Myofascial pain syndrome (MPS) and fibromyalgia (FM) have similar symptoms. Due to their similarities, sometimes these conditions are lumped together as one. Fibromyalgia is systemic, and myofascial pain syndrome is localized. Doctors not familiar with these conditions may mistake one for the other. With a physical exam and a detailed medical history, experienced doctors can distinguish these conditions from one another.
What Causes Myofascial Pain Syndrome and Fibromyalgia?
The reasons an individual develops MPS or FM can be unclear. However, scientists have provided a lot of plausible theories. One possible cause of MPS and FM is central sensitization. When someone has this condition, their brain is always on high alert, which causes them to perceive normal sensations as painful. This pain can be mild or severe.
Stress and sleep disturbances can also contribute to an individual developing MPS or FM. Physical trauma resulting from an injury or strenuous repetitive activity frequently triggers the onset of MPS. Since fibromyalgia is more common in women than men, hormones may play a role in the development of this condition.
Symptom Similarities and Differences Between MPS and FM
As previously mentioned, these conditions do share some symptoms.
Common symptoms of MPS and FM include:
- Fatigue.
- Muscle pain (from mild to severe).
- Headaches.
- Irritable bowel syndrome (e.g., diarrhea or constipation).
- Tingling sensations.
- Numbness.
- Migraines.
- Sleep disturbances.
Symptom differences between myofascial pain syndrome and fibromyalgia include:
- The location of the pain is probably the main difference in the symptoms of these two conditions.
- Muscle tenderness is the main symptom of MPS and FM. However, MPS pain is regional, which means the pain develops in a specific area (e.g., the shoulder or the left side of the neck). With fibromyalgia, the individual experiences pain all over their body.
- Another difference between these two conditions is that an individual who has MPS may only experience pain for a short period of time. However, FM pain is usually chronic (i.e., long-lasting).
- Some similar symptoms are seen more frequently with FM than with MPS. These symptoms include numbness, tingling, and fatigue.
Myofascial Pain Syndrome Trigger Points
An individual with MPS will have small, hard knots or tight muscles in the affected area. Sometimes these knots and tight muscles can be felt just beneath the skin. Typically, the knot itself doesn’t hurt, but upon being pressed, pain radiates to another part of the body. This type of pain is called referred pain.
What Causes MPS Trigger Points To Develop?
A trigger point usually results from a muscle injury that doesn’t heal correctly. Studies indicate that these points develop during the healing process when nerve cells connect to muscle cells. This may be why pressing on a trigger point causes referred pain. Experts aren’t sure why some people heal normally and others don’t.
Fibromyalgia Tender Points
Fibromyalgia tender points are different from MPS in that these points represent muscles that hurt with very little manual pressure. The tender points associated with FM don’t refer pain the way the trigger points with MPS do.
What Causes the Tender Points Experienced With FM?
Doctors believe that these tender points result from involuntary muscle contractions (i.e., muscle spasms). These spasms make it difficult for the muscles to get the oxygen-filled blood they need, which leads to a buildup of carbon dioxide and acid. This buildup causes the muscles to continue spasming, increasing the pain level. It is this cyclical event that causes the ongoing pain associated with fibromyalgia.
Diagnosing Myofascial Pain Syndrome and Fibromyalgia
Diagnosing MPS or FM requires a detailed clinical examination. A general practitioner, a pain specialist, or a rheumatologist can perform this exam. The main diagnostic difference between these conditions is the location of tender points in FM and trigger points in MPS.
Methods Used To Diagnose Myofascial Pain Syndrome
An experienced physician can find trigger points simply by pressing on them. Although the pain experienced with MPS is localized, it can be widespread. For instance, the root of an individual’s pain may be along the right side of the neck and back, with the pain referring down the right arm.
A physician can also order a tissue biopsy or magnetic resonance elastography (MRE) to help verify an MPS diagnosis. An MRE identifies stiff body tissues by combining magnetic resonance imaging with low-frequency vibrations.
Diagnosing Fibromyalgia
Most of the time, an individual receives an FM diagnosis based on the patient’s report of widespread pain. In addition, during a physical examination, the physician can press on certain areas to determine if they are tender.
Additional Diagnostic Tests
A physician can use blood tests to rule out other medical conditions that cause pain. One test that can help ensure that an underlying inflammatory process isn’t causing the pain a patient is experiencing is an erythrocyte sedimentation rate (ESR). To rule out thyroid disease, a doctor may order a thyroid-stimulating hormone (TSH) test. When a patient has FM, the results of these blood tests should be normal.
A sleep study can also be used to help diagnose fibromyalgia because many people with this condition experience sleep disturbances.
Potential Treatments Specifically for MPS
Just as with the symptoms, the potential treatments for MPS and FM overlap to some degree. However, there are also important differences between the two.
Trigger-Point Injections (aka Dry Needling)
This treatment loosens up the tight muscle band, which helps reduce pain. A physician inserts a needle into the trigger point itself or several places surrounding it. Sometimes the doctor also injects a pain medication into the area (e.g., lidocaine). These injections aren’t helpful for people with fibromyalgia.
Potential Treatments for Both MPS and FM
Physical Therapy
Spray-and-stretch is a special type of therapy frequently used to treat MPS. During this treatment, a physical therapist sprays a numbing substance on the patient’s muscles while guiding them through a variety of stretching exercises.
Patients with fibromyalgia can benefit from physical therapy because they can learn ways to strengthen their muscles and increase their range of motion.
Improving Posture
Since poor posture can contribute to the symptoms associated with fibromyalgia and myofascial pain syndrome, a physical therapist may be able to help the patient work on improving their posture.
Massage
Therapists can use specific massage techniques to loosen tight muscles, which reduces stiffness and pain.
K-Laser Therapy (aka High-Power Laser Therapy)
The wavelengths of light that the K-Laser uses are designed to enhance the body’s natural healing process. After passing through the skin, this laser enters a variety of cells (e.g., soft tissue, cartilage, ligaments, and nerves) to initiate photobiostimulation.
Photobiostimulation stimulates the release of collagen and endorphins and enhances the body’s natural regenerative functions. This treatment can reduce pain, inflammation, stiffness, and spasms. The goal of this therapy is to eventually normalize damaged tissues.
Oral Medications
Some of the most common medications that people with MPS use include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), including Advil and Aleve.
- The serotonin-norepinephrine reuptake inhibitor Cymbalta.
- Tricyclic antidepressants (e.g., Elavil).
- Muscle relaxants (e.g., Flexeril).
Medications that people with FM may find helpful include:
- The anticonvulsant Lyrica (pregabalin).
- Antidepressants (Elavil or Cymbalta) may also be helpful.
Acupuncture
This ancient Chinese practice is similar to trigger point injections. Although studies about how beneficial acupuncture is for treating MPS are limited, those that exist are promising. Many practitioners and patients report positive results. Acupuncture can also help people with fibromyalgia find relief.
Topical Medications
Topical medications are available in gels, creams, and sprays. Applying pain relief medication (e.g., lidocaine and capsaicin) to FM tender points or MPS trigger points can help reduce pain.
Most of the time, doctors recommend a multidisciplinary approach that includes a combination of medication and therapy.
The only way to find out if you have myofascial pain syndrome or fibromyalgia is to seek medical care from an experienced physician.
Dealing with Chronic Pain 