By Adrienne Dellwo
Fibromyalgia and myofascial pain syndrome often go together. Because of the frequent overlap and some similar symptoms, they’re often mistaken for the same condition and, as a result, people with both are sometimes only diagnosed with and treated for one.
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
It’s also common for people with one of these conditions to be misdiagnosed with the other, which also leads to the wrong treatments.
Some researchers use the name “chronic myofascial pain” (CMP) instead of myofascial pain syndrome because of evidence it’s a disease, not a syndrome. (A “syndrome” is a set of symptoms without a known cause.)
In MPS, muscles and connective tissues (which make up the fascia) develop what’s called a trigger point (TrP). These are not the same as FMS tender points.
A trigger point is a small, hard knot that you can sometimes feel under your skin. The knot itself can be painful, especially when poked, but it often causes pain in another area, which is called referred pain.
Trigger points typically form after the tissue is injured and, for some reason, doesn’t heal properly. Experts don’t know why damage that heals normally in most people causes TrPs in others.
However, studies suggest that muscle injury in some people leads to abnormalities where the nerve cells connect to muscle cells. This suggests MPS is a neuromuscular disease.
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.
Some symptoms associated with MPS are similar to symptoms associated with FMS, while others are linked to only one of.
The symptoms they have in common include:
- Soft-tissue pain ranging from mild to severe
- Headaches and/or migraines
- Disturbed sleep
- Balance problems and/or dizziness
- Tinnitus (ringing in the ears) and ear pain
- Memory problems
- Unexplained sweating
- Worsening symptoms due to stress, changes/extremes in weather, and physical activity
Symptoms associated with MPS but not with FMS include:
- Numbness in the extremities
- Popping or clicking joints
- Limited range of motion in joints, especially the jaw
- Doubled or blurry vision
- Unexplained nausea
Symptoms associated with FMS but not with MPS include:
- Panic attacks
- Feeling overwhelmed due to sensory overload
- Allergies and sensitivites
- Periodic confusion and disorientation
Referred pain makes MPS especially hard to diagnose and treat. Typically, a doctor says, “Where does it hurt?” and then looks where you point.
To treat MPS, you and your doctor need to examine your symptoms and figure out where your trigger points are.
Your doctor can find trigger points by feel or based on symptoms. Tests such as magnetic resonance elastography and tissue biopsy may show abnormalities in TrPs, but their roles in diagnosing MPS still aren’t clear.
By contrast, no test or scan reveals abnormalities in the tissues where people with FMS experience pain.
You have several options for treating MPS:
- Trigger-Point Injections: 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.
- Acupuncture: Acupuncture is an ancient Chinese practice similar to dry needling. While studies of its use in MPS are limited they are promising, and many patients and practitioners report good results.
- Physical Therapy: 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.
- Medications: Common drugs for MPS include nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve (naproxen) or ibuprofen-based drugs like Advil and Motrin, and tricyclic antidepressants such as amitriptyline, doxepin, and nortriptyline.
MPS Treatments vs. FMS Treatments
Here again, there is some overlap but also important differences. Treatments used for both MPS and FMS include:
- Physcial therapy (although in different forms)
- Tricyclic antidepressants (although SSRI/SNRI antidepressants are becoming more common for FMS)
Studies show trigger-point injections are not effective at relieving fibromyalgia tender points, and NSAIDs are not effective at treating FMS pain.
Most fibromyalgia experts recommend a multidisciplinary approach to treatments.
With significant differences in their symptoms, diagnostics and treatment, it’s clear that fibromyalgia and myofascial pain syndrome are not the same conditions. However, it can be extremely difficult to determine which condition is causing which pain when a person has both of them.
By working both on your own and with your doctor and/or physical therapist, you may be able to figure out where you have trigger points and how best to treat them without exacerbating your fibromyalgia. Relieving the myofascial pain is likely to quiet your fibromyalgia symptoms, so you could well see a double benefit.
Clinical Biomechanics. 2008 Jun;23(5):623-9. Epub 2008 Feb 21. “Ability of magnetic resonance elastography to assess taut bands.”
Schmerz. 2003 Dec;17(6):419-24. “Diagnosis and therapy of myofascial trigger points.”