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Breaking the Shell: Understanding centralization and myofascial trigger point's effects in Fibromyalgia
Wednesday 1 February 2012
As an RN, patient, published author, advocate, and past medical/nursing educator, I have great respect for the educational process; therefore, I have crucial concerns for the omission of chronic myofascial pain from myofascial trigger points (MTPs) as a comorbid condition, and the deletion of the anatomical tender point assessment in the “Preliminary Proposed Diagnostic Criteria for Fibromyalgia.” Though there is some debate over the tender point versus trigger point and widespread allodynia (unexplained pain), the anatomical diagram requires the examiner to touch the patient.
There are other reasons for unease. A recent news article at News Medical (1-21-12) speaks to a published study in the Journal of Psychotherapy and Psychosomatics, which suggests that a more positive lifestyle will abate the symptoms related to fibromyalgia. Certainly, it is impossible to separate the brain from the body because it is affected by signals from the peripheral, sympathetic and autonomic nervous systems, and visa versa. But to believe we can think away our symptoms and comorbid conditions is another consideration all together.
My concern (and the concern of other advocates) is that the interpretation of the new proposed diagnostic criteria for fibromyalgia will be seen as a purely somatic psychological disorder. As the criteria reads it is possible that the International Classification of Disease endorsed by the World Health Organization will move FM to the somatic/psychological ICD classification and away from the General ICD codes for the Musculoskeletal and Connective Tissue despite muscle pain (myalgia) being the number one reason people seek help from their healthcare provider. Physicians must meet the procedural changes being made in the ICD, which is used to code diagnosis by October, 2013.
No doubt, centralization in fibromyalgia is alive and well; however, the first complaint that takes us to the doctor is myofascial pain. Following are seven tips on myofascial trigger points.
Tip #1 Myofascial trigger points (MTPs) can be easily felt by a trained examiner unless behind bone or other deep muscle.
Tip #2 MTPs are either active, meaning they and their referral pattern hurt regardless of pressure applied.
Tip #3 Latent MTP hurts when pressed on.
Tip #4 Primary MTPs, can be either latent or active. The primary MTP starts the entire pain event.
Tip #5 MTPs can also cause local swelling, temperature or color changes, paresthesias (numbness) or neuralgia (nerve pain) depending on lymph vessels, nerves and blood vessels sharing its neighborhood.
Tip #6 MTPs shorten the muscle involved causing the malfunction of the muscle and increasing the work load on opposing muscles giving the term “bull in the china closet” real meaning in FM.
Tip #7 A primary MTP may be well away from the painful area, and trained therapists know to trace them according to the pain pattern.
These peripheral pain generators keep the FM brain sensitized to pain input, and they provide an objective assessment, just like a sleep study that shows dysfunctional sleep patterns in FM. If your doctor knows this, (they are included in the criteria) he/she can make appropriate referrals. Otherwise, patients will continue to feel helpless as an advocate in their own healthcare.
I do not discount the plethora of information regarding centralization in FM; symptoms and the presence of comorbid disorders exemplify it. These are things you should discuss with your doctor if you have or you suspect you have FM:
* A myofascial component has been identified in pelvic and bladder dysfunction, bruxism, migraine, TMD, RLS/PLM, visual disturbances, and cognitive dysfunction. We must remember that men have FM too, and MTPs in men lead not only to pain, but impotence. Chest wall tenderness causes difficulty taking a deep breath and in absence of fever; is most likely due to MTPs, (Qi gong and child’s pose yoga is very beneficial for this).
Skin eruptions and other consequences could be due to MTPs restricting the flow of lymph, which should normally carry cellular debris away from the area to be discarded. If a MTP is next door neighbors to one of the filters in the lymph system (the node), it can obstruct free flow and clog up filter like hair does a drain. There are many implications here for including the assessment of MTPs in fibromyalgia so proper therapies can be employed. Shouldn’t we add to the list of things to discuss with your physician?
Comorbid conditions have an effect on the centralization; they can and do interfere with orchestration of messages to the brain. It’s like the conductor (our brain) tells the cymbals to crash out of beat and the tuba to miss a note. We have all felt these effects, and I would guess you are shaking your head as you read this for the fourth or fifth time. I get it. We call it a flare. To have one day with all of the orchestra members playing in tune is our hope. Autonomic and metabolic effects, pain, dysfunction, neuralgias and neuropathies associated with MTPs should not be shunned as an unwanted band member who can’t play in key. Give it the tender loving care for which it cries out. And the band plays on, in us.
The message for hope here is to NOT let medical practitioners take their hands off of you. Ask for a thorough investigation into all of your symptoms, take in your check sheet, check or circle those that apply to you, and make sure comorbid conditions are discussed. Some of the symptoms of fibromyalgia may be attributed to other disorders that are treated differently. If need be, guide the physician to your myofascial trigger points or painful muscles. Ask for a physical therapy assessment by a therapist trained in assessing myofascial problems. And if other symptoms are plaguing you, remember, “not everything can be blamed on fibromyalgia, and the many clustering conditions and diseases deserve their day in court too.”
Celeste Cooper, RN, author,
- Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection (co-author, Jeff Miller, PhD) and Fibromyalgia Expert at Sharecare.com
The above originally appeared here.
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