Distinguishing Myofascial Syndrome from Fibromyaigia
What distinguishes MFS from fibromyalgia is that MFS is not usually associated with poor sleep or chronic fatigue, although some patients may have a little bit of both. Trigger points of MFS do not go away by getting the patient to sleep better. Since a patient can have both fibromyalgia and MFS, treating the fibromyalgia may improve things. However, persistent painful areas may be the result of MFS. For example, a patient may experience headaches and have classic fibromyalgia. Following the fibromyalgia protocol makes the patient feel much better, but the headache persists. Upon reexamination, the patient's physician finds the same mid-trapezoidal trigger points described above, greater on the right than the left. It turns out that the patient carries a heavy laptop every day on the right shoulder. When the trigger point is pressed upon very firmly, the patient develops neck pain that evolves into a migraine. Treating the trigger point and having the patient stop carrying the laptop for a while will result in resolution of the headaches. What has been described is, of course, the ideal diagnostic situation. Some patients may not develop the migraine right there in the office. However, anyone with unexplained headaches should have an evaluation for the presence of trigger points. The same is true for any persistent muscular pain that appears to be nondermatomal in origin.
- Repetitive motions; excessive exercise; muscle strain due to overactivity
- Lack of activity (eg, leg or arm in a sling)
- Nutritional deficiencies
- Nervous tension or stress
- Generalized fatigue
- Sudden trauma to muscles, ligaments, or tendons
- Hormonal changes (eg, premenstrual syndrome or menopause)
A Link to Depression and Anxiety
Many painful conditions, including headaches, migraines, temporomandibular joint (TMJ) pain, and muscle pain improve when trigger points associated with MFS are identified and treated. However, chronic pain may affect people emotionally, and many people with MFS experience depression or anxiety disorders. It may be beneficial to consult a mental health professional in addition to a regular physician (Glaros 2000) (see Life Extension’s Depression, Anxiety, and Stress Management protocols for additional information).
Antidepressants are often prescribed for the treatment of MFS. At low doses, medications, such as tricyclic antidepressants relax muscles, improve sleep, and help regulate neurotransmitter activity that contributes to associated pain. At higher doses, they will help relieve depression, but have side effects that often preclude long-term use.