Scoping review and interpretation of Myofascial Pain/Fibromyalgia syndrome: an attempt to assemble a medical puzzle

Abstract

Introduction: Myofascial Pain Syndrome (MPS) is a common overlooked and underdiagnosed condition, and with significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. Methods: Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro and medrXiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. Findings: 734 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. Interpretation: MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue, or "fascial armoring", which may explain pain, distribution of pain, decreased pressure/pain threshold, and other phenomena eg, occasional complete resolution after surgery. Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. MPS should no longer be overlooked but solidified in the domain of common modern medicine.

Fascial Nomenclature: Update 2022

“…In 2019, our research group (FORCE) coined a new term, to try to conceptualize the behavior of the living, that is, "fascintegrity"; the word combines the term of tensegrity with the concept of fascial continuum (solid and fluid) [ 74 ]. Recall that, when a theoretical model is not proven by experimental studies, the model remains theoretical; the mere fact of reporting the term and the concept it expresses a multitude of times does not make this model magically valid [ 75 , 76 ]. The model of biotensegrity and fascintegrity remain, for now, only conceptual theories.…”

Comparison of the Effects of Self-Myofascial Release and Combined Core Stabilization Exercises in Physiotherapy and Rehabilitation Students with Non-Specific Low Back Pain

“…The posture in a sitting position may lead to increased mechanical stress on the spine and may have an increased static load on the ligaments of the lumbar spine (Akkarakittichoke et al, 2017;Anggiat et al, 2018). Therefore, viscoelastic deformations on fascia (myofascial adhesions) could occur, thus leading to spasms of paraspinal muscles that could trigger metabolic reactions (Plaut, 2022). This accelerates disc degeneration and possibly disc herniation (Beach et al, 2005).…”