Fibromyalgia/Myofascial Pain Syndrome Handout # 4 & 5 - FMS/MPS Complex

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http://www.pendulum.org/related/FMS/fm-pain.htm

Fibromyalgia/Myofascial Pain Syndrome Handout # 4 & 5

Devin Starlanyl MD

FMS/MPS Complex

Synapse: the functional membrane to membrane contact between one

nerve cell and another nerve cell, receptor, or other cell. In

most cases, impulses are carried across the synapse by a chemical

transmitter " bridge " .

Neurotransmitter: any specific chemical agent released by a

presynaptic cell when activated, that causes the synapse to stimulate

or inhibit the postsynaptic cell.

Serotonin: a vasoconstrictor (constricts blood vessels) liberated by

blood platelets, that inhibits gastric secretions and stimulates

smooth muscle. It is present in large amounts in some areas of the

Central Nervous System.

Myofascia: the thin layer of connective tissue that covers, supports

and connects the muscle cells, muscle fibers, and the whole

muscles, as well as forming tendons and ligaments. It is the

support network that gives the body its shape, and determines its

flexibility.

Some times the start of FMS/MPS Complex creeps up on us. It

can start with a chronic runny nose. With muscle tightening,

normal fluid passages are constricted. Fluid backs up in the

sinuses, causing constant post nasal drip, although the nose itself

may be dry. Patients complain of unilateral sinus blockage, which

changes from side to side as they turn in bed. The side they sleep

on most often has the worst pattern of symptoms from post nasal

drip. The SCM TrPs are sore on that side, and the scaleni, with a

morning sore throat and digastric TrPs. From there, more TrPs

develop in the referred pain region, and these go on to develop

their own secondary TrPs. Sometimes this cascade can be avoided by

using warm salt water as nose drops before bed, cleaning off the

nasopharynx area and preventing post-nasal drip.

Some FMS/MPS patients say their symptoms started after a

severe cold or flu. Some feel that whiplash or other neck trauma

triggered the problem. Both of these conditions have a commonality

in neck congestion. Others have had their symptoms start in the

hips, especially after a difficult pregnancy, or a fall. Others

have body asymmetry that starts the Trigger Points, and eventually,

if the patient has a FMS tendency, the chronic pain from MPS can

trigger FMS. FMS consists of several subsets, just as there are

many forms of arthritis. There seems to be a genetic

predisposition. Many FMS patients have multiple environmental

sensitivities.

To understand FMS/MPS complex, look at the big

picture. Neurotransmitter activity determines the plasticity of the

tissues. Most of the body " s processes rely on the appropriate

movement of fluids through the system. In FMS/MPS, connective

tissues become stiffened, shortened and tightened. We know growth

hormone has a powerful effect on connective tissue. It directly

stimulates the production of fibroblasts and mast cells, ground

substance and collagen fibers. It " s significant in wound healing,

where rapid production of collagen fibers by many fibroblasts is

necessary for repair. But growth hormone is released during

delta-level sleep. People with FMS often have the alpha-delta sleep

anomaly. The patient with fibromyalgia never enjoys uninterrupted

delta level sleep. The body can " t repair itself, because repair

occurs during delta sleep. Connective chemistry monitors

inflammatory response, and its fluids deliver antibodies and white

blood cells to fight infection. All of these are disrupted in FMS.

Immune killer cells are present in the normal amounts in FMS, but

many are dormant.

Much of our psychological and physical sense of continuity

and security depends upon our ability to repeat appropriate and

predictable actions. Spindle reflex arcs keep muscles constantly

informed as to what they " re doing, so that the action can be

modified. In FMS, most of the required muscle tension of the body is

improperly controlled by the higher brain centers. Others think

nothing of picking up a glass of water, and bringing it to the lips.

They know how much contractile effort and speed it will take to do

this smoothly. People with FMS/MPS have muscular " incompetence in

the absence of proper sensory feedback " . The thumb grasps with too

little pressure. The wrist muscle lets go when flexed. The

economy of effort is not there. To sit, walk, and stand, the entire

musculature must feel its own activity.

FMS/MPS patients are usually burdened with a long history of

undiagnosed illness. They suffer from loss of self-esteem. Their

condition is invisible, so friends and family don " t believe them when

they say they hurt. Yet FMS amplifies the slightest pain. Skin

tissue scars and tears easily. FMS itself seems to trigger

Myofascial Pain Syndrome. Acute pain from FMS creates a muscle

contraction, " guarding " around the tender points. This impairs

circulation and neural transmission through the area. This effects

not only the muscles, but the surrounding organs. A muscle in a

state of sustained tension is working, thus its need for nutrition

and oxygen is high. At the same time, the sustained contraction

reduces circulation in the area by squeezing the small arteries and

capillaries which give the working cells fuel and oxygen. Chronic

muscle tension and contracture creates an area of heightened

metabolism and ischemia and buildup of toxic waste--a Trigger Point.

The contracting muscles produce increased waste products and demand

increased nutrients from capillaries that are less and less able to

handle them. This causes more contraction. This results in rigid

muscles until the Trigger Points are defused and the perpetuating

factors resolved. ***

Handout # 5

Fibromyalgia Network POB 31750 Tucson AZ 8575-21750

602-290-5508

National Foundation for Fibromyalgia POB 3439 San Diego

CA 91263-1429 800-251-9528

Social Security Administration 800-772-1213

National Family Caregivers Assn 9223 Longbranch Parkway Silver

Springs MD 20901

Migraine: constricted blood vessels inside the skull which suddenly

expand. Strong correlation to food sensitives, and neurotransmitter

imbalances. Serotonin regulates the constriction and dilation of

blood vessels. Prodrome aura of visual disturbances that can

include zigzag lines and flashes of light. the trigeminal nerve

pathway involved runs close to our reticular formation in the

eyes. The constant stimulation of both decreased blood flow and

increased nerve involvement causes optical effects.

Esophageal reflux: back pressure opens a muscular valve, called the

cardiac sphincter, between the bottom of our esophagus and top of

stomach. Bending over or lying down often adds just enough pressure

to gravity to cause reflux. Also, lax connective tissue can cause

hiatal hernia problems.

Itches: there are many kinds of itches--sensory itch, and allergic

itch are the most common. Merkel " s discs in the skin are pressure

plate receptors in outer skin layer. Unfamiliar pressures are

translated into itch, the skin " default " sense. Trigger Points can

also result in itch. For example, the coracobrachialis referred

pattern on the forearms often becomes itch, rather than pain.

The masseter TrP can cause a maddening itch inside the ear. Cold

numbs the receptors. Dryness creates an enhanced pressure

reception. Check for possible causative TrPs. ***