In some forums, there is a debate going on myofascial pain syndrome vs fibromyalgia, and where trigger point treatment fits into this picture.
When you look at the big picture, there is a large overlap between these two conditions. Understanding the similarities and differences is important. On a practical level, though, many of the same treatments apply.
Fibromyalgia is essentially a widespread abnormality of your pain system. The primary reason that people with fibromyalgia feel pain is because they have a sensitized pain system.
This sensitization is in the brain and dorsal horn of the spinal cord. This is how people can feel pain even when there’s anything physically wrong in that area of the body. The pain is primarily caused by sensitization of pain messages.
The classic definition of fibromyalgia is all quadrant pain. If you feel pain all around your body and the pain shifts around, this is likely fibromyalgia. There is also dysautonomia, which we classify the autonomic chronic pain type.
Being in the autonomic pain type means you can get dysfunction in your bowel and bladder, a racing heart rate, hot flushes and other autonomic symptoms.
In fibromyalgia, people feel pain and have all the other problems primarily because their central nervous system is malfunctioning.
Myofascial pain syndrome is when you feel pain because of trigger points.
However, things are not exactly cut and dried. There is a big overlap between fibromyalgia and myofascial pain syndrome, with mingled causes and effects.
There are a number of people who say trigger points can be a manifestation of sensitization.
Certainly, someone with myofascial pain syndrome has obvious trigger points in the painful area.
The question is: what is the primary driver, the trigger point, or a sensitized pain system?
Certainly, trigger points themselves may be focal, as in myofascial pain syndrome, which affects one area, or they may be widespread.
If you have widespread pain with active trigger points, there is one group of experts who believes the trigger points are the main issue. However, on a practical level, if triggers were the only issue, then treating the trigger points would make the pain should go away.
So often though, when you treat trigger points in people with myofascial pain syndrome, the trigger points don’t go away forever. They go away for a short length of time, and then they come back.
Which means that there’s something else driving them.
Trigger points can be part of a central sensitization problem. When a segment of the spine becomes sensitized, the messages coming through it can be amplified, which then causes the muscle to turn on trigger points.
In this case, trigger points are a secondary effect of pain sensitization.
If you look at fibromyalgia, you have widespread tenderness, or the medical word is hyperalgesia. This means even a little pressure on the skin will cause pain.
Fibromyalgia can also cause allodynia, where a normally benign touch, like brushing your skin, may be amplified up so that you feel pain. Hyperalgesia and allodynia are two strong signs of central sensitization.
A group in the 90s worked to create an objective diagnosis for fibromyalgia. They identified a number of bilateral (on both sides) tender spots. If you had a certain number of these tender spots, you could then make a positive diagnosis of fibromyalgia.
The interesting thing about those tender spots that they’re all trigger points. If you look at the position of all classic tender spots of fibromyalgia they are all in the same places as trigger points.
For fibromyalgia, the most likely explanation for the presence of trigger points is they’ve been turned on secondary to pain sensitization. They’re widespread because the sensitization is widespread.
Practically when you look at myofascial pain syndrome vs fibromyalgia, trigger points are present for both conditions. However, fibromyalgia is a widespread condition, and myofascial pain system tends to be a localized problem.
Fibromyalgia tends to have other symptoms like dysautonomia, huge fatigue, sleep deprivation, and brain fog. If you find trigger points, which you will do in people with fibromyalgia, those trigger points are not the primary cause of their pain, but a secondary symptom.
However, you may find with fibromyalgia who have a myofascial pain syndrome in a localized area. This means there are a large number of active trigger points that turn on and off depending on sleep, stress, and other factors. (The commonest area for this is in the neck and shoulders.)
If you have trigger points that keep coming back, it’s worth looking at these wider causes. If you’d like to find out more about sensitization and treating it, here’s one place to get started.