Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Myofascial Pain Syndrome vs. Fibromyalgia

It's all bad.
Many patients are labeled with fibromyalgia simply because they have chronic soft tissue pain. But it is important, at least for the sake of correctness, that not all chronic soft tissue pain be called fibromyalgia.

In fact, localized or regional pain is often due to myofascial pain syndrome (MPS), a rather common condition which affects certain muscle areas. MPS is often present in the fibromyalgia patient, but not all MPS patients also suffer from fibromyalgia.

MPS generally involves pain in the neck, shoulders, hips, back, jaw and head. This pain is often accompanied by stiffness or tightness. It is important that the doctor listen to the patient to learn where the pain is most intense. And because MPS is not diagnosed with a lab test or x-ray, it is important that the doctor carefully examine the patient.

Trauma is a common cause of MPS, in the form of muscle strain or ligament and tendon sprain; or as a result of chronic trauma due to repetitive work injury, or altered posture due to poor exercise. An example of the former is whiplash from an auto accident. An example of the latter is an individual who works at a computer all day, and subsequently develops MPS involving the muscles of the upper back and shoulders; such individuals often develop tension headaches. Of course, more than one area may be involved, and this can make distinguishing between MPS and fibromyalgia all the more difficult.

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MPS can occur with a variety of medical problems, including spinal disc disease, or inflammatory illnesses. And like fibromyalgia, MPS symptoms can be made worse due to stress, depression, fatigue and vitamin deficiencies, to name a few.

It is important for the doctor to identify all other illnesses in an individual patient so that therapy can be most effective and accurate.

As there is no cure for fibromyalgia, so there is no cure for MPS. The goals of treatment should obviously include pain relief and improvement/restoration of mobility and functionality. It is important to identify any other accompanying conditions, and give treatment to these also. Perhaps most importantly, the patient needs to be educated on how to best manage chronic pain, so that life can be lived as normally as possible.

Just because there is no cure for MPS, do not think there is no treatment. Treatments include physical therapy and stretching exercises, massage therapy, trigger point-injections, and medications such as anti-inflammatories, muscle relaxants, anti-depressants, and anti-seizure drugs (for example, gabapentin).

But I believe that education is the most important component of the treatment regimen. Patients must be taught and encouraged to perform home exercises. Patients must be vigilant about appropriate posture, and assuring that the workplace has the best ergonomics. Patients also benefit greatly from practicing biofeedback techniques which assist in stress reduction, which in turn reduces the tension in the muscles that contributes greatly to the pain a patient experiences.

And while the treatment for MPS sounds awfully similar to that given to our fibromyalgia friends, let us not forget the key differences between these two chronic pain syndromes:
1. MPS has more localized or regional pain versus the diffuse pain of fibromyalgia.
2. MPS patients have "trigger points" which can cause pain at a distant location when pressed, whereas fibromyalgia patients suffer from "tender points".
3. MPS has a better prognosis, as the pain often resolves with treatment or the rectification of the offending stimulus (such as the ergonomically incorrect office desk); the pain of fibromyalgia has a much higher chance of being chronic.

Unfortunately, both MPS and fibromyalgia are frequently not diagnosed properly. This in turn leaves many with chronic pain which is not being treated properly.

In a way, I don't really care whether a doctor gets MPS confused with fibromyalgia, or vice-versa. What I do care about is that we have doctors who understand the importance and the necessity of giving those patients with widespread pain all the help available, just as those with regional pain deserve all the treatment available to ease their suffering.

Chronic pain by definition is always there, but that does not mean it always must be there with the same intensity.

 

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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