Myofascial Pain - excerpt from book

[Guest guest]

Hi all,

I have a copy of this book and there is quite a bit of good info in

it that relates not just to fibromyalgia. I found this excerpt on

the internet and thought I'd share.

web address -- http://www.sover.net/~devstar/cmpsdef.htm

Adapted from " Fibromyalgia and Chronic Myofascial Pain: A Survival

Manual edition 2 " , by Devin J. Starlanyl and Ellen Copeland ©

the authors, 2001. All rights reserved. Please be aware that we

cannot hope to put all the information from ours and several other

books for patients on these disorders. Please get additional

information from one of these sources. We have listed some in the

bibliography.

Chronic Myofascial Pain Here is an example of how TrPs can spread:

You work at a desk alongside an air conditioning vent, and the cold

air blows directly on your neck on your right side. This constant

chilling of your muscle stresses your scalene muscles (Chapter 8) on

the right side of your neck. TrPs in the scalenes cause you to tilt

your head slightly, setting up stress on the left side of your neck

trying to compensate for the unequal weight distribution. This

develops secondary TrPs on the left side of your neck, and may cause

more TrPs on the right as well, as other muscles try to take up the

slack caused by the weak scalenes. Stresses caused by pain in the

referral pattern of the right scalenes cause levator scapulae TrPs to

develop on the right, causing a stiff neck on that side. Your

shoulder hitches up on that side, because it hurts to lengthen the

muscles. The muscles on the left abdominal area under the ribs are

compressed, and you develop secondary latissimus dorsi TrPs on that

side. These TrPs cause you to breath in a shallower pattern, setting

up TrPs in the other respiratory muscles. Your spine develops a

twist to protect these painful muscles, as the lower spine twists one

way and the upper spine twists the other way. This is called

rotoscoliosis, which activates a compensatory anterior rotation of

your pelvis. This process can continue until your entire body is

covered with TrPs. Sensitization of autonomic nerves in the

myofascial TrP can be the cause of autonomic nervous system

symptoms. Autonomic dysfunctions include abnormal sweating, tearing

of the eye, persistent runny nose, excessive salivation, and " goose

bumps " on your skin. TrPs may also have related proprioceptive

disturbances. Proprioceptors are receptors that are concerned with

your spatial awareness. This includes where you are in relation to

objects in the world around you, as well as the relationships between

one part of your body and another. Proprioceptor dysfunctions can

include imbalance, dizziness, ringing in your ears, and a distorted

weight perception of objects you pick up. Central TrPs are usually

in the belly of muscle, where the motor endplates lie. They cause

local tenderness, referred pain, altered sensation, referred motor

dysfunction, and referred autonomic changes due to sensitization of

local nerves and induced central nervous system changes. Attachment

TrPs occur in areas of tenderness where the muscle attaches to other

structures. These result from the inability of the muscle attachment

to withstand the sustained tension produced by the taut band. In

response, these tissues develop changes that are likely to produce

irritants, which could sensitize local nociceptors (Simons, Travell

and Simons, 1999, p 76). Attachment TrPs are caused by the

sustained tension of Central TrP-involved muscle fibers. Dr. Hong

feels that Attachment TrPs are tendon TrPs. They often respond well

to ice, whereas Central TrPs, unless there is nerve entrapment, often

respond better to moist heat. Remember, there is no such thing as a

fibromyalgia trigger point. TrPs are part of myofascial pain. Unlike

FMS tender points, TrPs can and do refer pain to other parts of the

body. Referred pain is not unique to TrPs. Most people have heard

of the referred pain radiating down the arm during a heart attack.

Many women have experienced pain radiating down their thighs during

painful menstrual periods. " When the myofascial nature of pain is

unrecognized, such as the pain caused by TrPs in the pectoral muscles

that mimics cardiac pain, the symptoms are likely to be diagnosed as

neurotic, psychogenic, or behavioral. This adds frustration and self-

doubt to the patient's misery and blocks appropriate diagnosis and

treatment " (Simons, Travell and Simons, 1999, p14). In myofascial

pain, local tissue changes are very similar to mechanically induced

muscle damage. In acute stages, they are accompanied by edema, and

in chronic forms by local fibrosis (Pongratz and Spath, 1997).

Nonmyofascial TrPs are not caused by the same mechanism that causes

myofascial TrPs. TrPs in the skin often cause sharp, moderately

severe stinging, prickling or numbness. TrPs that occur in scars can

cause burning, prickling, or lightning-like jabs. " A considerable

portion of the chronic pain due to myofascial TrPs could have been

prevented by prompt diagnosis with appropriate treatment...When the

myofascial nature of pain is unrecognized...the symptoms are likely

to be diagnosed as neurotic, psychogenic, or behavioral. This adds

frustration and self-doubt to the patient's misery and blocks

appropriate diagnosis and treatment.... The total cost is

incalculable, but enormous, and most of it is unnecessary (Simons,

Travell and Simons, 1999). Some medical and dental practitioners use

the term " myofascial pain syndrome " to refer to a TMJ dysfunction.

This use is confusing and obsolete. TMJ Dysfunction may be caused

by TrPs, but chronic myofascial pain can be body wide. When chronic

myofascial pain develops, overlapping pain patterns may cause

confusion even in care providers experienced in single muscle TrPs.

Since myofascial pain is no longer a syndrome, we prefer the term CMP

rather than MPS to indicate this widespread condition. Once

doctors and therapists learn to recognize CMP, they are surprised to

see how very common it is. One reason CMP is that single TrPs have

gone unrecognized and untreated! Early, aggressive treatment of

myofascial pain gives the patient a much better chance to get better

(McClaflin, 1994). Even with CMP, as progress is made in resolving

the perpetuating factors, the involved muscles become increasingly

treatable. Within the International Myopain Society, a Special

Interest Group for Certification in Myofascial Trigger Point Pain

Diagnosis and Treatment has been formed this year (2000). There is

also a move underfoot to ensure we get separate special medical codes

(for insurance and other purposes) for fibromyalgia and for

myofascial pain. Please urge your doctors to join this organization

(Resources). A subscription to the Journal of Musculoskeletal Pain

comes with the membership.