For example, an intestinal bug can set up TrPs that will perpetuate symptoms of diarrhea and vomiting that will persist even after the virus is gone. The TrPs have to bet identified and treated first (and not with antibiotics.) Doctors must learn to identify TrPs. "Most of the six million Americans with fibromyalgia have at least one associated syndrome which mandates specialized attention in addition to traditional therapeutic approaches."(12). In the vast majority of chronic pain patients, including FMS and arthritis patients, myofascial pain is a co-existing condition.
It is important to learn individual TrPs to learn their specific referral patterns, but it is also important to understand that complex overlapping pain patterns may exist in chronic pain patients. Body-wide TrPs may cause widespread pain, with TrPs in many areas and layers of many muscles. (The TrPs in the text diagrams are common, but they can occur anywhere.) As the perpetuating factors are addressed, single muscle pain patterns will eventually become apparent and then those TrPs can be treated.
Spray and stretch and TrP injections are part of therapy for myofascial TrPs, not for FMS. One study showed that patients with both FMS and myofascial TrPs find TrP injections more painful, they have less effect (although they are still worthwhile to treat the TrPs), and the post-injection soreness would be worse, than if the patient only had TrPs.(6) This is often the case with bodywork as well. Physical therapy, other bodywork, exercise and other therapies must proceed carefully and gradually if FMS and TrPs coexist. The amount of pain involved should not be underestimated. Any treatment will be more complicated and less successful than if the patient had only one of the conditions, and some bodywork may require extra medication to prevent added central sensitization. Each patient can vary in many ways. In the chronic myofascial pain component there is a wide variety of TrP combinations plus there may be different nerves, blood and lymph vessels entrapped. There may be different perpetuating factors. In the FMS component, there may be different biochemicals affected in different ways, and they may be affecting other biochemicals in different ways. Each case is different. Care providers and patients must understand both of these conditions to ensure adequate medical care. Insurance companies must understand that they will save money in the long run if the TrPs are treated promptly and adequately by trained providers, and the perpetuating factors controlled. Once the TrPs are appropriately treated and their perpetuating factors brought under control, you may find that remaining FMS symptoms are more easily managed. Some people may even find that they do not even have FMS after all.
