Two overlapping chronic pain conditions showing similar symptoms are myofascial pain syndrome and fibromyalgia. If these conditions are ever confused, they could be treated as only one single condition, and the pain lingering from the other condition is not addressed; therefore, it is key to seek guidance from a pain management physician. Those are real problems, for three major reasons:
>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
Myofascial pain syndrome is defined by trigger points, which are felt as taut bands of muscle. The trigger points refer pain to other (nearby) locations in the body. When pressed, trigger points elicit a twitch response, also known as a “jump sign.” One of the main characteristics of myofascial pain syndrome is that the pain is regional, or confined to a limited area of the body.
Generally, myofascial pain will be found in the shoulders, neck, arms, face, low back and/or legs. It is quite often a result of misaligned posture. People with myofascial pain and trigger points tend to have tight muscles and limited flexibility. Myofascial pain syndrome occurs in an approximately 1:1 male to female ratio.
Treatment of Myofascial Pain Syndrome
As there is no cure for fibromyalgia, so there is no cure for MPS. The goals of treatment should obviously include pain relief and improvement/restoration of mobility and functionality. It is important to identify any other accompanying conditions, and give treatment to these also.
Perhaps most importantly, the patient needs to be educated on how to best manage chronic pain, so that life can be lived as normally as possible. Myofascial pain syndrome can be treated in a number of ways, including injections, stretching with the use of a cooling spray (a method called spray and stretch), and specific manual or massage techniques that eradicate the trigger points.
The doctor inserts a needle directly into a TrP or in several places around it to loosen up the taut bands. The doctor may inject a pain-relieving medication, such as corticosteroids or lidocaine. (Note: some doctors believe corticosteroids can exacerbate fibromyalgia symptoms.) When no medication is used, it’s called dry needling.
A special kind of therapy called spray-and-stretch is common for treating MPS. A physical therapist guides you through stretching exercises while spraying a numbing substance on your muscle. The therapist may also use certain massage techniques to loosen your muscles and TrPs. In addition, a therapist can work with you on factors such as poor posture that may contribute to MPS.
What is the difference between fibromyalgia and myofascial pain syndrome?
Both of the conditions you mention are chronic pain disorders, meaning they cause pain that lasts for long periods of time and can be difficult to manage. Myofascial pain syndrome involves mainly muscular pain; whereas, fibromyalgia includes more widespread body pain, along with other symptoms, such as headaches, bowel problems, fatigue and mood changes.
Myofascial pain is a more localized or regional pain (along the muscle and surrounding fascia tissues) process that is associated with trigger point tenderness. A trigger point is a localized small lump (nodule) that, when pressed on, elicits a reproducible pattern of referred local pain. Sometimes “triggering” this pain also produces twitching of nearby muscles.
Trigger points and myofascial pain can be treated with a variety of methods (sometimes in combination) including stretching, ultrasound, ice sprays with stretching, exercises, and injections of anesthetic. Fibromyalgia is felt to be a more systemic process that causes tender points (local tender areas in normal-appearing tissues) in typical areas of the body and is frequently associated with a poor sleep pattern and stressful environment.
Diagnosing Myofascial Pain
Your doctor can diagnose myofascial pain after a physical examination reveals trigger points. Locating the trigger points is important to the diagnostician. X-rays are not helpful in diagnosing myofascial pain. Onset of myofascial pain can be acute following injury or chronic following poor posture or overuse of the muscles. This is a common condition.
Considering that 14.4% of the general U.S. population has chronic musculoskeletal pain, it has been estimated that 21% to 93% of patients complaining of regional pain actually have myofascial pain.
How Does Fibromyalgia Relate to MPS?
Fibromyalgia and MPS are both conditions that cause pain in the musculoskeletal system. With MPS however, the pain is localized. With fibromyalgia, the pain is believed to be centralized. Treating MPS and other chronic pain early on can prevent developing fibromyalgia 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
But I believe that education is the most important component of the treatment regimen. Patients must be taught and encouraged to perform home exercises. Patients must be vigilant about appropriate posture, and assuring that the workplace has the best ergonomics. Patients also benefit greatly from practicing biofeedback techniques which assist in stress reduction, which in turn reduces the tension in the muscles that contributes greatly to the pain a patient experiences.
Unfortunately, both MPS and fibromyalgia are frequently not diagnosed properly. This in turn leaves many with chronic pain which is not being treated properly. In a way, I don’t really care whether a doctor gets MPS confused with fibromyalgia, or vice-versa.
What I do care about is that we have doctors who understand the importance and the necessity of giving those patients with widespread pain all the help available, just as those with regional pain deserve all the treatment available to ease their suffering. Chronic pain by definition is always there, but that does not mean it always must be there with the same intensity.