Fibromyalgia vs. Myofascial Pain Syndrome
by Cynthia Webber
Learning to differentiate between fibromyalgia and chronic myofascial pain isn't as difficult as it sometimes appears to be. Dr. Devin Starlanyl has made the distinction very easy to understand on both her fibromyalgia & myofascial pain web site, and in her books. Not all doctors are able to diagnose fibromyalgia accurately, and it is possible to be given a diagnosis of fibromyalgia when what one has is chronic myofascial pain. Tender points are different than trigger points, and yet many people are given a diagnosis of fibromyalgia based upon trigger point pain.
While it is possible to have both fibromyalgia and myofascial pain, there are definite differences. One difference is that more women than men have fibromyalgia, but the ratio of men to women who have myofascial pain syndrome is equal. Also, in fibromyalgia, the muscles have generalized sensitivity, while with myofascial pain, the muscle areas that are located away from the trigger points and their referral regions have normal sensitivity. With fibromyalgia, there is total body achiness, while with myofascial pain there are specific pains in specific areas. With myofascial pain, the areas not affected by trigger points don't hurt, but with fibromyalgia, the areas outside the tender points still ache. Fibromyalgia is a neuroendocrine disorder while myofascial pain is a neuromuscular condition.
The similarities between the two conditions and a physician's lack of skill in administering the Tender Point Index test can often lead to a misdiagnosis. If we were given a choice of which condition to have, most likely we all would choose myofascial pain syndrome. It is easier to treat with massage, stretching, and exercise, or even trigger point injections. However, for any of these therapies to work, the perpetuating factors must be addressed.
Sleep disturbances occur with both conditions because trying to sleep when one is in pain is very difficult, plus living with any kind of chronic pain can lead to depression. In both cases, at least part of the fatigue, and usually the largest part, is due to lack of restorative sleep. In fibromyalgia, this is due to the neuroendocrine imbalance, and in myofascial it is due to the pain.
People with only chronic myofascial pain can improve and can return to a normal life with treatment and control over their perpetuating factors, but those with a true diagnosis of fibromyalgia don't have a specific treatment plan available that works for every one of us at this time.
Cognitive deficits in fibromyalgia are also present in myofascial pain syndrome but the deficits are due to proprioceptor dysfunction and autonomic concommittants. Also, if one is on many different medications in order to relieve pain, help sleep, or deal with depression, they may also have times when their brain seems to be in a fog. The fog of fibromyalgia is a real condition, and although it is unknown what causes it, it is specific to fibromyalgia and not myofascial pain syndrome. However, there are aspects of myofascial pain that do affect the perceptions.
Learning to differentiate between these two separate syndromes within our own bodies is easier when we learn to listen to our pain. Those of us who have both conditions can learn to feel the difference between a trigger point and a tender point, and thus we can find ways which will reduce the trigger points and the pain that they cause us. The deep aching and burning pain of a fibromyalgia flare is different than the pain of multiple trigger points which can rear their ugly heads on occasion. It is possible to reduce trigger point pain by massage or even relaxing in a bath, but during a severe fibromyalgia flare, we may not want our bodies to be touched by even a single sheet on our beds.
Our role is to learn to differentiate which syndrome we are dealing with, educate ourselves about the differences between these two syndromes, and learn how to listen to our bodies to see which type of pain we are actually dealing with so we can treat ourselves in the best possible ways.
© 1999 Cynthia Webber
Cynthia Webber was a contributing editor to Suite101.com's Coping with Fibromyalgia site, which features articles, links and discussions on living with fibromyalgia.