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Some people with fibromyalgia tell me that trigger point injections (TPIs) put them in a tailspin, making them physically ill and their body-wide pain worse. Yet, others hail the value of TPIs for the pain relief they bring. So, why is there such disparity?
Trigger point injections treat trigger points.
The knotted up pieces of muscle fiber called trigger points (TrPs) are found in myofascial pain syndrome (MPS), not fibromyalgia. The two are distinctively different conditions with very different diagnostic criteria.
Trigger points and tender points are not the same.
Trigger points can be felt by the examiner and the pain is felt by the patient. Tender points cannot be felt by the examiner, but when the examiner applies enough pressure to cause blanching of their fingernail bed, it causes pain to the patient.
Trigger points and tender points are affected by different parts of the nervous system.
A trigger point (TrP) is a self-sustaining irritable area in a taut/tight band of muscle fiber that is felt as a nodule or bump. The irritated spot creates shortening of the muscle involved, interferes with movement, and causes pain and weakness. You know it is a trigger point, because when pressed, a TrP will radiate pain and other symptoms in a predictable pattern associated with its location. The muscle pain and dysfunction from a TrP occurs in the peripheral nervous system (which relays pain messages to the brain).
Identification of tender points (characteristic of FM) relies solely on us, the patient, to report pain when we are poked and prodded. Unlike TrPs, tender points cannot be felt by someone examining us, and they do not radiate pain or other symptoms like trigger points do. Tender points are thought to occur body-wide in fibromyalgia because of centralized pain, perception of pain that occurs within the brain, not pain from the muscle.
Confusion over terminology and abbreviations.
MTrP = myofascial trigger point
TrP = trigger point (sometimes used interchangeably with MTrP)\
TP = tender point
Misconceptions that FM and MPS are the same thing.
While myofascial pain syndrome (MPS) often coexists with fibromyalgia (FM) and many other painful conditions, it is not the same. However, if someone has both FM and MPS it is more difficult to manage and for some, even more difficult to diagnose.
People who have fibromyalgia but don’t have myofascial pain syndrome do not respond to trigger point injections because they do not have trigger points. And people with MPS who are misdiagnosed with FM do not respond to present treatments for FM.
Fibromyalgia and myofascial pain syndrome can co-exist, but treatment for TrPs is dependent on the right protocol.
Isolated muscle injury, from say a sports injury, can result in the development of TrPs. This is not the same as myofascial pain syndrome. Trigger point injection treatment for an acute sprain, strain, or other muscle injury and the TPI protocol for chronic myofascial pain varies greatly. In MPS, more than one muscle has TrPs, and many times they can be present in all four quadrants of the body (upper right and left, and lower right and left). Unlike acute TrPs, the pain associated with MPS persists.
Using steroids to treat TrPs related to MPS is contraindicated because studies suggest steroids are no more effective than a local anesthetic or dry needling. And when steroids are used (in the instance of that isolated injury), it significantly limits the number of injections. The right provider knows that some patients need 20-30 in one session, and one session is not sufficient to get all TrPs to relax and return the muscle fibers affected to their normal resting state.
So, are trigger point injections helpful for fibromyalgia pain? No! Are trigger point injections helpful for someone who has fibromyalgia and myofascial pain syndrome? Yes, when the right protocol is used.
If you wonder if you might have trigger points, feel around your body and get to know it intimately. If you feel a pea sized knot in a moderately large muscle, if it hurts before, or after, you push on it, if it radiates pain when you push on it, you have found a trigger point. Trigger points are more difficult to detect in muscles that require fine muscle movement, such as those around the face and hands, and in muscles that are buried under larger muscle or bone. In the later instance, the right practitioner knows the location by the pain pattern. This is not characteristic of fibromyalgia, but it is characteristic of myofascial pain syndrome.