Many people with fibromyalgia also have chronic myofascial pain or CMP (formally known as Myofascial Pain Syndrome, MPS) and don’t even know it. It is often missed because it is easy to confuse the pain and it’s origins with that of FM. As a result, it is missed in the diagnosis. Both are connected to the musculoskeletal system which makes up almost 50% of our body weight, but should not be confused as being the same. Understanding FM and CMP and what makes them tick, will empower you to help yourself. You will be able to figure out some of the contributing factors to your pain, where it originates and what makes it feel better. It will help you understand treatments and find the one(s) that work for you.
It was recently discovered that MPS is not actually a syndrome at all, but a neuromuscular disease. This is important news! The difference? Diseases have known causes and a well-understood process for producing symptoms. Myofascial pain due to trigger points is now considered a true disease, rather than a syndrome. Fibromyalgia is a syndrome like rheumatoid arthritis and lupus and has tender points (not to be confused with trigger points). Even with these differences, it is believed by many researchers that one can influence the other.
I have mentioned before that I have a few experts that I follow closely and call my “fibro heroes” because they helped me through their studies and publications to understand and validate my pain. Devin Starlanyl is one of those heroes. Actually, she was my first. I read a book she co-authored, Fibromyalgia and Chronic Myofascial Pain: A Survival Manual, and quickly followed that by her book, The Fibromyalgia Advocate: Getting the Support You Need to Cope with Fibromyalgia and Myofascial Pain – she is amazing! She is a sufferer herself as well as a doctor/researcher. She set about trying to give doctors perspective from the patient’s point of view and has created diagnostic guidelines, patient resources with an empathy you can’t get anywhere else. She is at the forefront of all the research, news and information & shares it with FM & CMP sufferers in a way we can understand. Finding out about her work, was the beginning of my understanding.
What are trigger points? Trigger points are subtle, but taut bands that constrict the muscle and cause tremendous pain. Trigger points can be in the fascia that surrounds the muscle or in the muscle itself. They are extremely sensitive to pressure at the site and also cause “referred” pain – meaning pain at another location of the body. The part of the muscle fiber that actually does the contracting is a miniscule component called a sarcomere which cannot be seen by the naked eye. Contraction occurs in a sarcomere when its two parts come together and interlock like fingers. Myofascial trigger points are confined in one area and are dying for oxygen, which causes a demand for energy. There is a chemical reaction in central nervous system which sensitizes nearby nerves. This triggers the motor, sensitivity and autonomic (not under voluntary control) reactions of the trigger points. Muscles with trigger points are in a perpetual state of energy crisis.
Trigger points cause headaches, neck and jaw pain (TMJ), low back pain, tennis elbow, and carpal tunnel syndrome. They can cause pain in the shoulder, wrist, hip, knee, and ankle and are often mistaken for arthritis, tendonitis, bursitis, or ligament injury.
Trigger points can also cause dizziness, earaches, sinusitis, nausea, heartburn, false heart pain, heart arrhythmia, genital pain, and numbness in the hands and feet. Some experts believe that fibromyalgia may sometimes start as a result of myofascial trigger points. In CMP trigger points, the pain is more intense with a radiating pattern along the same muscle or muscle group. There is usually some loss of the range of motion, as well as a substantial weakness in the muscles that have active trigger points. The pain decreases when the muscle is at rest, and the intensity of the pain increases as soon as the that muscle starts to contract.
Proof of myofascial trigger points has been produced by the use of electromyographic imaging (a device that converts the electrical activity associated with functioning skeletal muscle into a visual record or into sound and has been used to diagnose neuromuscular disorders and in biofeedback training). Researchers have also used ultrasounds of localized twitch responses of trigger points. They can even do biopsies of myofascial trigger points that show the contraction knots and rounded muscle fibers. In one of Devin Starlanyl’s articles, I read that, as a result of this, The Journal of Musculoskeletal Pain has stated that the trigger points involve the “nerve terminal and the postjunctional muscle fiber” which “identifies myofascial trigger points as a neuromuscular disease”. Simons DG. 1999. Diagnostic criteria of myofascial pain caused by trigger points. J Musculoskeletal Pain 7(1-2):111-120.
What causes trigger points? There are many factors that can be attributed to trigger points: poor posture, scoliosis, thyroid deficiency, estrogen deficiency, loss of flexibility, nerve root compression (pinched nerve), emotional stress/anxiety that leads to lack of sleep which can increase muscle tension, fatigue and pain threshold. Other factors that MAY cause or worsen CMP trigger points are: nutritional deficiencies, chronic infections, muscle imbalance, inactivity (static posture).
When I injured my left knee, which resulted in surgery, I developed a limp and without even thinking about it, continued to favor (protect) that knee long after surgery. As a result, my entire left side became weak and I experienced pain that radiated from my lower back all the way to my ankle. My lower back and hip would tighten up so much to compensate for the muscles in my leg, that I sometimes couldn’t even move. The pain felt like all my muscles from the waist down on that side had “seized”. It was so intense, I would have to freeze in that position until it eased. It still happens today, but the difference is, I know what to do about it.
After a car accident, my FM and CMP were inflamed to a point that I was sent to a therapist for continual treatment. I had been reading about myofascial release therapy and was really wanting to try it. I was pleasantly surprised to find a myofacial release therapist that had practiced under John F. Barnes, President and Director of the Myofascial Release Treatment Centers and National Myofascial Release Seminars. Barnes developed the most incredible, pain-easing therapy that makes your fascia and muscles feel like they are melting like butter and gently releasing and unfolding your muscles! Of course, that is MY non-clinical way of describing it, BUT that is what it felt like to me.
Being a military family, we eventually had to move to another base and I immediately started searching for a therapist that knew and understood the John Barnes method. I saw several therapists (covered by my insurance) that claimed to know it, but I was incredibly disappointed and ended up hurting more after a session than when I went in. So, my recommendation is to make sure these people have actually studied under Barnes or were trained at one of his seminars. Ask for proof. You can also find a link to his site on my website where you kind find a list of therapists.
With all of the research and progress being made in understanding and treating chronic myofascial pain, who knows what tomorrow will bring! I will continue to bring you more information on CMP – from diagnosis to traditional and alternative treatments. There is a great deal of hope for people like you and me!