The Hunt for the Correct Diagnosis: Fibromyalgia vs Myofascial Pain Syndrome
A Glance at the Latest Breakthroughs in Diagnosis and Treatment
Although hard to believe, there was a time when Fibromyalgia was treated as a “catch all diagnosis” or a diagnosis applied to any patient in diffuse, widespread chronic pain without a clear cause. As there was no initial diagnostic criteria, and the condition was poorly understood, many patients would be mislabeled with the diagnosis of “Fibromyalgia” without a clear understanding of why or how this diagnosis was reached. Fortunately, there has been a great deal of headway in defining Fibromyalgia, learning about its cause, and separating this diagnosis from other similar pain conditions.
Fibromyalgia is regarded as a chronic condition that causes intense pain all over the body as well as causes a range of other symptoms. Doctors have classified Fibromyalgia as a syndrome, which means it is comprised of signs, symptoms, and characteristics that often go hand-in-hand. A few commonly reported characteristics include “hurting all over,” “feeling exhausted,” morning stiffness, poor or un-refreshing sleep, memory impairment, and abdominal cramps. See the Centers for Disease Control Fact Sheet on Fibromyalgia.
The term Fibromyalgia was coined circa 1976. However, it wasn’t until 1990 that the American College of Rheumatology published the first diagnostic criteria. Historically, a patient was diagnosed with Fibromyalgia once other syndromes were ruled out, and was founded upon “tender points.” These tender points needed to be on both sides of the body, above and below the waist in 11 of 18 specific spots on the body (as the diagram below demonstrates). These tender points needed to persist for at least 3 months. A new paradigm in diagnosing Fibromyalgia has stirred the medical community in recent years and caught everyone’s attention – patients and physicians alike. The Widespread Pain Index (WPI) and the Symptoms Severity Scale Score (SS) were recently introduced as two novel methods of assessing for Fibromyalgia. In essence, a diagnosis of Fibromyalgia may be reached under this new paradigm via a minimum score combination of the WPI and SS.
The medical community’s understanding of fibromyalgia has not only led to novel methods of diagnosis, but also in treatment and understanding of cause. The current thought is that Fibromyalgia represents a ‘malfunction’ of the central nervous system or a ‘central sensitization’ so to speak. In other words, those stimuli that would be interpreted by the brain and spinal cord as “mildly unpleasant” may be misinterpreted or increased in amplitude to “very unpleasant / painful.” This amped up neural circuitry may explain why patients not only may feel pain throughout their body but also why it may affect many other body systems including the gastrointestinal tract and cognitive functioning. This forward progress is in-line with the FDA approving three drugs in the treatment of Fibromyalgia (Lyrica, Cymbalta, and Savella) all with direction action on the central nervous system and more focused research into future potential therapies. Moreover, improved sleep habits, regular exercise, and stress reduction are also regarded as beneficial for this condition.
Fibromyalgia should not be confused with Myofascial Pain Syndrome. Understanding the differences between these commonly confused conditions not only helps direct targeted therapy but reduces misdiagnosis. Unlike the symmetric “tender points” once touted in Fibromyalgia, Myofascial pain syndrome is hallmarked by “trigger points” or focal, painful, taut muscle bands that may be felt on the physical exam. These tender points or “knots” can be painful, especially when under direct pressure and may result from tissue trauma, inflammation/irritation, or stress. Others speculate these taut muscle bands represent regions of reduced blood flow. Patients with these trigger points may experience pain at these sites or referred pain resulting in headaches, poor sleep, or decreased range of motion in joints. The treatment for Myofascial Pain Syndrome is commonly regarded as physical therapy, medications including NSAIDs and tricyclic antidepressants, and trigger point injections which increase regional blood flow and decrease inflammation through the deposition of local anesthetic and steroids in these regions. Ultrasound guidance has allowed for enhanced safety and efficacy of these injections.
At Capitol Pain Institute, our expert Austin pain doctors are aware of nuances in these pain conditions, the latest diagnostic criteria, therapeutic modalities, and medications to treat each of these pain conditions. We invite you to engage our physicians and nurse practitioners to speak more about your pain condition and how we may be of help!