Thursday 9th September, 2021

How do you get fibromyalgia- and what you can do about it

Man suffering from fibromyalgia
We will share with you what causes fibromyalgia and what you can do about it

Fibromyalgia is a sensitisation of the nervous system which causes pain to be amplified plus a host of other symptoms. While there are a vast number of things that can stress the nervous system and cause this sensitisation, scientists have found that by far the most common cause is un-diagnosed or poorly treated (myofascial) trigger points bombarding the nervous system with pain. They are those tender lumps in muscles therapists find.

In this article we will briefly discuss how trigger points do this. The good news is that scientists have successfully relieved fibromyalgia by dealing with trigger points, and say that when someone has fibromyalgia trigger points are the first thing that should be considered. Because of this we’ll share with you the best ways to deal with trigger points, including effective home therapy.

CONTENTS

What is fibromyalgia
How fibromyalgia develops
What you can do about it
Getting started with your trigger point treatment program
Your home trigger point therapy options
Professionals
Appendix: Summary of the evidence that trigger points cause fibromyalgia
Appendix: Summary of clinical trials of massage for fibromyalgia
Appendix: What the research says about individual trigger point therapies
References

Amplifier
Fibromyalgia is where the nervous system is sensitised causing it to act like an amplifier

What is fibromyalgia

Fibromyalgia is basically a sensitisation of the nervous system causing it to act like an amplifier, making normal stimuli painful and pain feel much worse. Also, because the nervous system controls your body sensitisation can cause seemingly unrelated symptoms such as fatigue, poor sleep and digestive problems (1–5)⁠.

What causes the sensitisation

Scientists have found that this sensitisation is most commonly caused by the nervous system being continually bombarded by pain from trigger points, but it can be caused by any condition that bombards the nervous system. Examples can include arthritic conditions, injuries, emotional events and diseases. Although scientists have found trigger points to be the major cause this is not usually mention by doctors or medical websites so I’ve put the details and the evidence in an appendix

Trigger points also add to the symptoms of fibromyalgia

As well as sensitising the nervous system trigger points are arguably the biggest cause of non-fibromyalgia musculoskeletal pain (6–11)⁠, so this adds to any symptoms caused by fibromyalgia. Sufferers have actually got two problems combining to cause their symptoms: pain from the trigger points and the amplification caused by sensitisation.

How fibromyalgia develops

Dr Graeme's comments

Graeme's comments

In over 27 years in practice as a chiropractor I’ve seen patients at every stage of the development of fibromyalgia, so I’ll share with you how it happens, but before I do there are several very important things you need to know.

Background

Fibromyalgia facts
Facts about fibromyalgia from the American College of Rheumatology website

Doctors do not actually diagnose fibromyalgia

While doctors and specialists will run a battery of tests and authoritatively diagnose fibromyalgia, there are no tests for fibromyalgia and doctors don’t even know what it is apart from the general comment that the nervous system is involved. If a doctor diagnoses you with fibromyalgia all it means is you’ve described widespread pain and other symptoms, but they can’t find anything wrong with you. All they have is shopping list of symptom relieving drugs and other therapies.

Doctors generally don’t diagnose trigger points

Despite being arguably the biggest cause of musculoskeletal pain trigger points do not show up in medical tests and are barely mentioned in medical journals. As an example a clinical trial found that trigger points are the major cause of shoulder pain (12)⁠ but they are not even mentioned as possible causes in these medical journals (13–15)⁠. Because of this the trigger points are usually not identified and symptom relieving drugs prescribed instead.

Even when trigger points are diagnosed they are often poorly treated

As we discuss in our article on trigger point therapy even if trigger points are diagnosed trigger point therapies tend to just temporarily relieve the pain rather then get rid of them. Even when treated trigger points still continue to bombard the nervous system.

The process: from aches and pains to full blown fibromyalgia

Understanding that, lets look at how fibromyalgia commonly develops

Doctor with patient-neck pain
Fibromyalgia starts with musculoskeletal pains not being diagnosed and masked with drugs

Early stages: un-diagnosed and poorly treated trigger points

In the early stages people develop trigger points which result in typical musculoskeletal pains such as back, neck and shoulder pain. These are typically dealt with by:

  • self medicating with pain killers
  • doctors prescribing drugs and ineffective therapies
  • trigger point therapies that only provide temporary relief

Middle stages: the pain worsens, but doctors still don’t diagnose the cause

As the trigger points continue to develop pain worsens, and becomes more constant and widespread. Usually similar “treatments” are continued, though as the condition has worsened it needs either stronger or more frequent medication or more therapy to provide relief. At this stage although sensitisation is not yet an issue, the person still has widespread pain and tenderness due to the trigger points and they don’t show up on medical tests, so some doctors will start diagnosing fibromyalgia.

