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


7 comments:

  1. Hi Kevin. I am so glad you addressed this issue. There are just a couple of additional comments I would like to make.

    First, MPS is defined by the presence of myofascial trigger points, which unless in deep muscles or behind bone, one can easily feel the lumped up piece of muscle fiber if they have trained hands. These trigger points (TrPs) radiate pain and other symptoms in a particular pattern associated with the TrP location, and that pattern remains consistent among all patients.

    Second, Myofascial Pain Syndrome can become chronic. When this happens, research shows us it can lead to the centralization of pain in fibromyalgia, exacerbating symptoms. Research also tells us chronic MPS is also associated with overlapping conditions to FM, such as migraine, intersitial cystitis or irritable bladder, restless leg syndrome, TMJ/TMD, other rheumatologic diseases, and conditions that affect the musculoskeletal system.

    Thank you for addressing this important issue. Fibromyalgia and myofascial pain syndrome are not the same, but they can co-occur and when not identified, it can limit helpful treatments as you point out.

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  2. Fibromyalgia, How I see this dreaded disease.

    FM does have a formal diagnostic criteria. IMO this is for academic and legal purposes because in reality the clinical picture is the major issue which will alter a patient's life and well being.

    I would not try to box FM into the criteria. This is how I suggest a provider address FM and to educate and advise treatments and therapy. Therapy is the key to avoiding ruining a patient’s life with delays and confusion.

    FM is a great masquerader and will trick the best of the best and even confuse the patient too. Here are a few pictures of what FM can look like;

    >Early FM, say with only 75% of the needed criteria.
    >Partly treated FM
    >Full blown textbook FM
    >FM with other myofascial issues.
    >FM with other musculoskeletal issues.
    >FM in addition to RA, Lupus, OA etc
    >Migraine Headache with FM
    >PTSD with FM
    >Medication induced FM like syndromes. (Statins are the greatest culprits in this case)

    What providers should do is breach the topic and let the patient grief the diagnosis.
    Try not to send these patients to surgeons to be fixed.
    Try not to send these patients to rheumatologists to be medicated.
    Try not to be fooled and allow the patients to be miserable with a bizarre array of signs and symptoms.
    Try not to use high technology to figure out if something else is going on.
    Try not to put them on opiates and sedatives.
    Try not to blame allergies or the weather or environmental exposures.
    Try not to blame the patient or not believe them and avoid helping them.

    In 2013, we do have a recipe in place to begin the healing or repair process. I will call this “Therapy.” Pain patients have to be proactive in their care. Therapy has to be done on a regular basis; Hourly, daily, weekly and monthly. See below.

    Self-Care and hands-on care;
    >Regular Chiropractic, physical therapy, massage therapy, sports medicine.
    >Stretching, yoga and Pilates, Aerobic and any exercise
    >Vitamins, minerals and trace elements (Magnesium glycinate)
    >Sleep hygiene, Stress management, Wellness, Mindfulness and forgiveness.
    >Get a foam roller to work on your upper and lower body area.
    >Swimming, Aqua-Therapy and Hot-tub Spa therapy.
    >Use self-trigger point release with your hands or a Thera-cane.
    >Find a PT specialist who can perform “Spray and Stretch.”
    >Use John F. Barnes myofascial unwinding.

    More invasive or minimally invasive care with Myofascial Release Therapy with needles. (Actually any needle will do, be if fine filament or hypodermic)

    In the 50’s some doctors dabbled with a theory and therapy of stressed muscles and ligaments breakdown and repair called trigger points. These doctors use injection therapy with saline or glycerine and other chemicals. Trigger Point Injection or Prolotherapy are the names.

    >Acupuncture of the body. (Not just the Ear, Foot or Scalp)
    >Formal Dry Needling
    >C. Chan Gunn-IMS
    >Prolotherapy
    >Botox injections (rarely)
    >Steroid injections (rarely)
    >Janet G. Travell, MD and David Simons, MD Trigger Points Injections.

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  3. i suffer from both because i am greedy

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    Replies
    1. In my experience, one of the most important determinants of who lives well and who doesn't when they have fibromyalgia (or chronic pain of any kind) is a sense of humour. I'm very glad to see you have retained yours. Never lose it, as it can be a life-saver.

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  4. Thanks very much for this. And I enjoyed the answers....including Greedy.
    It is a comfort to read MFP can evolve into FM, as I believe that's what happened to me. In fact, that is the only thing that reminds me it might not be something else.
    Continuing with the blog...thanks

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  5. Hi...Your post really got me thinking man..... an intelligent piece ,I must say. Get more information about. Thanks for us...Myofascial pain in Korea

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  6. I have fm and mfp and I've been unable to work for 5 years, it very hard for me to do daily activities I also have a hard time thinking! I also have vestibular lynbrith disorder so my world is in a spin! I wanted to know if my ear condition had anything to do with fm or mfp thank you

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