Skip to main content
Top
Published in: Current Pain and Headache Reports 5/2011

01-10-2011

Effects of Treatment of Myofascial Trigger Points on the Pain of Fibromyalgia

Authors: Maria Adele Giamberardino, Giannapia Affaitati, Alessandra Fabrizio, Raffaele Costantini

Published in: Current Pain and Headache Reports | Issue 5/2011

Login to get access

Abstract

Myofascial pain syndromes (MPSs) from trigger points (TrPs) and fibromyalgia syndrome (FMS) are common musculoskeletal pain conditions that frequently coexist in the same patients. In recent decades, it has become evident that these entities greatly influence each other’s clinical expression. FMS is mainly rooted in the central nervous system, while TrPs have a peripheral origin. However, the nociceptive impulses from TrPs may have significant impact on symptoms of FMS, probably by enhancing the level of central sensitization typical of this condition. Several attempts have been made to assess the effects of treatment of co-occurring TrPs in FMS. We report the outcomes of these studies showing that local extinction of TrPs in patients with fibromyalgia produces significant relief of FMS pain. Though further studies are needed, these findings suggest that assessment and treatment of concurrent TrPs in FMS should be systematically performed before any specific fibromyalgia therapy is undertaken.
Literature
1.
go back to reference •• Mense S, Gerwin RD (Eds): Muscle Pain. Diagnosis and Treatment. Heidelberg, Dordrecht, London, New York: Springer; 2010: 365 pp. This book provides a comprehensive description of musculoskeletal pain conditions, particularly myofascial pain syndromes from trigger points and fibromyalgia, and critically discusses their overlap, interaction, and implications for therapy. •• Mense S, Gerwin RD (Eds): Muscle Pain. Diagnosis and Treatment. Heidelberg, Dordrecht, London, New York: Springer; 2010: 365 pp. This book provides a comprehensive description of musculoskeletal pain conditions, particularly myofascial pain syndromes from trigger points and fibromyalgia, and critically discusses their overlap, interaction, and implications for therapy.
2.
go back to reference Cummings M. Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol. 2007;21:367–87.PubMedCrossRef Cummings M. Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol. 2007;21:367–87.PubMedCrossRef
3.
go back to reference Borg-Stein J. Management of peripheral pain generators in fibromyalgia. Rheum Dis Clin North Am. 2002;28:305–17.PubMedCrossRef Borg-Stein J. Management of peripheral pain generators in fibromyalgia. Rheum Dis Clin North Am. 2002;28:305–17.PubMedCrossRef
4.
go back to reference Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep. 2001;5:412–20.PubMedCrossRef Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep. 2001;5:412–20.PubMedCrossRef
5.
go back to reference Podichetty VK, Mazanec DJ, Biscup RS. Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgrad Med J. 2003;79:627–33.PubMedCrossRef Podichetty VK, Mazanec DJ, Biscup RS. Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgrad Med J. 2003;79:627–33.PubMedCrossRef
6.
go back to reference Mense S, Simons DG, Russell IJ, editors. Muscle pain. Understanding its nature, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 385. Mense S, Simons DG, Russell IJ, editors. Muscle pain. Understanding its nature, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 385.
7.
go back to reference Giamberardino MA, Affaitati G, Fabrizio A, Costantini R: Myofascial pain syndromes and their evaluation. Int J Clin Pharmacol Ther 2011; in press. Giamberardino MA, Affaitati G, Fabrizio A, Costantini R: Myofascial pain syndromes and their evaluation. Int J Clin Pharmacol Ther 2011; in press.
8.
go back to reference Simons DG, Travell JG, Simons LS (Eds): Travell & Simons' Myofascial Pain and Dysfunction. The Trigger Point Manual, Vol 1. Upper Half of Body, 2nd edn. Baltimore: Williams & Wilkins; 1999:1038 pp. Simons DG, Travell JG, Simons LS (Eds): Travell & Simons' Myofascial Pain and Dysfunction. The Trigger Point Manual, Vol 1. Upper Half of Body, 2nd edn. Baltimore: Williams & Wilkins; 1999:1038 pp.
9.
go back to reference Alvarez DJ, Rockwell PG. Trigger Points: diagnosis and management. Am Fam Physician. 2002;65:653–60.PubMed Alvarez DJ, Rockwell PG. Trigger Points: diagnosis and management. Am Fam Physician. 2002;65:653–60.PubMed
10.
go back to reference Majlesi J, Unalan H. Effect of treatment on trigger points. Curr Pain Headache Rep. 2010;14:353–60.PubMedCrossRef Majlesi J, Unalan H. Effect of treatment on trigger points. Curr Pain Headache Rep. 2010;14:353–60.PubMedCrossRef
11.
