Here is a very good article on the difference between Fibromyalgia and Chronic Myofascial Pain, and Myofascial Trigger Point Pain. These are confusing and sometime will show up in the same patient. However, as a very wise physician I trained with told me " first get rid of all of the myofascial trigger points and myofascial pain then see how much of the fibromyalgia is left".
Dry Needling is a very effective way of treating myofascial trigger points and the referred pain that they create. At times it is too difficult to get to the trigger point using conventional manual trigger point techniques such as INIT ( Ischemic Neurologial Inhibition Technique), or ART (Active Release Techniques). In these instances the dry needling works wonderfully. If questions please email me.
Thanks:
Here is the article:
Published Online:
Monday, June 25th, 2012
Karen Cooksey
Karen Cooksey
Fibromyalgia was previously diagnosed using the 1990 American
College of Rheumatology (ACR) criteria (http://1.usa.gov/KRiJWi),
which required that physicians perform a Tender Point Test, a physical exam
that focuses on 18 specified tender points throughout the body. A diagnosis was
made when pain had been present in all four quadrants of the body for over
three months’ duration and at least 11 of these 18 points elicited pain upon
digital palpation. The 1990 ACR criteria did not take into account any symptoms
other than pain. In 2010, a preliminary new set of ACR criteria were published
in Arthritis Care & Research (http://bit.ly/KRLXEr),
in which the Tender Point Test had been replaced by an assessment of pain (ie,
the number of painful areas from a checklist of 19 specified areas) and
severity of other symptoms (including fatigue, waking unrefreshed, and
cognitive problems) over the past week. One reason that patients with
fibromyalgia experience a number of symptoms other than pain was suggested by a
study by Geisser and colleagues (http://1.usa.gov/KRM2b8)
that found that fibromyalgia is associated with central sensitization.
Unlike fibromyalgia pain, the pain in myofascial pain syndrome is
more localized or regional (along the muscle and surrounding fascia tissues)
and is associated with localized small hypersensitive nodules (ie, taut bands),
known as myofascial trigger points.
Over the years, attempts have been made in the literature to
differentiate between the tender points associated with fibromyalgia (http://1.usa.gov/NprJ62)
and the trigger points associated with myofascial pain syndrome (http://1.usa.gov/M7MrHW).
However, many researchers use the terms interchangeably, and many patients have
both tender and trigger points, causing confusion and complicating diagnosis.
“I have long maintained that tender points and trigger points are one and the
same,” says Robert M. Bennett, MD, professor of medicine and nursing at Oregon
Health and Science University.
Results of a study published by Ge and colleagues (http://1.usa.gov/LTDmTs)
suggest that fibromyalgia pain may be due in large part to active (vs. latent)
myofascial trigger points. In this study, 30 patients with fibromyalgia and 30
healthy age- and gender-matched controls were asked to draw all areas of their
current spontaneous pain on an anatomical map and rate the overall intensity of
their pain. The location of all active trigger points was then determined in
the fibromyalgia patients using manual palpation. A total of 308 active trigger
points were found in the 30 patients with fibromyalgia, and 305 of these were
confirmed by spontaneous electrical activity demonstrated on needle
electromyography. The locations of these 308 active myofascial trigger points
were then mirrored onto the 30 healthy controls as an aid to identifying latent
trigger points, and spontaneous electrical activity was found in 304 of these
latent points. The authors concluded that most of the tender point sites were
trigger points, with local and referred pain from active trigger points partly
reproducing the overall spontaneous pain pattern. The total number of active
trigger points was positively correlated with the spontaneous fibromyalgia pain
intensity. This study provided evidence of the importance of active trigger
points, which may serve as peripheral generators of fibromyalgia pain, and the
authors suggested that inactivation of active trigger points may be an
alternative for the treatment of fibromyalgia.
The findings of Ge and colleagues have been replicated by
Alonso-Blanco and colleagues (http://1.usa.gov/KEvy87), who also found that
widespread pain hypersensitivity in fibromyalgia patients was related to
increased numbers of active myofascial trigger points.
In a 2011 editorial (http://1.usa.gov/Kn05Zo),
Bennett described the technique for distinguishing between active trigger
points (which are found in patients with fibromyalgia) and latent trigger
points (which are found in healthy individuals). “Gentle palpation should be
performed across the direction of the muscle fibers in order to identify a
region of tenderness and nodularity (that is, the taut band). Continued firm
palpation of a myofascial trigger point for at least 5 seconds is required to
elicit the typical distribution of referred pain. An active myofascial trigger
point is deduced if firm pressure over the taut band reproduces the patient’s
spontaneous pain symptoms. If the pain symptoms are not reproduced, the tender
area is designated a latent trigger point.”
