Posted by MERM on 6/15/2008, 12:45 pm, in reply to "2 : Fibromyalgia and Chronic Myofascial Pain"
A case of arthritis may be otherwise well managed, for example, but the accompanying TrPs are overlooked. The pain load of that patient could be substantially lessened if the secondary TrPs were treated successfully.
TrPs can occur in the myofascia, skin, ligaments, bone lining, and other tissues. They can be caused by a surgical incision, as is often the case with abdominal surgery. Each specific TrP on the body has a referred pain or other symptom pattern that is carefully documented in the Trigger Point Manuals. Most specific pains commonly attributed to FMS are actually from TrPs. Trigger Points seem to form throughout life as a response to many things that happen to our bodies. This includes overuse, repetitive motion trauma, bruises, strains, joint problems, etc. Pain creates a neuromuscular response, and the muscle around the pain site tightens, "guarding" the hurt area.
Dr. Janet Travell, in her autobiography, "Office Hours Day and Night," explains how dizziness, ringing of the ears, loss of balance, and other symptoms can all be caused by TrPs in the sternocleidomastoid (SCM). Proprioceptors in the SCM transmit nerve impulses that inform the brain of the position of the head and body in relation to the environment. Trigger points distort proprioception. When head movement changes the SCM message, dizziness can result. This can make it seem that the walls are tilting or result in a "drunken" walk, with unintentional veering and bumping into doorways and walls. Checking for SCM TrPs costs nothing, takes a minute, and can save needless time and expense. 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 appropriately, immediately and vigorously, and perpetuating factors (conditions that aggravate and perpetuate the TrPs) are avoided or controlled, TrPs can be eliminated. Unfortunately, if TrPs are left untreated, are inappropriately treated, 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 fully functional. Satellite TrPs develop in muscle in the 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). TrPs can occur in any layer of any muscle, in any position in a muscle and there may be multiple layers of TrPs in many areas of one muscle, and many or even all muscles may be involved. The TrPs diagramed in the Trigger Point Manuals are in the most common areas and are simply guides to show you where to start looking.
Developing secondary and satellite TrPs can give the false impression that CMP is a condition that is progressive. CMP is not progressive. TrPs can be minimized or eliminated with proper treatment and control of perpetuating factors. TrPs can be broken up and minimized or even eliminated, depending on how well the perpetuating factors can be controlled.
Patients with Both Fibromyalgia and Chronic Myofascial Pain
FMS and CMP are different conditions, even though the vast majority of physicians lump them together because they see many patients who have both. Unless doctors have a thorough knowledge of and familiarity with individual TrPs, they can't sort out the symptoms. One interesting difference between the two syndromes 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 TrPs of CMP have normal sensitivity. In FMS, there is a generalized sensitivity. Hard nodules, ropy bands and restricted range of motion are part of myofascial pain.
FMS is, among other things, a systemic neurotransmitter imbalance with many biochemical factors involved. These may vary from patient to patient. There are other imbalances as well, but they are all systemic in nature. Chronic myofascial pain, however, is a neuromuscular condition. Due to the nature of trigger points, some of the symptoms may seem to be systemic, but they are localized, even if the local TrPs are overlapping and cover the body. Initiating events, such as repetitive motion injury, trauma and illness, can start a cascade of TrPs, but it is reversible.
TrPs form with excess acetylcholine release at the motor end plate, with resultant excess calcium release. This is part of a cycle that causes physiological contracture of muscles due to TrP formation. The specific muscle weakness that occurs from TrPs is not the same as the diffuse fatigue of FMS, but this can lead to confusion. TrPs can cause enough pain to disrupt sleep, although the mechanism is different than that of FMS sleep-disruption.
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