Effects of Treatment of Myofascial Trigger Points on the Pain of Fibromyalgia

Abstract

Myofascial pain syndromes (MPSs) from trigger points (TrPs) and fibromyalgia syndrome (FMS) are common musculoskeletal pain conditions that frequently coexist in the same patients. In recent decades, it has become evident that these entities greatly influence each other's clinical expression. FMS is mainly rooted in the central nervous system, while TrPs have a peripheral origin. However, the nociceptive impulses from TrPs may have significant impact on symptoms of FMS, probably by enhancing the level of central sensitization typical of this condition. Several attempts have been made to assess the effects of treatment of co-occurring TrPs in FMS. We report the outcomes of these studies showing that local extinction of TrPs in patients with fibromyalgia produces significant relief of FMS pain. Though further studies are needed, these findings suggest that assessment and treatment of concurrent TrPs in FMS should be systematically performed before any specific fibromyalgia therapy is undertaken.

Fibromyalgia: A Critical and Comprehensive Review

“…Very similar results were obtained with hydroelectrophoretic treatment of painful joints with diclofenac and betamethasone in patients with FMS and joint pain due to microtrauma or osteoarthritis. These findings are consistent with other data suggesting that inactivation of active MTrPs is associated with decreased central sensitization; conversely, sustained manipulation of latent MTrPs in healthy subjects results in an extrasegmental increase in mechanical hyperalgesia, which is indicative of central sensitization [530,531]. Altogether, these results strongly suggest that both central sensitization and clinical pain in FMS stem from, or are maintained by, persistent peripheral nociceptive input and that treatment of such peripheral pain sources can relieve not only local pain, but can also improve overall pain and diminish central sensitization.…”

Immediate Effects of Spinal Manipulative Therapy on Regional Antinociceptive Effects in Myofascial Tissues in Healthy Young Adults

“…Although the pathophysiology of MPS is still unclear, research suggests that myofascial trigger points (MTPs) play an integral role in the pathophysiology and clinical manifestation of MPS. 15,16 It is currently unknown if the antinociceptive effects of SMT in myofascial tissues are manifest predominantly via regional or general mechanisms, or a combination of both. A study is needed to specifically investigate the hypothesis that SMT evokes robust antinociceptive effects in MTPs preferentially located within neurosegmentally linked myofascial tissues.…”

Anti-CGRP monoclonal antibodies in migraine: current perspectives

“…An insufficient response to these classic therapies is unfortunately found in a substantial percentage of patients. In addition, safety is frequently a problem, due to side effects and contraindications, but also drug-drug interactions in the case of comorbidities, very frequent in migraine, such as psychiatric and cardiovascular diseases, various forms of visceral pain, fibromyalgia or myofascial pain syndromes [33][34][35][36][37][38][39][40][41][42][43][44]. Alternative treatments are, therefore, necessary, particularly in the field of prophylaxis of high-frequency episodic and chronic migraine.…”