Sunday, April 5, 2009


In Part 1 of this discussion of myofascial pain syndromes (MPS), we talked about symptoms caused by trigger points (TP). While this type of pain syndrome is aggravating for the sufferer and complex for a physician to treat, it is actually fairly straightforward in comparison to those without trigger points. The TP generated pain conditions are caused by lesions that are local and readily identifiable once the symptom pattern and history are considered. Myofascial pain in the absence of TPs is a different matter.

Some people regard this as a completely separate condition but that may be splitting hairs. The results of both are similar in that there is muscle pain, joint pain, tenderness, and inflammation. In fact, the American Medical Association’s (AMA) coding manual used by almost every physician, insurance company and workers’ compensation organization uses the same code number for myofascial pain syndrome, myofascitis, myositis, fibromyositis and fibromyalgia. For clarity, we will refer to this form as Fibromyalgia and the pain caused by trigger points as TP Syndrome.

While the AMA, the National Institutes of Health (NIH) and the World Health Organization (WHO) recognize the existence of Fibromyalgia, some physicians do not. Consequently, many patients spend years and visit a number of physicians looking for an accurate diagnosis. Patients become frustrated with treatments that do little or nothing to address their complaints; some even undergo surgeries that are, at best, unnecessary.

There are clear differences, though, between Fibromyalgia and TP Syndromes. Fibromyalgia is more systemic than the localized TP Syndromes. Both cause and affect of Fibromyalgia are more widespread. Most recent research supports central nervous system (CNS) involvement. It is thought that the CNS is made overly sensitized to stimuli.

Defining the problem is necessary but is certainly not a solution. It is only a first step. What must follow are investigations into characteristics of the condition. Research has shown chemical, endocrine and hormonal differences between Fibromyalgia sufferers and the wider population. What findings differentiate the Fibromyalgia group from the “normal” population? What causes the changes in some patients? What can be done to alleviate the symptoms? What can be done to assist the patient in eliminating this painful and debilitating condition completely? These are complex questions I will attempt to address in the next part of our discussion.