We use cookies to improve your experience. By continuing to browse this site, you accept our cookie policy.×
Skip main navigation
Aging Health
Bioelectronics in Medicine
Biomarkers in Medicine
Breast Cancer Management
CNS Oncology
Colorectal Cancer
Concussion
Epigenomics
Future Cardiology
Future Medicine AI
Future Microbiology
Future Neurology
Future Oncology
Future Rare Diseases
Future Virology
Hepatic Oncology
HIV Therapy
Immunotherapy
International Journal of Endocrine Oncology
International Journal of Hematologic Oncology
Journal of 3D Printing in Medicine
Lung Cancer Management
Melanoma Management
Nanomedicine
Neurodegenerative Disease Management
Pain Management
Pediatric Health
Personalized Medicine
Pharmacogenomics
Regenerative Medicine

Myofascial pain and fibromyalgia: two different but overlapping disorders

    César Fernández-de-las-Peñas

    *Author for correspondence:

    E-mail Address: cesar.fernandez@urjc.es

    Department of Physical Therapy, Occupational Therapy, Rehabilitation & Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

    Cátedra de Investigación y Docencia en Fisioterapia, Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

    Centre for Sensory-Motor Interaction (SMI), Department of Health Science & Technology, Aalborg University, Aalborg, Denmark

    &
    Lars Arendt-Nielsen

    Centre for Sensory-Motor Interaction (SMI), Department of Health Science & Technology, Aalborg University, Aalborg, Denmark

    Published Online:https://doi.org/10.2217/pmt-2016-0013

    There is good evidence supporting that people with fibromyalgia syndrome (FMS) exhibit central sensitization. The role of peripheral nociception is under debate in FMS. It seems that widespread pain experienced in FMS is considered multiple regional pains; therefore, several authors proposed that muscles play a relevant role in FMS. Trigger points (TrPs) have long been a contentious issue in relation to FMS. Preliminary evidence reported that the overall spontaneous pain is reproduced by referred pain from active TrPs, suggesting that FMS pain is largely composed of pain arising, at least partially, from TrPs. Finally, there is preliminary evidence suggesting that management of TrPs is able to modulate the CNS and is effective for reducing pain in FMS, although results are conflicting and future studies are clearly needed.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