go back to reference Graff-Radford SB. Myofascial pain: diagnosis and management. Curr Pain Headache Rep. 2004;8:463–7.PubMedCrossRef Graff-Radford SB. Myofascial pain: diagnosis and management. Curr Pain Headache Rep. 2004;8:463–7.PubMedCrossRef
12.
go back to reference Vecchiet L, Giamberardino MA, Saggini R. Myofascial pain syndromes: clinical and pathophysiological aspects. Clin J Pain. 1991;7:16–22. Vecchiet L, Giamberardino MA, Saggini R. Myofascial pain syndromes: clinical and pathophysiological aspects. Clin J Pain. 1991;7:16–22.
13.
go back to reference Affaitati G, Fabrizio A, Savini A, et al. A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds. Clin Ther. 2009;31:705–20.PubMedCrossRef Affaitati G, Fabrizio A, Savini A, et al. A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds. Clin Ther. 2009;31:705–20.PubMedCrossRef
14.
go back to reference Vecchiet L, Giamberardino MA, de Bigontina P, Dragani L: Comparative sensory evaluation of parietal tissues in painful and nonpainful areas in fibromyalgia and myofascial pain syndrome. In Proceedings of the 7th World Congress on Pain, Progress in Pain Research and Management. Edited by Gebhart GF, Hansmond DL, Jensen TS. Vol 2. Seattle: IASP Press; 1994: 177-185. Vecchiet L, Giamberardino MA, de Bigontina P, Dragani L: Comparative sensory evaluation of parietal tissues in painful and nonpainful areas in fibromyalgia and myofascial pain syndrome. In Proceedings of the 7th World Congress on Pain, Progress in Pain Research and Management. Edited by Gebhart GF, Hansmond DL, Jensen TS. Vol 2. Seattle: IASP Press; 1994: 177-185.
15.
go back to reference Shah JP, Phillips TM, Danoff JV, Gerber LH. A in vivo microanalytical technique for measuring the local biochemical mileu of human skeletal muscle. J Appl Physiol. 2005;99:1977–84.PubMedCrossRef Shah JP, Phillips TM, Danoff JV, Gerber LH. A in vivo microanalytical technique for measuring the local biochemical mileu of human skeletal muscle. J Appl Physiol. 2005;99:1977–84.PubMedCrossRef
16.
17.
go back to reference Srbely JZ. New trends in the treatment and management of myofascial pain syndrome. Curr Pain Headache Rep. 2010;14:346–52.PubMedCrossRef Srbely JZ. New trends in the treatment and management of myofascial pain syndrome. Curr Pain Headache Rep. 2010;14:346–52.PubMedCrossRef
18.
go back to reference Scott NA, Guo B, Barton PM, Gerwin RD. Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med. 2009;10:54–69.PubMedCrossRef Scott NA, Guo B, Barton PM, Gerwin RD. Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med. 2009;10:54–69.PubMedCrossRef
19.
go back to reference Ho KY, Tan KH. Botulinum toxin A for myofascial trigger point injection: a qualitative systematic reviews. Eur J Pain. 2007;11:519–27.PubMedCrossRef Ho KY, Tan KH. Botulinum toxin A for myofascial trigger point injection: a qualitative systematic reviews. Eur J Pain. 2007;11:519–27.PubMedCrossRef
20.
go back to reference Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum. 1990;33:160–72.PubMedCrossRef Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum. 1990;33:160–72.PubMedCrossRef
21.
go back to reference Wolfe F, Clauw DJ, Fitzcharles MA, et al.: Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011 Feb 1. Epub ahead of print. Wolfe F, Clauw DJ, Fitzcharles MA, et al.: Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011 Feb 1. Epub ahead of print.
22.
go back to reference Abeles AM, Pillinger MH, Solitar BM, Abeles M. Narrative review: the pathophysiology of fibromyalgia. Ann Int Med. 2007;146:726–34.PubMed Abeles AM, Pillinger MH, Solitar BM, Abeles M. Narrative review: the pathophysiology of fibromyalgia. Ann Int Med. 2007;146:726–34.PubMed
23.
go back to reference Bennett RM. Clinical manifestations and diagnosis of fibromyalgia. Rheum Dis Clin North Am. 2009;35:215–32.PubMedCrossRef Bennett RM. Clinical manifestations and diagnosis of fibromyalgia. Rheum Dis Clin North Am. 2009;35:215–32.PubMedCrossRef
24.
go back to reference Robinson ME, Craggs JG, Price DD, et al.: Gray Matter Volumes of Pain-Related Brain Areas are Decreased in Fibromyalgia Syndrome. J Pain 2010 Dec 9. Epub ahead of print. Robinson ME, Craggs JG, Price DD, et al.: Gray Matter Volumes of Pain-Related Brain Areas are Decreased in Fibromyalgia Syndrome. J Pain 2010 Dec 9. Epub ahead of print.
25.
go back to reference Giamberardino MA: Update on Fibromyalgia Syndrome. PCU 2008; XVI(4):1-6. Giamberardino MA: Update on Fibromyalgia Syndrome. PCU 2008; XVI(4):1-6.
26.
go back to reference Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008;67:536–41.PubMedCrossRef Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008;67:536–41.PubMedCrossRef
27.
go back to reference Sommer C: Fibromyalgia: a clinical update. PCU 2010; XVIII(4):1-4. Sommer C: Fibromyalgia: a clinical update. PCU 2010; XVIII(4):1-4.
