Thursday, 15 August 2013

Fibromyalgia and Myofascial Pain Syndrome: Similarities & Differences

I just read a comment to one of my many YouTube videos, one called
Fibromyalgia: The Disease Where Even Hugs Hurt, in which the writer asked me if fibromyalgia and myofascial pain syndrome are the same. I'd like to respond to that question here.

To begin with, let me say that the two conditions are alike in many ways. Both are associated with chronic (i.e., long-standing) muscle pain. In both conditions, that pain can be anywhere from mild and merely annoying to severe and disabling. And both conditions are poorly understood by most doctors.

But this is how they are different. Myofascial pain syndrome (MPS) refers to chronic muscle pain in a localized area... for example, your shoulder or hip.  Fibromyalgia (FM), on the other hand, refers to generalized pain. In fact, about half of patients with fibromyalgia say they hurt everywhere. This doesn't mean that they hurt everywhere all the time or even every day. But if you ask them to colour in where they've had pain in the last month on a pain diagram like the one below, most will colour in at least half of it. Meanwhile, the person with MPS will just colour in their shoulder and areas next to it (possibly their upper back and chest on the same side; maybe their neck on the same side; potentially even that same arm).  That is not to say that people with MPS can't have MPS in more than one place. Having MPS in your shoulder doesn't prevent you from getting it in your hip.  Theoretically, if you had MPS in enough places, you could have widespread pain that is virtually indistinguishable from the pain of fibro. But there is one major difference: MPS generally is pain; fibro is pain PLUS a host of other symptoms (Read below) 

Pain Diagram: Patients are asked to colour in where they have pain.
If you ask people with MPS what their worst symptom is, almost all will say that it is their pain. Some may be extremely tired because the pain keeps them from sleeping. Some may have severe headaches if their MPS affects their neck. Some may be very depressed about everything. But pain is GENERALLY the #1 worst symptom they have. Among those with fibro, however, pain is the worst symptom in only about half. The remainder will rank fatigue, or sleeplessness, or headaches, or problems with memory and concentration (the so called fibro fog), or irritable bowel syndrome as #1. That, more than the localized versus generalized distribution of the pain, is the #1 difference between these two conditions.

That being said, can MPS and FM co-exist? Most certainly. In fact, they commonly do.  I have met relatively few patients with fibro who don't have one area that is always painful, that is their worst area. Most also have an area that is so tender that pushing on it causes pain to shoot elsewhere. This last phenomenon - where pushing on someone's upper back on the right side causes pain to shoot all the way down their right arm - is called triggering; and locating trigger points is a major way doctors diagnose MPS. 

Similarly, many people with FM once started with pain that was localized to one area. In other words, they started with MPS that then spread to become generalized pain associated with numerous other symptoms. Their MPS spread to become fibro.

Are there differences in the way MPS and FM are treated? Yes and No. If someone has localized pain only, treatment generally should be geared locally, for example with physiotherapy directed to that affected shoulder or hip, or with local injection(s) of anesthetic +/- a steroid to reduce pain +/- inflammation. However, if someone with fibro has one really bad area, localized treatment of that area also may be helpful. 

If someone asked me which I'd rather have, MPS or fibro, I wouldn't hesitate a second: I'd rather have MPS because treatment IS more localized and there is a reasonably good chance that the pain can ultimately be made to go away or, at least, be significantly reduced. That is not to belittle MPS, as for some it is a nightmare. But MPS usually does NOT become fibro, and most patients ultimately do well.  That being stated, MPS must be treated aggressively and as soon as possible, so that the pain doesn't spread and other symptoms develop. 

Developing FM on top of MPS is a real pain.

Kevin White, MD, PhD, multiple award-winning researcher, author, teacher & speaker
Multiple award-winning author of Breaking Thru the Fibro Fog: Scientific Proof Fibromyalgia Is Real