Understanding Fibromyalgia vs. Myofascial Pain: Symptoms, Diagnosis, & Treatments

When unraveling the intricacies of chronic musculoskeletal disorders, distinguishing between fibromyalgia and myofascial pain can be quite overwhelming. Both conditions are sources of significant discomfort, yet they diverge in their manifestations, diagnostic criteria, and therapeutic approaches.

In this article, we will explore the difference between these two conditions, highlighting their characteristic differences, whether they can coexist with each other, how they are diagnosed, and outline treatment options. So you can be better equipped with the knowledge to manage your symptoms.

Are myofascial pain syndrome & fibromyalgia the same?

It's common to mix up myofascial pain syndrome (MPS) with fibromyalgia, yet they are distinct disorders. They share some similarities, but they are unique in their own ways.

Imagine comparing myofascial pain syndrome and fibromyalgia to apples and oranges. Both are fruits that provide nutrition and grow on trees, yet they differ in taste, color, and texture. In the same vein, myofascial pain syndrome and fibromyalgia both cause chronic pain but examining their symptoms closely shows clear differences: fibromyalgia entails a wide range of problems including sleep disruption and cognitive issues, whereas myofascial pain usually originates from distinct trigger points in the body.

What is the difference between fibromyalgia & myofascial pain syndrome?

Myofascial pain syndrome and fibromyalgia are two different characters in the story of chronic musculoskeletal pain disorders. Both are chronic musculoskeletal pain disorders, but they present different symptoms.

Think of fibromyalgia as a sneaky character that spreads pain all over the body, moving around and causing trouble in different places. It's known for widespread muscle pain, fatigue, and sleep disturbances. This pain comes from the way the brain deals with signals and stimuli.

On the other hand, myofascial pain syndrome is a predictable character. Myofascial pain is localized to specific musculoskeletal regions and causes pain in specific muscles because of tight muscle fibers and trigger points that can make other areas hurt too¹. While fibromyalgia pain is like a shadow, always there but hard to pin down, myofascial pain is more like a guest who overstays its welcome in one spot.

What is fibromyalgia?

Fibromyalgia is believed to arise from a phenomenon known as central sensitization². Your central nervous system – the brain and spinal cord – is the main player in your experience with pain, and it's interpreting signals in an atypical fashion. It's as if there's a volume knob for pain perception in your brain, and in the case of fibromyalgia, it's cranked up to the maximum setting.

As a result, you may experience pain from stimuli that others might barely notice, like a gentle touch or simple movement. This heightened sensitivity is sometimes linked to an imbalance in brain chemicals, as well as malfunctioning pain inhibition pathways – ones that are supposed to mitigate the sensation of pain³.

What is myofascial pain syndrome?

The reasons behind myofascial pain syndrome are a bit of a mystery, but doctors think it might come from overuse and strain of muscles, injury, chronic stress, or the muscles not reacting in the way they should. It's like your muscles are getting mixed signals and reacting in a way that causes pain.

There are various types of myofascial pain:

• Active: These are the trigger points that are actively causing pain and are sensitive when pressure is applied. They're the main culprits for the discomfort you feel.
• Latent: These trigger points are like sleeper agents, not currently causing pain but can become active when stressed or strained.
• Secondary: These are additional trigger points that appear as a result of a primary trigger point. They're like the sidekicks to the main villain.
• Satellite: A trigger point in a muscle that is influenced by other trigger points nearby – they're interconnected, and when one is activated, it can set off its satellite counterpart, spreading the pain further.

How common is myofascial pain vs fibromyalgia?

Discovering the extent to which these disorders affect people might come as a revelation. Myofascial pain syndrome is a condition that could potentially touch the lives of up to 85% of the population at some stage⁴. On the other hand, fibromyalgia is estimated to affect 2% to 5% of people, with a higher incidence among middle-aged women⁵.

Can fibromyalgia coexist with myofascial pain?

Can fibromyalgia and myofascial pain syndrome happen at the same time? The short answer is yes. Imagine your body is like a big city, with lots of different neighborhoods. Fibromyalgia is like a storm that affects the whole city, causing widespread pain and making you feel tired and sleep poorly. Myofascial pain syndrome, on the other hand, is like construction noise in just one neighborhood, causing pain in specific muscles.

When someone has both conditions, it's like dealing with the storm and the construction at the same time – it can be a lot to handle and makes figuring out the best way to help even trickier.

How are either of these conditions diagnosed?

To distinguish between fibromyalgia and myofascial pain syndrome, medical professionals employ their expert discernment. They perform thorough physical exams and delve into the patient's health history to spot the hallmarks of each disorder, which might include tender points for fibromyalgia and trigger points for myofascial pain syndrome.

Fibromyalgia

Diagnosing fibromyalgia typically depends on patients' descriptions of their pain and related symptoms. The earlier method of pinpointing tender points has evolved into a broader assessment. Nowadays, healthcare providers engage in detailed conversations with patients about their pain and other symptoms, including chronic fatigue, sleep disturbances, and mood challenges.

In 2010, the American College of Rheumatology introduced the Widespread Pain Index and the Symptom Severity Scale to better measure the patient's pain and its impact on their everyday life. For a fibromyalgia diagnosis to be confirmed, the patient must have experienced widespread pain for at least three months, and other possible reasons for the pain must be ruled out.

The diagnostic criteria set by the American College of Rheumatology now cover a wider range of fibromyalgia symptoms, offering a more comprehensive view of the patient's health status.

Myofascial pain syndrome

Diagnosing myofascial pain syndrome involves a combination of patient history, physical examination for trigger points, and ruling out other conditions. While imaging tests like ultrasound or MRI can help exclude other causes, they don't show trigger points directly.

