MPS, FM

Fibromyalgia and Myofascial Pain Syndrome

• Overview

  • Fibromyalgia (FM) and myofascial pain syndrome (MPS) are chronic pain syndromes often confused with one another.

  • FM is characterized by widespread pain, while MPS has localized muscle changes.

  • Treatment approaches differ, reflecting the distinct nature of each syndrome.

Fibromyalgia

Definition

• Chronic condition marked by:

  • Widespread pain affecting half the body and the axial skeleton.

  • Symptoms lasting for over 3 months.

  • Presence of 11 of 18 tender points at specific body sites, nonrestorative sleep, morning stiffness, and fatigue.

Prevalence

• Approximately 2% of the population (around 5 million adults) has FM.

• Higher prevalence in women (3.4%) compared to men (0.5%), and the rates increase with age (7.4% in women aged 70-79).

Clinical Characteristics

• Symptoms can start at any age, most commonly during early to middle adulthood.

• Often develops post-physical trauma or viral infections.

• Pain characteristics: muscular origin, particularly in scapula, neck, chest, and low back.

• Symptoms fluctuate—individuals may experience cycles of being pain-free followed by exacerbated symptoms, often triggered by over-exertion or exercise.

• Increased incidence of comorbid conditions: tendonitis, headaches, irritable bowel syndrome, TMJ dysfunction, restless leg syndrome, anxiety, and depression.

Factors Contributing to Flare-Ups

• Noninflammatory and nonprogressive, yet may be aggravated by:

  • Environmental stresses: Changes in barometric pressure, cold weather, fluorescent lights.

  • Physical stresses: Repetitive activities, prolonged sitting/standing.

  • Emotional stresses: General life stressors.

Management

• Multimodal approaches include:

  • Aerobic and strengthening exercises.

  • Prescription and over-the-counter medications.

  • Pacing activities to manage symptoms.

  • Cognitive behavioral therapy.

  • Stress factor avoidance, reduced alcohol and caffeine intake, and dietary modifications.

  • Manual therapy techniques: stretching, massage, and trigger point release.

Myofascial Pain Syndrome

Definition

• MPS is a chronic regional pain syndrome characterized by myofascial trigger points (MTrPs) causing referred pain patterns along with sensory, motor, and autonomic symptoms.

• Trigger points are hyperirritable areas in tight muscle bands, described as dull, aching pain with decreased range of motion and strength when stretched.

Prevalence

• 85% of the general population may experience MPS during their lifetime.

Trigger Points

• Trigger points can be:

  • Active: produce pain spontaneously and with movement.

  • Latent: asymptomatic unless palpated.

Possible Causes of Trigger Points

• Etiology varies but includes:

  • Chronic overload from repetitive activities.

  • Acute overload from trauma or unexpected muscle loading.

  • Poor muscle conditioning.

  • Postural stresses.

  • Direct trauma and muscle contractures.

Clinical Presentation

• Symptoms include:

  • Pain upon compression, may exacerbate existing pain.

  • Local twitch response upon palpation.

  • Muscle tightness and sensitivity to stretching.

  • Local muscle weakness without noticeable atrophy.

• Autonomic phenomena: vasoconstriction, pilomotor response, and abnormal sweating.

Diagnosis

• Essential criteria include:

  • Palpable taut bands.

  • Tenderness recognized by the patient.

  • Pain with limited stretch range.

• Confirmatory observations:

  • Local twitch response.

  • Referred pain sensation on compression.

  • Electromyography to confirm trigger points.

Management

• Focused on correcting contributing factors and eliminating trigger points.

• Techniques used:

  • Stretching techniques (contract-relax stretches).

  • Trigger point release methods.

  • Modalities like dry needling.

Main Differences Between Myofascial Pain and Fibromyalgia

Similarities

• Both conditions involve muscular pain, decreased range of motion, and postural stresses.