Myofascial Pain & Fibromyalgia 101

What a fall!

How often have too many of us heard a fibromyalgia patient say that his or her fibro started after some sort of traumatic event such as a fall, a physical assault, or a motor vehicle collision?  Often they claim that the fibro did not come on quickly but that it took many months or years to develop.  How can this be?  What's going on?

For today's discussion, let's use the example of a neck injury.  Surely many, if not most cases of neck (i.e., cervical) strain and sprain, resolve themselves within a few weeks.  However, some don't.  For a variety of reasons the neck, pain and stiffness persist despite medical treatment.  This is how a condition called "myofascial pain syndrome" (MPS) frequently develops. (See links to Dr. Travell here and  here and myofascial pain here and here.)  A muscle - or muscles - hurt as a result of the trauma,  the area doesn't heal, and, in fact, there's a new development: abnormal areas which are called "taut myofascial bands" which contain irritable places called "trigger points."  These trigger points can be extremely painful when stimulated by direct pressure on them or by stretching the muscle in which they are found.  (Understatement of the week!)   To make things worse, the pain may be felt not only WHERE the trigger point exists, but in distant areas as well.  For example, a trigger point in the neck can cause headaches, shoulder pain and/or upper back pain.

Some people get over MPS with standard treatment such as massage therapy, trigger point injections, pain medication, muscle relaxers, and so forth.  (All of which will hopefully be addressed in the future.)  However, other now-patients develop a chronic form of MPS, and still others develop fibromyalgia on top of the chronic MPS.  And how is it that this happens?  Well, I'm absolutely tickled that you asked!

It's known that fibromyalgia develops in patients who have a deficiency of deep sleep.  If the MPS sufferer is in chronic pain and sleeps poorly, he/she is at risk for developing fibro.  

There are complicated mechanisms involving "expansion of receptive fields" which also involve the neurotransmitter Substance P (for more on Substance P link to here and here).  Substance P travels from the muscle that was originally injured to other muscles causing them to hurt in turn as well.  If this happens long enough, there can actually be changes in the brain which can alter pain perception through a mechanism called "central nervous system neuroplasticity,"  This can take many months or years to evolve thus leaving the injured person with a widespread pain condition despite everything originating with "simply" a neck injury.  In 1997, this was explained in great detail in a study done in Israel by Drs. Buskila and Wolfe which was published in the journal, "Arthritis and Rheumatism."  

So, there you have it.  A neck injury can be resolved in a few weeks.  Unfortunately, it can all too often develop into MPS, and even evolve into fibro if the chronic pain condition is not addressed and controlled early.  The best way to treat this type of fibro is to prevent it. 

Can you believe it?  A short post - and you didn't think that was possible!  

Hopefully, this will allow you to better understand my earlier posts dealing with how pain medications work. In addition, I hope this helps to create a better foundation for understanding other more scientifically-oriented posts about pain in the future.  I suppose I'll have to start on creating a new tab with "definitions" - SOON! 

As always, I hope everyone's feeling their best, only better.  Ciao and paka! 


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