Identifying trigger points vs tender points

A trigger point in myofascial pain is a specific spot that hurts when you press it, and it can make pain shoot to other places. Tender points in fibromyalgia don't do that; they're just generally sore areas.

Treatment modalities: Addressing pain & symptoms

It's essential to distinguish between myofascial pain syndrome and fibromyalgia when considering treatment strategies. Treatments that bring relief for myofascial pain syndrome might not be suitable for those with fibromyalgia.

Treating myofascial pain syndrome

For those dealing with myofascial muscle pain you might try:

• physical therapy, including specific strengthening exercises and treatments – one method is called spray-and-stretch, which uses a cooling spray on the muscle before gently stretching it
• trigger point injections, a medicated injection into the painful muscle, which can bring relief to some people
• massage therapy
• acupuncture⁷ or dry needling
• TENS, which uses electrical currents, ultrasound therapy, which uses sound waves, or shock wave therapy
• medications, such as pain relievers or muscle relaxants.

Various medications are employed to control discomfort and enhance quality of life.

• Non-prescription analgesics such as ibuprofen and naproxen sodium come in forms like creams and patches.
• Muscle relaxants, for example clonazepam⁶.
• Topical remedies with capsaicin or lidocaine serve the purpose of alleviating pain.

Treating fibromyalgia

For treating fibromyalgia, doctors recommend a multidisciplinary approach that may include medications, talking to a therapist, physical therapy, and regular, gentle exercise.

Medication

For those living with fibromyalgia, treatment encompasses more than just medication. Pharmaceuticals can be part of a comprehensive approach that integrates educational, lifestyle, and psychological interventions to manage pain effectively.

Typical medicinal approaches include:

• common pain relievers available over the counter, such as acetaminophen and naproxen
• antidepressants, for instance, sertraline and fluoxetine
• specific pain medications like Low Dose Naltrexone (LDN)
• anticonvulsants, which have been found to aid nerve pain, including drugs like topiramate and carbamazepine.

Retraining your pain

To understand how we can influence our brain's interpretation of pain, it's important to realize that pain is not just a physical feeling. It's a complex experience that's influenced by your emotions, thoughts, and the environment around you.

The first step is to identify what makes your pain worse, like stress, negative thinking, or certain activities. Once you know these triggers, you can start to change them. This might mean eating differently, getting better sleep, being more active, or learning new ways to think about and respond to these triggers. With time and practice, you can teach your brain to deal with pain differently, which could make it less intense and less of a problem in your life.

Stress management

While stress is an inevitable aspect of human experience, mastering its management can significantly mitigate its impact on your body. Developing proficiency in stress management techniques can diminish the likelihood of everyday stressors manifesting as physical pain.

There are effective strategies to reduce stress, such as engaging in cognitive behavioral therapy (CBT) and practicing mindfulness, which can sharpen your cognitive processes, anchor you in the present, and foster relaxation. Additionally, it's beneficial to seek out social support, whether through conversations with friends, counseling sessions, or participation in support groups where you can express your emotions and receive encouragement.

Movement & exercise

Initiating a regimen of physical activity may appear challenging, but the payoff in terms of pain relief is worth it. Engaging in physical activities not only lifts your mood but also increases your energy and promotes healthier sleep patterns.

It's important to find physical activities that you enjoy and are suitable for your physical condition, such as yoga, light dancing, or even tending to a garden.

Gentle stretching and low-impact activities like walking can also help alleviate muscle stiffness. As you gain flexibility, you may find that your pain diminishes, which can enhance your overall sense of wellness.

Start with simple, easy exercises and gradually build up your strength and endurance. Remember to be kind and patient with yourself as you progress, allowing your body to guide you in safely increasing your activity level.

Sleep quality

Sleep acts as a rejuvenating agent for those battling fibromyalgia, playing a critical role in pain management.

Achieving restorative sleep can be a challenge for fibromyalgia sufferers, yet it's essential for aiding the body's recovery process. To enhance your sleep quality and overall well-being, consider these tips:

• Establish a regular sleep schedule by aiming for eight hours of sleep and maintaining consistent bedtimes and wake-up times.
• Limit naps to short durations to prevent them from disrupting your nighttime sleep.
• Engage in daytime activities to promote easier sleep onset at night.
• Implement a pre-sleep routine that excludes electronic devices, allowing your mind to transition into a state of relaxation.
• Design your sleep environment to be conducive to rest, ensuring it is dark and tranquil.
• Monitor your caffeine intake, particularly in the latter part of the day, as it can linger in your system and impede sleep.
• Avoid heavy meals and alcohol close to bedtime as they can have a detrimental effect on sleep quality.
• Dedicate time to relaxing activities outside of sleep that can aid in better sleep and symptom management.

Physical therapy approaches

Using a source of gentle heat, such as a warm towel or a heating pad, can serve as a beneficial preliminary step before starting any physical activity. The warmth helps to alleviate your discomfort, facilitating a more comfortable experience during exercise. This soothing effect is due to the heat's ability to relax your muscles, which in turn diminishes the pain that can come from stretching or engaging in physical exercises.

More information

At MoreGoodDays®, our mission is to empower you in navigating life with fibromyalgia. Recognizing the profound impact this condition can have on your daily routine, we've crafted a suite of resources and strategies that are straightforward and actionable. Our aim is to provide you with knowledge about fibromyalgia and practical methods for managing the pain and exhaustion that often accompany it.

We are committed to guiding you towards a more vibrant and fulfilling life, even amidst the challenges posed by fibromyalgia.

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