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What is the Difference Between Myofascial Pain Syndrome and Fibromyalgia?

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Updated January 22, 2008

Question: What is the Difference Between Myofascial Pain Syndrome and Fibromyalgia?
Myofascial pain syndrome and fibromyalgia are two different muscle pain conditions, each involving palpable “points.” Aside from crossover –- 72% of people with fibromyalgia also have active trigger points, one of the main symptoms of myofascial pain syndrome -- most of the remaining symptoms in each could not be more distinct from one another.
Answer:

Fibromyalgia
Fibromyalgia is also known as chronic “widespread pain.” This type of pain is usually felt in all four limbs and in the trunk. The American College of Rheumatology classifies chronic widespread pain as fibromyalgia if it is also accompanied by the confirmed presence of at least 11 out of 18 (pre-identified) tender points. These tender points are 1 centimeter areas in specific muscles which are very sensitive to the touch. Pain from tender points is local, that is, it goes no further than the tender point itself.

When comparing fibromyalgia patients to those with widespread pain but no tender points, research shows that the presence of the extra sensitive tender points is linked to greater pain, more severe symptoms and a more pronounced decrease in the quality of life. Fibromyalgia patients often complain of fatigue, sleep problems, headaches and mood disturbances.

The muscles of fibromyalgia patients have been described by experts as “soft and doughy,” and there is excessive range of motion in the joints. Fibromyalgia occurs mostly in females. The female to male ratio is between 4 and 9: 1.

Myofascial Pain Syndrome
Myofascial pain syndrome is defined by trigger points, which are felt as taut bands of muscle. The trigger points refer pain to other (nearby) locations in the body. When pressed, trigger points illicit a twitch response, also known as a “jump sign.” One of the main characteristics of myofascial pain syndrome is that the pain is regional, or confined to a limited area of the body. Generally, myofascial pain will be found in the shoulders, neck, arms, face, low back and/or legs. It is quite often a result of misaligned posture.

Myofascial pain syndrome can be treated in a number of ways, including injections, stretching with the use of a cooling spray (a method called spray and stretch), and specific manual or massage techniques that eradicate the trigger points.

People with myofascial pain and trigger points tend to have tight muscles and limited flexibility. Myofascial pain syndrome occurs in an approximately 1:1 male to female ratio.

Summarizing the Differences Between Myofascial Pain Syndrome and Fibromyalgia
As we have seen, fibromyalgia and myofascial pain syndrome are two very different problems. Fibromyalgia is a widespread pain syndrome accompanied by fatigue and muscle tenderness. These symptoms are not associated with inflammation. Treating fibromyalgia is often multidisplinary, for example, you may need gentle to moderate exercise, counseling, and anti-depressants all at the same time. Myofascial pain, on the other hand, is the condition of muscles that occurs when trigger points cause reduced functioning in soft tissue, and pain. Myofascial pain syndrome benefits from treatments that are physical in nature, such as manual medicine and restorative movement aimed at improving postural alignment.

Research also supports the use of injections as a way to relieve pain from trigger points. For people with tender points alone however, treatment with injections has not shown to be very effective. This is one notable difference between fibromyalgia and myofascial pain syndrome as published in medical literature. So, if you are considering injections for myofascial pain or for fibromyalgia, ask your doctor for more information.

Sources:

Rachlin, E. Myofascial Pain and Fibromyalgia: Trigger Point Management. Mosby-Year Book. 1994. St. Louis.

Simons, D., MD, Travell, J. MD, Simons, L., PT. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 1 Upper Half of the Body. 2nd Edition. Williams & Wilkins A Waverly Company 1999. Baltimore.

Wolfe, F., et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia (embedded pdf). Report of the Multicenter Criteria Committee.

Coster, L, et. Al. Chronic widespread musculoskeletal pain – A comparison of those who meet criteria for fibromyalgia and those who do not. Eur J Pain. Nov 14 2007.

Staud, R. Are tender point injections beneficial: the role of tonic nociception in fibromyalgia. Curr Pharm Des. 2006.

Staud, R. Treatment of fibromyalgia and its symptoms. Expert Opin Pharmacother. Aug. 2007.

Borg-Stein, J. Stein, J. Trigger points and tender points: one and the same? Does injection treatment help? Rheum Dis Clin North Am. May 1996.

Schneider, MJ. Comment in: Tender points/fibromyalgia vs. trigger points/myofascial pain syndrome: a need for clarity in terminology and differential diagnosis. J Manipulative Physiol Ther. July-Aug 1995

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