing diagnostic confusion. Fascia surrounds your heart and holds other organs in place.
Myofascial TrPs are extremely sore points that can occur in taut ropy bands throughout the body. They may feel like painful lumps or nodules, and they restrict range of motion. They are not part of FMS. Because it is found so many places in the body, tight myofascia can cause a vast array of symptoms. Single myofascial TrPs can occur in anyone. If there are one or more TrP perpetuating factors out of control, TrPs may seem to spread. TrP perpetuating factors include anything that will perpetuate stress on the muscle, including trauma, body asymmetry, or co-existing conditions.
When you have a TrP in a muscle, it causes pain at the end of range of motion when you stretch that muscle, and it weakens the muscle even before it causes pain. Your ankle, knee or hip may buckle, or your grip may fail, depending on which muscle is involved (These symptoms are not part of FMS.) You then avoid stretching this muscle because it hurts. Muscles are designed to work best with motion. Since you don't stretch the muscle, it becomes less healthy and your range of motion lessend. Circulation in your capillaries, your microcirculation, becomes impaired around the TrP. Nutrients and oxygen can't be delivered easily, nor wastes removed. Your lymph system depends on muscle movement to move lymph, so that system begins to stagnate as well. Other muscles do the work of the TrP-weakened muscle.