Pain syndrome; fibromyalgia, myofascial pain syndrome treatment & physical therapy managment

In this article we will learn about pain syndrome which are Fibromyalgia and myofascial pain syndrome their causes, symptoms and physical therapy managment with indications and contraindications.


Fibromyalgia (FM) and myofascial pain syndrome (MPS) are chronic pain syndromes that are often confused and interchanged. Each has a distinct proposed etiology. Individuals with FM process nociceptive signals differently from individuals without FM,48 and individuals with MPS have localized changes in the muscle.59 Although there are some similarities, the differences are significant and determine the method of treatment.


is a chronic condition characterized by widespread pain that covers half the body (right or left half, upper or lower half) and has lasted for more than 3 months. Additional symptoms include 11 of 18 tender points at specific sites throughout the body ,  nonrestorative sleep, and morning stiffness. A final common

problem is fatigue with subsequent diminished exercise tolerance.

Characteristics of FM

The characteristics of FM include the following. The first symptoms of FM can occur at any age but usually appear during early to middle adulthood. For more than 30% of those diagnosed, the symptoms develop after physical trauma such as a motor vehicle accident or a viral infection.

Although the symptoms vary from individual to individual, there are several hallmark complaints. Pain is usually  described as muscular in origin and is predominantly reported to be in the scapula, head, neck, chest, and low back. Another common report is a significant fluctuation in symptoms. Some days an individual may be pain-free, whereas other days the pain is markedly increased. Most individuals report that when they are in a cycle where the symptoms are diminished they try to do as much as possible. This is usually followed by several days of worsening symptoms and an inability to carry out their normal daily activities. This is often the response to exercise.. Individuals with FM have a higher incidence of tendonitis,Headaches, irritable bowel, temporal mandibularMjoint dysfunction, restless leg syndrome, mitral valve prolapse, anxiety, depression, and memory problems.

Contributing Factors to a Flare

Although FM is a noninflammatory, nondegenerative, nonprogressive disorder, several factors may affect the severity of symptoms. These factors include environmental stresses, physical stresses, and emotional stresses. FM is not caused by these various stresses, but it is aggravated by them. Environmental stresses include weather changes, especially significant changes in barometric pressure, cold, dampness, fog, and rain. An additional environmental stress is fluorescent lights. Physical stresses include repetitive activities, such as typing, playing piano, vacuuming; prolonged periods of sitting and/or standing; and working rotating shifts. Emotional stresses are any normal life stresses.


Research supports the use of exercise, particularly aerobic exercise, to reduce the most common symptoms associated with FM.

In addition to exercise, interventions include:

§  Prescription medication

§  Over-the-counter medication

§  Instruction in pacing activities, in an attempt to avoid

§  fluctuations in symptoms

§  Avoidance of stress factors

§  Decreasing alcohol and caffeine consumption

§  Diet modification.



Myofascial Pain Syndrome

Myofascial pain syndrome is defined as a chronic, regional pain syndrome.38 The hallmark classification of MPS comprises the myofascial trigger points (MTrPs) in a muscle which have a specific referred pattern of pain. The trigger point is defined as a hyperirritable area in a tight band of muscle. The pain from these points is described as dull, aching, and deep. Additional impairments from the trigger points include decreased ROM when the muscle is being stretched, decreased strength in the muscle, and increased pain with muscle stretching. The trigger points may be active(producing a classic pain pattern) or latent.

myofascial pain


Possible Causes of Trigger Points

Although the etiology of trigger points is not completely understood, some potential causes are:

Chronic overload of the muscle that occurs with repetitive activities or that maintain the muscle in a shortened position.

Acute overload of muscle, such as slipping and catchingoneself, picking up an object that has an unexpected weight, or following trauma such as in a motor vehicle

accident. Poorly conditioned muscles compared to muscles that are exercised on a regular basis.

Postural stresses such as sitting for prolonged periods of time, especially if the workstation is not ergonomically correct, and leg length differences. Poor body mechanics with lifting and other activities.

Management—Myofascial Pain Syndrome

Treatment consists of three main components: eliminating the trigger point, correcting the contributing factors, and strengthening the muscle.If the cause of the trigger point is a chronic overload of the muscle, the contributing factor should be eliminated prior to addressing the trigger point. When ROM is restored and the trigger point has been addressed, muscle strengthening is initiated. Several

techniques are used to eliminate trigger points. Contract–relax–passive stretch done repeatedly until the

muscle lengthens Contract–relax–active stretch also done in repetition ,Trigger point release

Spray and stretch ,Dry needling or injection


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