    References

    • 1 Clauw DJ. Fibromyalgia: a clinical review. JAMA 311, 1547–1555 (2014).
    • 2 Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr. Pain Headache Rep. 17, 356 (2013).
    • 3 Branco JC, Bannwarth B, Failde I et al. Prevalence of fibromyalgia: a survey in five European countries. Semin. Arthritis Rheum. 39, 448–453 (2010).
    • 4 Lawrence RC, Felson DT, Helmick CG et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part II. Arthritis Rheum. 58, 26–35 (2008).
    • 5 Staud R. Is it all central sensitization? Role of peripheral tissue nociception in chronic musculoskeletal pain. Curr. Rheumatol. Rep. 12, 448–454 (2010).
    • 6 Üceyler N, Zeller D, Kahn A et al. Small fibre pathology in patients with fibromyalgia syndrome. Brain 136, 1857–1867 (2013).
    • 7 English B. Neural and psychosocial mechanisms of pain sensitivity in fibromyalgia. Pain Manag. Nurs. 15, 530–538 (2014). • Discusses the neurophysiological aspects of pain sensitivity in people with fibromyalgia syndrome (FMS).
    • 8 Montoya P, Pauli P, Batra A, Wiedemann G. Altered processing of pain-related information in patients with fibromyalgia. Eur. J. Pain 9, 293–303 (2005).
    • 9 Desmeules JA, Cedrashi C, Rapiti E et al. Neurophysiologic evidence for a central sensitization in patients with fibromyalgia. Arthritis Rheum. 48, 1420–1429 (2003).
    • 10 Petzke F, Clauw DJ, Ambrose K, Khine A, Gracely RH. Increased pain sensitivity in fibromyalgia: effects of stimulus type and mode of presentation. Pain 105, 403–413 (2003).
    • 11 Staud R, Rodriguez ME. Mechanisms of disease: pain in fibromyalgia syndrome. Nat. Clin. Pract. Rheumatol. 2, 90–98 (2006).
    • 12 DeSantana JM, Sluka KA. Central mechanisms in the maintenance of chronic widespread non-inflammatory muscle pain. Curr. Pain Headache Rep. 12, 338–343 (2008).
    • 13 Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science 288, 1765–1769 (2000).
    • 14 May A. Chronic pain may change the structure of the brain. Pain 137, 7–15 (2008).
    • 15 Cagnie B, Coppieter I, Denecker S, Six J, Danneels L, Meeus M. Central sensitization in fibromyalgia? A systematic review of structural and functional brain MRI. Semin. Arthritis Rheum. 44, 68–75 (2014). •• This review confirms the presence of common structural and functional changes in the brain in people with FMS.
    • 16 Mendell LM, Wall PD. Responses of single dorsal cord cells to peripheral cutaneous unmyelinated fibres. Nature 206, 97–99 (1965).
    • 17 Staud R, Nagel S, Robinson ME, Price DD. Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. Pain 145, 96–104 (2009).
    • 18 Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, Giamberardino MA. Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur. J. Pain 15, 61–69 (2011). •• This clinical trial supports the role of peripheral nociception for the treatment of individuals with FMS.
    • 19 Staud R. Peripheral pain mechanisms in chronic widespread pain. Best Pract. Res. Clin. Rheumatol. 25, 155–164 (2011).
    • 20 Hoheisel U, Mense S. Response behaviour of cat dorsal horn neurones receiving input from skeletal muscle and other deep somatic tissues. J. Physiol. 426, 265–280 (1990).
    • 21 Schaible HG, Schmidt RF, Willis WD. Convergent inputs from articular, cutaneous and muscle receptors onto ascending tract cells in the cat spinal cord. Exp. Brain Res. 66, 479–488 (1987).
    • 22 Wall PD, Woolf CJ. Muscle but not cutaneous C-afferent input produces prolonged increases in the excitability of the flexion reflex in the rat. J. Physiol. 356, 443–458 (1984).
    • 23 Bennett R. Fibromyalgia: present to future. Curr. Rheumatol. Rep. 7, 371–376 (2005).
    • 24 Vierck CJ. Mechanisms underlying development of spatially distributed chronic pain (fibromyalgia). Pain 124, 242–263 (2006).
    • 25 Mense S, Gerwin RD. Muscle Pain: Understanding the Mechanisms. Springer-Verlag, Berlin, Germany (2010).
    • 26 Graven-Nielsen T, Mense S. The peripheral apparatus of muscle pain: evidence from animal and human studies. Clin. J. Pain 17, 2–10 (2001).
    • 27 Gandevia SC, Phegan C. Perceptual distortions of the human body image produced by local anaesthesia, pain and cutaneous stimulation. J. Physiol. 15, 609–616 (1999).