28.
29.
go back to reference Cakit BD, Taskin S, Nacir B, et al. Comorbidity of fibromyalgia and cervical myofascial pain. Clin Rheumatol. 2010;29:405–11.PubMedCrossRef Cakit BD, Taskin S, Nacir B, et al. Comorbidity of fibromyalgia and cervical myofascial pain. Clin Rheumatol. 2010;29:405–11.PubMedCrossRef
30.
go back to reference Ge HY, Nie H, Madeleine P, et al. Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain. 2009;147:233–40.PubMedCrossRef Ge HY, Nie H, Madeleine P, et al. Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain. 2009;147:233–40.PubMedCrossRef
31.
go back to reference •• Alonso-Blanco C, Fernández-de-Las-Peñas C, Morales-Cabezas M, et al.: 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. 2011 Feb 28. Epub ahead of print. This article demonstrates the high prevalence of active TrPs in multiple muscles of FMS patients, as compared to control patients, and the correlation between TrP activity and FMS pain and hypersensitivity. •• Alonso-Blanco C, Fernández-de-Las-Peñas C, Morales-Cabezas M, et al.: 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. 2011 Feb 28. Epub ahead of print. This article demonstrates the high prevalence of active TrPs in multiple muscles of FMS patients, as compared to control patients, and the correlation between TrP activity and FMS pain and hypersensitivity.
32.
go back to reference Ge HY. Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems. Curr Pain Headache Rep. 2010;14:339–45.PubMedCrossRef Ge HY. Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems. Curr Pain Headache Rep. 2010;14:339–45.PubMedCrossRef
33.
go back to reference • Ge HY, Wang Y, Danneskiold-Samsøe B, et al.: The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain. 2010;11:644-651. This article shows that most of the TePs sites in FMS are TrPs. It underlines the role of TrPs as peripheral generators of fibromyalgia pain and suggests that their inactivation may be an important option for the treatment of FMS. • Ge HY, Wang Y, Danneskiold-Samsøe B, et al.: The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain. 2010;11:644-651. This article shows that most of the TePs sites in FMS are TrPs. It underlines the role of TrPs as peripheral generators of fibromyalgia pain and suggests that their inactivation may be an important option for the treatment of FMS.
34.
go back to reference • 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 2009;145:96-104. This article emphasizes the important role of peripheral impulse input in maintaining central sensitization in FMS by showing a reduction of local and distant hyperalgesia upon anesthetic injection of the trapezius tender point. • 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 2009;145:96-104. This article emphasizes the important role of peripheral impulse input in maintaining central sensitization in FMS by showing a reduction of local and distant hyperalgesia upon anesthetic injection of the trapezius tender point.
35.
go back to reference •• Affaitati G, Costantini R, Fabrizio A, et al.: Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain 2011; 15:61-9. This article provides clear evidence of the effects of local treatment of TrPs (not coinciding with the sites of TePs) on pain symptoms of fibromyalgia using a standardized experimental approach. •• Affaitati G, Costantini R, Fabrizio A, et al.: Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain 2011; 15:61-9. This article provides clear evidence of the effects of local treatment of TrPs (not coinciding with the sites of TePs) on pain symptoms of fibromyalgia using a standardized experimental approach.
36.
go back to reference Castro-Sánchez AM, Matarán-Peñarrocha GA, Granero-Molina J, et al. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011;2011:561–73. Castro-Sánchez AM, Matarán-Peñarrocha GA, Granero-Molina J, et al. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011;2011:561–73.
37.
go back to reference Staud R. Is it all central sensitization? Role of peripheral tissue nociception in chronic musculoskeletal pain. Curr Rheumatol Rep. 2010;12:448–54.PubMedCrossRef Staud R. Is it all central sensitization? Role of peripheral tissue nociception in chronic musculoskeletal pain. Curr Rheumatol Rep. 2010;12:448–54.PubMedCrossRef
Metadata
Title
Effects of Treatment of Myofascial Trigger Points on the Pain of Fibromyalgia
Authors
Maria Adele Giamberardino
Giannapia Affaitati
Alessandra Fabrizio
Raffaele Costantini
Publication date
01-10-2011
Publisher
Current Science Inc.
Published in
Current Pain and Headache Reports / Issue 5/2011
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-011-0205-3

Other articles of this Issue 5/2011

Current Pain and Headache Reports 5/2011 Go to the issue