People who have fibromyalgia often have symptoms of chronic myofascial pain (CMP) too. But CMP, like CFIDS, is a syndrome unto itself. Experts believe that CMP originates with a muscle lesion or strain on a particular muscle, ligament, or tendon, which in turn creates a small spastic knot called a trigger point. Trigger points cause local pain and often send pain to other parts of the body — called referred pain — sometimes quite a ways from the location of the trigger point. CMP may also come on as a result of fatigue, repetitive motion, a medical condition, or lack of activity.

To better understand CMP, consider the word myofascial. “Myo” means muscle and “fascia” means connective tissue. So myofascial pain stems from problems in muscles and connective tissue. This makes it different from FMS, which is the result of oversensitivity in the parts of your nervous system responsible for sensing and processing pain.

It appears that irritation or damage to muscles can, in some cases, cause a change in the nerves responsible for telling the muscle to contract. As a result, instead of just telling the muscle to work when you want it to, the nerve starts constantly releasing chemicals that activate the muscle. This causes that local area of muscle to go into a tight, spastic knot that actually reduces blood flow. As a result of the decrease in blood flow, the area doesn't get the oxygen it needs, and lactic acid (among other things) starts to build up. This activates nerves in the area, causing pain.

The trigger point causes pain when you try to move, and you lose range of motion. As you become increasingly resistant to moving, other muscles are summoned to compensate for the weakness. Once these other muscles are overworked, they too become vulnerable to the development of trigger points. The resulting pain is typically steady, dull, deep, and can be anything from mild to excruciating.

Symptoms and Diagnosis

People who have CMP complain about regional pain that is persistent and restricts motion. Often, the neck, shoulder, low back, and pelvic muscles are affected. You may experience tension headaches, tinnitus (a ringing of the ears), temporomandibular joint disorder, joint pain, vision problems, and torticollis (wry neck). CMP does not cause systemic problems such as joint swelling.

The key to diagnosing CMP is identifying trigger points in muscles that reproduce pain when pressed. There are actually four different kinds of trigger points, which can all be felt by palpation. Palpation is the application of pressure — usually by the diagnosing physician — on a suspected trigger point, which causes tremendous pain.

Active Trigger Points

Active trigger points spontaneously hurt, are extremely sensitive to touch, and can cause both local and referred pain. When pressed, active trigger points can sometimes produce severe pain.

Latent Trigger Points

Latent trigger points don't hurt unless someone is pressing on them. But they still cause muscle tension, restrict movement, and weaken the muscle. They can become active due to lack of exercise, injury, infection, or stress.

Secondary Trigger Points

When a muscle gets overused as the result of a trigger point elsewhere, a secondary trigger point can develop. Secondary trigger points result from muscle compensation and become highly irritable.

Satellite Trigger Points

Satellite trigger points are located inside an inactive muscle that is located in the referred pain area of an active trigger point. These trigger points are also quite irritable.

At this time, there are no lab tests or imaging studies that can diagnose CMP. Diagnosis is based on patient's self-reported pain and the ability to reproduce that pain by pressing on trigger points.

Essential

The Alexander Technique is a method that reeducates your body's movements. The method helps you ditch old habits of moving that cause discomfort and pain and helps you adopt new ways to move that are more fluid and effortless. Devotees say it can help avoid repetitive stress injuries, cure a stiff neck, and even enhance your voice.

Treating CMP

Eliminating the pain of CMP usually requires a combination of passive and active forms of physical therapy. The most common treatment is to press on the trigger point while the muscle is being stretched. This pressure should be right between “good” hurt and “bad” hurt. Some patients are given the stretch-and-spray treatment, which involves spraying the affected muscle with a coolant, then slowly stretching it. Others may undergo complementary therapies, such as massage, acupuncture, and the application of heat and cold.

In some cases, patients are given trigger-point injections of different substances including an anesthesia such as lidocaine or botulinum toxin A. Sometimes a corticosteroid is added to the treatment. But corticosteroids add little benefit and significantly increase the risk of side effects. Treatment may also involve medications for pain and sleep and/or muscle relaxants.

How CMP Differs from FMS

If you're unfortunate enough to have both conditions you may not be able to distinguish one from the other. Both conditions cause sleep disturbances and depression. And although you can have CMP and FMS at the same time, the two conditions are actually quite different.

For instance, CMP is the result of trigger points, which may occur anywhere on the body, alone or in multiple locations. Trigger points also cause referred pain, so that a trigger point on the upper back may cause pain to resonate into the lower arm.

People with FMS but not CMP do not suffer from restricted motion and will not feel the hard lumps or tight, ropy bands that are characteristic of trigger points in CMP. In addition, FMS does not cause referred pain. The pain of pure FMS tends to move around without obvious reasons, and it is not reproduced by pressure on a specific site. But FMS can make you extra sensitive to any kind of pain and make ordinary sensations painful.