    • 28 Graven-Nielsen T. Fundamental of muscle pain: referred pain and deep tissue hyperalgesia. Scand. J. Rheumatol. 122, 1–43 (2006).
    • 29 Staud R, Price DD, Robinson ME, Vierck CJ. Body pain area and pain-related negative affect predict clinical pain intensity in patients with fibromyalgia. J. Pain 5, 338–343 (2004).
    • 30 Staud R, Vierck CJ, Robinson ME, Price DD. Overall fibromyalgia pain is predicted by ratings of local pain and pain related negative affect: possible role of peripheral tissues. Rheumatology 45, 1409–1415 (2006).
    • 31 Gerwin RD. A review of myofascial pain and fibromyalgia: factors that promote their persistence. Acup. Med. 23, 121–134 (2005).
    • 32 Bennett RM, Goldenberg DL. Fibromyalgia, myofascial pain, tender points and trigger points: splitting or lumping? Arthritis Res. Ther. 13, 117 (2011). • This letter opens the discussion about trigger and tender points in fibromyalgia.
    • 33 Chandola HC, Chakraborty A. Fibromyalgia and myofascial pain syndrome: a dilemma. Indian J. Anaesth. 53, 575–581 (2009).
    • 34 Harden RN, Bruehl SP, Gass S et al. Signs and symptoms of the myofascial pain syndrome: a national survey of pain management providers. Clin. J. Pain 16, 64–72 (2000).
    • 35 Wolfe F, Smythe HA, Yunus MB et al. The American College of Rheumatology 1990 criteria for classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum. 33, 160–170 (1990).
    • 36 Wolfe F, Clauw DJ, Fitzcharles MA et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 62, 600–610 (2010).
    • 37 Kamaleri Y, Natvig B, Ihlebaek C M, Bruusgaard D. Localized or widespread musculoskeletal pain: does it matter? Pain 138, 41–46 (2008).
    • 38 Graven-Nielsen T, Sörensen J, Henriksson KG et al. Central hyperexcitability in fibromyalgia. J. Musculoskeletal Pain 7(1/2), 261–271 (1999).
    • 39 McVeigh JG, Finch MB, Hurley DA, Basford JR, Sim J, Baxter GD. Tender point count and total myalgic score in fibromyalgia: changes over a 28-day period. Rheumatol. Int. 27, 1011–1018 (2007).
    • 40 Petzke F, Gracely RH, Park KM, Ambrose K, Clauw DJ. What do tender points measure? Influence of distress on 4 measures of tenderness. J. Rheumatol. 30, 567–574 (2003).
    • 41 Henriksen M, Lund H, Christensen R et al. Relationships between the fibromyalgia impact questionnaire, tender point count, and muscle strength in female patients with fibromyalgia: a cohort study. Arthritis Rheum. 61, 732–739 (2009).
    • 42 Ashina M, Stallknecht B, Bendtsen L et al. Tender points are not sites of ongoing inflammation – in vivo evidence in patients with chronic tension-type headache. Cephalalgia 23, 109–116 (2003).
    • 43 Muro-Culebras A, Cuesta-Vargas AI. Sono-myography and sono-myoelastrography of the tender points of women with fibromyalgia. Ultrasound Med. Biol. 39, 1951–1957 (2013). •• Shows no structural changes in tender points in subjects with FMS.
    • 44 Simons DG, Travell J, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual Volume 1 (2nd Edition). Williams & Wilkins, Baltimore, MD, USA (1999).
    • 45 Shah JP, Phillips TM, Danoff JV, Gerber L. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J. Appl. Physiol. 99, 1977–1984 (2005).
    • 46 Shah JP, Danoff JV, Desai MJ et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch. Phys. Med. Rehabil. 89, 16–23 (2008).
    • 47 Li LT, Ge HY, Yue SW, Arendt-Nielsen L. Nociceptive and non-nociceptive hypersensitivity at latent myofascial trigger points. Clin. J. Pain 25, 132–137 (2009).
    • 48 Wang YH, Ding X, Zhang Y et al. Ischemic compression block attenuates mechanical hyperalgesia evoked from latent myofascial trigger point. Exp. Brain Res. 202, 265–267 (2010).
    • 49 Kuan TS, Hong CZ, Chen JT, Chen SM, Chien CH. The spinal cord connections of the myofascial trigger spots. Eur. J. Pain 11, 624–634 (2007).
    • 50 Xu YM, Ge HY, Arendt-Nielsen L. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects. J. Pain 11, 1348–1355 (2010).
    • 51 Srbely JZ, Dickey JP, Bent LR, Lee D, Lowerison M. Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans. J. Pain 11, 636–643 (2010).
