Treating TrPs without treating the perpetuating factors means that the same TrPs will keep coming back. Treating the perpetuating factors is the key to both FMS and CMP, but it won't make existing TrPs go away. Latent TrPs are like land mines waiting to explode. If you fall, or catch a cold or are hit with any other stressor, they may all activate at once. This may be mistaken for or even cause an FMS "flare."
Multiple latent TrP activation often happens in the elderly. Much of the aches and pains and muscle weakness of old age may be due to unsuspected TrPs, and may respond to proper treatment. (14) People who have been incontinent or have had sexual dysfunction for years due myofascial TrPs may be relieved-and astonished-at their response to adequate TrP treatment. Then they often become angry as they realize that they have suffered needlessly because their doctors did not understand TrPs. TrPs cause muscle weakness and other dysfunction before they cause pain, so they may be unsuspected even by some doctors who have TrP medical texts. Some care providers just look at TrP diagrams. That is insufficient preparation to treat myofascial TrPs. Myofascial medicine requires study, and it is well worth the time spent on it. Many patients endure needless pain and medical tests due to lack of recognition and treatment of myofascial TrPs. (9) Some researchers lump FMS and CFIDS together and ignore myofascial pain. We won't have clear research results until we distinguish these conditions. It is frustrating to see medical research that claims to be on FMS/CFS patients (written by researchers who lump these conditions together) and yet it describes nodules, ropy bands and restricted range of motion of myofascial pain. The authors of the article did not know better, and neither did their peer reviewers! This is a sad state.
Many dentists, psychologists and others use the terms "temporomandibular dysfunction" and "myofascial pain syndrome (MPS)" to describe the same jaw dysfunction. Their research conclusions may be honestly but erroneously used by other researchers to apply to MPS due to TrPs. Further research may build on those faulty conclusions. An article attempting to prevent this clarified the issue (13), yet this potentially misleading research still comes out in quantity.
An enormous amount of research has also been done on FMS patients with no regard for co-existing TrPs. Much of this research is suspect because some of the symptoms described could be due to myofascial TrPs instead. I believe it would reduce FMS clinical study variables considerably if patients in FMS studies were routinely screened for co-existing myofascial TrPs. Researchers may find that some symptoms now associated with FMS are more commonly due to myofascial TrPs, and some may not be associated with FMS at all. This may also be true for CFIDS. Many experts believe that one way deal effectively with these conditions is to separate them into meaningful subgroups that might give clues to effective treatment.
An important step to symptom control is to deal with the causes of the symptoms. When you have chronic unrestorative sleep, it is logical that you also have chronic fatigue. This is not the same as CFIDS. If pain from myofascial TrPs is disrupting sleep, or you waken often with urinary urgency or diarrhea caused by TrPs, you need to take care of the TrPs (and other factors disrupting your sleep.) If you take care of the TrPs and their perpetuating factors, it will be much easier to deal with the remaining symptoms. It's not as easy for doctors as throwing a pill at the problem (and the patient), but it is good medical practice. The medical dictum "do no harm" is often lost in the field of chronic pain because care providers are unaware of the pervasiveness of myofascial TrPs.
Some symptoms once linked with FMS may not be. Carbohydrate cravings, weight fluctuations and some swelling may be due to insulin resistance. Research indicates that insulin resistance may be a common perpetuating factor of FMS. (18) It can perpetuate TrPs. Sleep dysfunction, prevalent in FMS, may adversely affect glucose tolerance (10), and may unbalance the hypothalamic-pituitary-adrenal (HPA) axis. (8) Treating the insulin resistance through diet, especially if it is the main FMS perpetuating factor, may ease the symptom load considerably, and may make co-existing TrPs more treatable.