Fibromyalgia and drugs
This is the perfect process to create people dependant on a lifetime of drugs

Later stages: you become sensitised and everything gets much worse

After a long period of time the person will have widespread pain due to trigger points, plus his or her nervous system will become sensitised making the condition much more painful and complicated. The doctors were unable to identify and deal with the issues earlier, but now they can tell you that you have this condition called fibromyalgia that has no known cause but a shopping list of symptom relieving drugs they can try.

Dr Graeme's comments

Graeme's comments

Drug companies have massive economic influence over every source of information for your doctor or specialist. Giving people pain killers and ineffective therapies rather than proper trigger point therapy for pain is great for drug companies but bad for people. After a couple of decades doing that people develop fibromyalgia with it’s supposed unknown cause and the drug companies get to sell cocktail of more drugs.

What you can do about it

Prevention

The best way to deal with fibromyalgia is to diagnose and effectively treat musculo-skeletal pain before fibromyalgia develops. For your options on treating trigger points before fibromyalgia sets in please see our article How to treat trigger points at home

If you have fibromyalgia

Basic treatment strategy

We know that fibromyalgia is caused by sensitisation of the nervous system, usually caused by being bombarded by pain. Scientists call this pain “peripheral pain”. The treatment they recommend is to eliminate the peripheral pain, stopping the sensitisation (16,17)⁠. They call this treatment of peripheral pain generators. In contrast the medical way of treating fibromyalgia is to use drugs to suppress the pain or the nervous system.

What if there is a main cause other than trigger points

As discussed, trigger points are the most common but there are other sources of pain such as for example an arthritic joint. Even though, trigger points are so common that they will certainly be adding to the problem, so treating trigger points will at least go some way towards providing relief.

The extra trigger point treatment complications because of fibromyalgia

Our article How to treat trigger points at home discusses basic trigger point therapy. However, because fibromyalgia takes so long to develop the trigger points will be far more entrenched. Also you will also be less tolerant to therapy meaning you will need to start with smaller less intense applications of therapy. This means that you will need a very large number of applications of therapy. In appendix 3 we discuss the scientific merits of the common professionally delivered trigger point therapies. Of these, massage has the best scientific record of helping with fibromyalgia. However, if you relied on these alone it would be horrendously expensive so we will give you several very effective self treatment options.

Getting started with your trigger point treatment program

With that background information lets look at how you can use these therapies to help with fibromyalgia. Please keep in mind that this is for general information only. For specific advice you need to ask a professional familiar with your own needs. In the case of fibromyalgia this is a bit more than just a general disclaimer to cover our backsides.

  • Trigger points are usually part of a more complex musculoskeletal problem, plus usually have things that cause or aggravate them.
  • The sensitisation often adds further complications and increases the risk of adverse reactions.

We recommend that you find a qualified professional who deals with trigger points, such as a Chiropractor, Osteopath or a suitably qualified therapist. Discuss that you wish to combine home trigger point therapy with his or her management to properly eliminate the problem. If you don’t have a professional a good place to look would be to go to our massager order section, select your country, then select the first option: from a clinic that sells and recommend them. The website has these clinics on a map, plus listed in post code order.

Your home trigger point therapy options

There are two basic types of trigger point therapy you can use at home: those based on manual massage techniques and those using vibration massage. In this section we’ll show you how to find your trigger points and how to do both of these therapies, but first let us share how to find those trigger points.

Trigger point examination
Simple trigger point examination: start with flat fingers to find tightness and tenderness

How to find your trigger points

Trigger points are tender lumps within tight bands of muscle. When you press on them they will shoot pain and sometimes cause the muscle to twitch. We thoroughly recommend that you consult a professional who deals with trigger points to help identify the ones affecting you and show you how to find them, but we share with you the basic examination procedure. These are demonstrated in our video on treating forearm muscles

Flat fingers examination technique (the one we use in clinic)

Gently press on the muscle with flat fingers, examining for areas of general tightness and tenderness. When found, use one or two fingers to explore more deeply for tightness and a tender lump.

Home trigger point therapies using manual massage

Manual massage techniques performed by professional therapist can be an effective trigger point therapy. There are home techniques that mimic these. As we discuss in our article Do foam rollers work we have reservations about the use of tools such as balls and foam rollers to apply painful pressure, but will show you two relatively safe and effective techniques.

Forearm self massage
Using thumb pressure to self massage forearm muscles

Combining squeezing massage with holds

One of main massage techniques is called “stripping” (technical name= effleurage). Think of gradually moving along the muscle like squeezing out an old sponge. To do this lubricate your skin, apply moderate pressure and move along the muscle slowly. As the veins and lymphatic vessels have one way valves this needs to be done towards your heart.

