Posted by MERM on 6/15/2008, 12:42 pm, in reply to "2 : Myofasical Pain and Fibromyalgia "
TrPs can cause restrictions to blood vessels, lymph vessels and nerves. Remember that these structures pass through the fascia.
Other associated symptoms may include
stiffness, muscle tightness,
localized sweating, tearing,
salivation, poor balance,
irregular heart beat, dizziness,
pelvic pain, diarrhea, impotence,
nausea, tinnitus, goose bumps,
runny nose, buckling knees,
weak ankles, illegible handwriting,
headaches and muscle cramps.
A new way of imaging soft tissue elasticity has been mentioned in a Mayo Clinic press release as a potential method to locate many myofascial trigger points.
Chronic Myofascial Pain
If TrPs are treated immediately and vigorously, and perpetuating factors (conditions that aggravate and perpetuate the TrPs) are eliminated or controlled, TrPs can often be eliminated quickly.
Unfortunately, if a TrP is left untreated or muscle action is restricted to avoid pain, the TrP usually becomes latent. If the muscle is pushed to work in spite of the pain, especially if perpetuating factors exist, active TrPs may develop secondary and satellite TrPs.
Secondary TrPs develop when a muscle is subject to stress because another muscle with a TrP isn't doing its job. Satellite TrPs develop when a muscle is in a referred pain zone of another TrP. Without proper intervention, and with perpetuating factors, the TrPs can lead to severe and widespread chronic myofascial pain (CMP).
Developing secondary and satellite TrPs can give the false impression that CMP is a systemic condition that will steadily worsen with time — that it is progressive.
CMP is not progressive.
Body-wide TrPs, often in many layers of many muscles, can seem like FMS. With proper and timely intervention, these TrPs can be broken up and eliminated. If chronic myofascial pain has persisted for some time, you may have fibrotic muscles and/or calcified areas at the attachment points.
This usually indicates multiple perpetuating factors, and it will take longer work and a lot of patience to regain function.
Many people are living with incontinence, dizziness, muscle weakness, IBS, and avoiding activities (including sex) because they have TrPs that are unrecognized and untreated.
So much misery and unnecessary health-care cost could be prevented by adequate training of medical care professionals.
FMS and CMP Together
FMS and CMP are different conditions. However, the vast majority of physicians lump them together because they see so many patients who have both.
They are treated differently, however, and the difference is important. Unless doctors have a thorough knowledge of and familiarity with individual TrPs, they can't sort out the symptoms easily.
It is also difficult to treat the individual TrPs without knowing the pain patterns. They must also be identified because certain postures and body movements, or mechanical inequalities, may be the perpetuating factors. Certain TrPs may develop if you fail to change your gaze enough (especially if you work at a computer screen), and you may simply need to do eye exercises every day to stop those killing headaches.
Or you may need the focal length changed on your glasses or the glare removed from your computer screen. Your work station may be ergonomic, but you may be lying on a sofa watching TV at night and your posture may be causing TrPs along the spine.
One interesting difference between the two conditions is that more women than men have FMS, but CMP affects men and women in equal numbers.
Another difference is that muscles in locations that are some distance from the TrPs of CMP have normal sensitivity.
In FMS, there is a generalized sensitivity.
With FMS, you and your care providers need to reduce unnecessary and confusing stimuli.
With CMP, you need to identify the specific TrPs and treat them with specific TrP therapy. With both conditions, the key to successful treatment is identifying and controlling or eliminating perpetuating factors.
This may involve changing to a healthy diet and
avoiding excess carbohydrates,
adding vitamin and mineral supplements,
regaining restorative sleep (which may need no more than adding Benadryl at night, or may be much more complex), and adding some gentle exercise and stress-removing activities.
Deleting unhealthy habits such as smoking can make a world of difference.
People with both FMS and CMP face more than just the two sets of symptoms of both conditions.
Today, more researchers are realizing that FMS and CMP not only occur together, they reinforce each other.
FMS and CMP can interact.
The many different autonomic symptoms and proprioceptor dysfunctions associated with TrPs can be amplified by FMS. The research by Dr. Roland Staud and others indicates that pain from localized TrPs can perpetuate the central sensitization of FMS.
Physical therapy and all other forms of treatment must proceed very carefully when both of these conditions are involved, because any excess pain caused by the therapy can further sensitize the central nervous system. Any treatment regimen will be both more complicated and less successful than if the patient had only one of the two conditions.
Furthermore, some of the treatments normally prescribed for FMS patients can cause damage to CMP patients, and the reverse is also true. You cannot strengthen a muscle that has a TrP, because the muscle is already physiologically contracted, for example.
Too many physical therapists see a weakened muscle and immediately attempt to strengthen it without testing for the presence of TrPs.
Attempts at strengthening a muscle with TrPs will only cause the TrPs to worsen and may develop satellites and secondaries. In the context of FMS, many different neurotransmitters are affected to different degrees and in different combinations in each patient.
Other biochemicals in the body are also affected to different degrees. Various hormones may be involved.
Histamine (a neurotransmitter), for example, is often an important factor when there are many allergic manifestations.
The possible combinations are endless, so this is no place for a doctor who practices "cookbook" medicine, especially when you figure in the possible combinations of TrPs.
A lot can be done to relieve FMS and CMP, lighten the symptom load and return at least some of your function.
Much of this is under your control. It's important for you to take on the responsibility of managing your own treatment.
The resources are available for you.
It isn't easy, and it takes concentrated focus to change the habits of a lifetime. Getting as well as possible — optimizing your quality of life — takes commitment and patience.
You didn’t get where you are overnight, and there are no quick fixes. One of your best hopes in the challenge to regain function and well-being is education, both yours and your medical care team. Source Devin J. Starlanyl wellnesstrtainresearchteam!M
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