Wednesday 25th April 2018

Research findings: fibromyalgia caused by trigger points and successfully treated by trigger point therapy

Summary

According to a review of research relating to the association between fibromyalgia and myofascial trigger points (trigger points) , trigger points are an important cause of fibromyalgia.   It is believed that chronic pain impulses from trigger points sensitise the central nervous system so normal stimuli becomes painful.  A clinical trial showed that treating trigger points to eliminate these impulses not only diminished localised pain, but also substantially improved overall fibromyalgia symptoms.  The authors not only state that treating trigger points substantially improves fibromyalgia symptoms, they concluded that this approach should be used before any other therapy was initiated.


In over 25 years of practice this author has seen countless patients diagnosed as having fibromyalgia.  Every one has had a significant myofascial pain syndrome, usually involving multiple myofascial trigger points, though some exhibited increased sensitivity, a psychological overlay and various autonomic symptoms.

A review by Giamberardino et. al. investigated the relationship between fibromyalgia and trigger points, presenting the following evidence.

Trial One
In a trial with 44 patients with fibromyalgia and 50 controls the fibromyalgia patients were found to have on average 10 active (pain producing) and one latent (non pain producing) triggerpoints.  On the other hand the control group had an average of just 2 latent trigger points.  Furthermore, for the fibromyalgia patients the combined referral patterns from their trigger points tended to reproduce their fibromyalgia symptoms.

Trial two
For the diagnosis of fibromyalgia there are 18 (9 symmetrical pairs) of points that are tested for tenderness.  In 30 patients diagnosed with fibromyalgia these tender points were examined both manually and with EMG for trigger point characteristics. Most were found to be trigger points, and pain from these active points reproduced the fibromyalgia symptoms.

Trial three
In a trial of 28 fibromyalgia sufferers subjects were found to have abnormal pain sensitivity to heat on the forearm.  Injections of lidocaine in trigger points in the upper trapezius muscles resulted in a reduction in sensitivity to heat.  This demonstrates the core mechanism upon which the sensitisation theory is based.

Trial four
In a double blind trial of 68 fibromyalgia sufferers an injection of anaesthetic into trigger points not only caused a reduction in local and referred pain, but also an improvement in fibromyalgia symptoms overall.  This is a demonstration of the so called “extinguishment of peripheral pain generators treatment”, where simply the cause of the sensitisation is removed.

Trial five
In a controlled trial of 74 fibromyalgia sufferers subjects had trigger points treated with massage and myofascial release over a period of 20 weeks.  They exhibited a reduction in pain and anxiety, and an improvement in sleep.  Improvements were still evident after 6 months.

To quote the conclusion of the reviewers:

On the whole, the results of the reported studies indicate that nociceptive muscle input in fibromyalgia, most often originate from trigger points, exacerbates fibromyalgia symptoms, and a reduction/extinction of this input substantially contributes to improving the fibromyalgia condition. …  Thus, a systematic search for trigger points in fibromyalgia and their extinction is an approach that should systematically be adopted before any other therapy is initiated when faced with a patient with fibromyalgia.

Extra Clinical Perspective

It is great that this research explains what musculoskeletal practitioners have been seeing in practice for a very long time, and provides that evidence basis to treat this condition appropriately.  However, the following comments are based on 25+ years of clinical practice and the reading of other research.

Trigger points are tough
Its easy for researchers to do something such as inject trigger points with lidocaine to temporarily extinguish their noxious impulses and measure the results.  However, as discussed elsewhere, in practice the extinguishment of trigger points is a long time consuming process.  In trial five the researchers used therapies over 20 weeks.  When additional sensitivity is a factor, such as in fibromyalgia, a larger number of smaller applications of therapy may be appropriate.  Our massagers are designed for home use under professional advice, making this more practical and affordable.

Prevention is better than a cure
The researchers failed to state the obvious.  The impulses from chronic myofascial pain cause a sensitisation of the central nervous system resulting in fibromyalgia.  Wouldn’t it be easier to deal with myofascial issues appropriately, have regular massages, trigger point screening and so forth so people would net get the chronic pain then fibromyalgia would not develop.  Again, our massager were designed to help make this more practical and affordable.

Reference

Giamberardino MA, Affaitati G, Fabrizio A, Costantini R Effects of treatment of myofascial trigger points on the pain of fibromyalgia. Curr Pain Headache Rep. 2011 Oct;15(5):393-9

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Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and ... read more