    • 52 Ge HY, Fernández-de-las-Penas C, Arendt-Nielsen L. Sympathetic facilitation of hyperalgesia evoked from myofascial tender and trigger points in patients with unilateral shoulder pain. Clin. Neurophysiol. 117, 1545–1550 (2006).
    • 53 Kumbhare DA, Elzibak AH, Noseworthy M. Assessment of myofascial trigger points using ultrasound. Am. J. Phys. Med. Rehabil. 95, 72–78 (2016).
    • 54 Brezinschek H. Mechanisms of muscle pain: significance of trigger points and tender points. Z. Rheumatol. 67, 653–657 (2008).
    • 55 Wolfe F, Simons DG, Fricton J et al. The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. J. Rheumatol. 19, 944–951 (1992).
    • 56 Bengtsson A, Henriksson KG, Jorfeldt L, Kagedal B, Lennmarken C, Lindstrom F. Primary fibromyalgia: a clinical and laboratory study of 55 patients. Scand. J. Rheumatol. 15, 340–347 (1996).
    • 57 Ge HY, Nie H, Madeleine P, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L. Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain 147, 233–240 (2009).
    • 58 Alonso-Blanco C, Fernández-de-Las-Peñas C, de-la-Llave-Rincón AI, Zarco-Moreno P, Galán-Del-Río F, Svensson P. Characteristics of referred muscle pain to the head from active trigger points in women with myofascial temporo-mandibular pain and fibromyalgia syndrome. J. Headache Pain 13, 625–637 (2012).
    • 59 Ge HY, Wang Y, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L. The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J. Pain 11, 644–651 (2010). •• This is the first controlled study demonstrating that the tender point sites used for diagnosis of FMS are trigger point areas.
    • 60 Ge HY, Wang Y, Fernández-de-las-Peñas C, Graven-Nielsen T, Danneskiold-Samsøe B, Arendt-Nielsen L. Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients. Arthritis Res. Ther. 13, R48 (2011). •• This is the first study demonstrating that the overall pain pattern of individuals with FMS can be reproducible with trigger point referred pain areas.
    • 61 Alonso-Blanco C, Fernández-de-las-Peñas C, Morales-Cabezas M, Zarco-Moreno P, Ge HY, Florez-García M. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin. J. Pain 27, 405–413 (2011).
    • 62 Harris RE, Williams DA, McLean SA et al. Characterization and consequences of pain variability in individuals with fibromyalgia. Arthritis Rheum. 52, 3670–3674 (2005).
    • 63 Xu YM, Ge HY, Arendt-Nielsen L. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects. J. Pain 11, 1348–1355 (2010).
    • 64 Niddam DM, Chan RC, Lee SH, Yeh TC, Hsieh JC. Central representation of hyperalgesia from myofascial trigger point. Neuroimage 39, 1299–1306 (2008).
    • 65 Ge HY. Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems. Curr. Pain Headache Rep. 14, 339–345 (2010).
    • 66 Ge HY, Monterde S, Graven-Nielsen T, Arendt-Nielsen L. Latent myofascial trigger points are associated with an increased intramuscular electromyographic activity during synergistic muscle activation. J. Pain 15, 181–187 (2014).
    • 67 Yuan SL, Matsutani LA, Marques AP. Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis. Man Ther. 20, 257–264 (2015).
    • 68 Meyer HP. Myofascial pain syndrome and its suggested role in the pathogenesis and treatment of fibromyalgia syndrome. Curr. Pain Headache Rep. 6, 274–283 (2002).
    • 69 Staud R. Are tender point injections beneficial: the role of tonic nociception in fibromyalgia. Curr. Pharm. Des. 12, 23–27 (2006).
    • 70 Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Effects of treatment of myofascial trigger points on the pain of fibromyalgia. Curr. Pain Headache Rep. 15, 393–399 (2011). • Discusses the role of trigger point treatment in the management of people with FMS.
    • 71 Freeman MD, Nystrom A, Centeno C. Chronic whiplash and central sensitization: an evaluation of the role of a myofascial trigger points in pain modulation. J. Brachial. Plex. Peripher. Nerve Inj. 4, 2 (2009).
    • 72 Hong CZ, Hsueh TC. Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. Arch. Phys. Med. Rehabil. 77, 1161–1166 (1996).
    • 73 Casanueva B, Rivas P, Rodero B, Quintial C, Llorca J, González-Gay MA. Short-term improvement following dry needle stimulation of tender points in fibromyalgia. Rheumatol. Int. 34, 861–866 (2014).