Posted by BETHIE on 8/12/2007, 11:19 am, in reply to "The Fibromyalgia Spectrum – Part of the Big Picture in Understanding Fibromyalgia " Subset 1: Predisposed State The individual is asymptomatic. Clinical Fibromyalgia is not present in this state. Subset 2: Prodromal State Prodromal means preceding, or the state leading to the condition. Pain may be present at times, but intermittently (not chronic, persistent pains). Typical Fibromyalgia pain must be present before we can diagnose clinical Fibromyalgia, no matter how many associated conditions may be present, but those who have numerous associated conditions are at risk. Subset 3: Undiagnosed Fibromyalgia The person has painful tender points which may or may not meet the American College of Rheumatology-defined 11 of 18 criteria. If this individual were to see a knowledgeable physician, that diagnosis would be made. Subset 4: Regional Fibromyalgia Individuals in this stage have been diagnosed with Fibromyalgia, but not generalized. Myofascial pain syndrome is defined by painful muscles and the presence of triggerpoints and taut bands of muscle fibers which are ropey and painful when palpated. An involuntary shortening of the fibrous muscle band can create a local twitch response. They both have trigger points, tender points, ropey muscles, sympathetic nerve dysfunction, ATP abnormalities, peripheral and central mechanisms, regional and generalized versions, and associated conditions. Sound familiar? The treatments are essentially the same. Individuals with regional Fibromyalgia, over time, often develop generalized Fibromyalgia. Subset 5: Generalized Fibromyalgia Various associated conditions seen with Fibromyalgia can be present – sleep disorder, Subset 6: Fibromyalgia with Particular Associated Conditions People in this group have developed associated conditions that are giving them particular problems which appear as “separate” entities requiring separate attention. Some of these particular associated conditions include Another associated condition is dysautonomia (dysfunction of the small nerves), which can cause abnormalities such as hypoglycemia [low blood sugar], hypotension [low blood pressure],
In other words, there is no going back.
Let’s review the features of each subset.
The individual is at risk for developing Fibromyalgia due to hereditary factors, which may include one or both parents with Fibromyalgia or a rheumatic/connective tissue disease, or a sibling or first-degree relative with Fibromyalgia.
Clinical Fibromyalgia is still not present. There is no widespread pain or painful tender points.
The individual is not asymptomatic, however.
Associated conditions common with Fibromyalgia may be present in this stage,
such as headaches, restless leg syndrome, fatigue, or irritable bowel syndrome.
Even though the individual may have one or more associated condition(s), widespread persistent pain is not present, so therefore Fibromyalgia is not yet present.
Chronic pain is now present, either regional or generalized in nature. This is the point of no return.
The person in this stage usually has milder symptoms and has not yet seen a doctor or been officially diagnosed with Fibromyalgia.
Chronic pain is limited to one or a few areas such as the upper body or the low back. The symptoms may wax and wane.
Usually, this subset is triggered by a trauma.
I believe myofascial pain syndrome is part of this regional Fibromyalgia, and both terms are essentially synonymous. Myofascial pain syndrome has become familiar through the work of the late Dr. Janet Travell, MD, and Dr. David Simons, MD.
Some of those who work with myofascial pain syndrome will argue that it is a separate distinct entity from Fibromyalgia. I disagree.
The similarities between myofascial pain syndrome and Fibromyalgia are far greater than their differences.
As our clinical experience has evolved and our knowledge and research have become more refined, I think it is clear that myofascial pain syndrome is a part of the overall Fibromyalgia spectrum.
Or they can remain in this stage indefinitely.
Identifying the regional stage early and treating it can definitely help to prevent progression.
Individuals in this stage have widespread pain and tender points.
They will usually meet the American College of Rheumatology-defined 11 of 18 criteria, but as previously explained, one can still have generalized Fibromyalgia with fewer tender points.
irritable bowel syndrome,depression, fatigue, and so on. These associated conditions are not taking on a life of their own, so to speak, but are part of the whole and managed with the overall Fibromyalgia treatment. Regional Fibromyalgia can progress to this subset. Various causes of generalized Fibromyalgia include genetic factors,
trauma, infections, and more, but secondary Fibromyalgia from a primary disease is not included in this subset.
irritable bowel syndrome, fatigue, tension/migraine headaches, and depression.
None of these conditions in themselves have “classic” disease laboratory markers or cause tissue destruction, yet they may require treatments in addition to the overall Fibromyalgia treatment.
cardiac arrhythmia, irritable bowel syndrome, and vascular headaches.
Message Thread:
« Back to thread