To turn this stripping technique into a very effective trigger point therapy, when you get to a tight spot or trigger point stop and hold the pressure for 5-10 seconds, then slowly move on. The safest and best way to do this technique is to start with light to moderate pressure then gradually repeat with more pressure. For a demonstration of this please see our video on treating forearm muscles

Pressure techniques

Professional therapists use various techniques that apply pressure direct to the trigger point. There are a lot of people advising to do this at home with balls and rollers. As discussed though we have reservations about the risks and benefits of doing this. In clinic we have seen seen way to many patients hurt themselves and get very little benefit. However, there is a very safe and effective way to use pressure techniques at home. In a trial of a traditional Thai home massage (18) a special tool with a long handle was used to apply moderate pressure to relaxed muscles. Each day each trigger point was given five applications of this moderate pressure for five seconds each. This tells us painful pressure is not needed. Multiple applications of moderate safe pressure work very well.

Self massage tool: Wilai stick
Using this simple tool and a conservative technique was effective (click image for details)

Safe and effective Thai technique
Using the tool allowed the muscles treated to be relaxed. 5 seconds of moderate pressure pressure was applied five times. This was repeated each day. To use this technique find each trigger point, make sure the muscle is relaxed, then use either your hands or some sort of tool to give multiple applications of moderate pressure.

Trigger point self therapy: balls
Please compare with Thai technique: awkwardness, control, tension in the muscles

Ball and roller techniques
For comparison this picture shows applying pressure to the same muscles using a ball. Note that the muscles are far from relaxed, and being an awkward position it would be far harder to control the pressure.

Home trigger point therapy using vibration massage (our recommendation)

Vibration massage is widely used by professionals to treat trigger points. It is done by simply placing the vibration massager over the trigger point allowing the vibrations to penetrate and have their effect. Because it does not require penetrating pressure it is relatively safe, and because no special skills are required it is far easier to self apply.

Dr Graeme's comments

Dr Graeme's comments: you can get professional results from self therapy

Manual therapies rely on skilled application and it can be difficult to get into some positions for self massage, so self applied manual massage is often no where as effective as professional therapy. On the other hand because a vibration massager just sits on the surface and does the work, as long as it is applied in the right place self applied vibration massage can be as effective and professionally applied vibration.

Trigger point: positive feedback loop

Why vibration massage works

As shown in this diagram the key parts of a trigger point are muscle spasm, muscle tightness, restricted blood flow, and a build up of toxic wastes. Vibrations have been shown to help all of these. For more information please see our guide The scientifically proven effects of vibration massage- with clinical applications.

Self massage allows the benefits of quality massage at home for little cost

How to use vibration massage

Using vibration massage is extra-ordinarily easy. We ask you to check our our instructions for the fine points and precautions, but basically all you need to do is place the vibration massager on the muscle over the trigger point and let the vibrations penetrate for 30-60 seconds. This can easily be repeated every day. Please note that you need a proper effective vibration massager. As discussed in our article Should I get a massage gun or a vibration massager most of the common massage guns and percussion massagers will be ineffective.

Please continue these therapies after your pain has gone

Most people just use these therapies for pain relief, but as discussed in our article Why trigger point pain keeps coming back trigger points don’t go so the pain returns. However, if you continue using regular trigger point therapy after the pain goes it will continue to diminish the trigger points and you will be much better off than those who just do pain relief.

Dr Graeme's comments

Dr Graeme's comments: combining professional help with home therapy

Typically professionals who deal with trigger points must examine and determine the problem, provide care for things other than trigger points, provide advice, and provide trigger point therapy. If you are able to do a lot of the therapy yourself this will free up your professional to spend more times doing the other things. If you don’t have a professional a good place to look would be to go to our massager order section, select your country, then select the first option: from a clinic that sells and recommend them. The website has these clinics on a map, plus listed in post code order.

Professional at desk

Professionals

If you are a professional wishing to help your patients/clients with home trigger poing therapy DrGraeme massagers were originally built by Dr Graeme for use in his clinic for this purpose and are now used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.

Appendix: Summary of the evidence that trigger points cause fibromyalgia

If you discuss fibromyalgia with your doctor or read about fibromyalgia on medical websites you will usually find no mention of trigger points whatsoever. You will continue to be told that there is no known cause and the only solution is symptom relieving drugs and therapies. Here is the evidence that gets omitted from the medical journals. Scientists gradually put together pieces of the puzzle, then confirmed it by successfully treating trigger points.

Trigger points are a big cause of pain that can bombard the nervous system

Trigger are arguably the biggest cause of musculoskeletal pain such as back neck and shoulder pain. As mentioned doctors rarely diagnose it, and as discussed in our article Why trigger points keep coming back therapies for trigger points usually don’t get rid of them. Also, even when not causing pain (or their pain is masked by drugs) trigger points continue to bombard the nervous system with sub-threshold levels of pain (3)⁠.

People with fibromyalgia have a lot more trigger points

Scientists have compared people with fibromyalgia to people without and found that in comparison fibromyalgia sufferers are generally riddled with trigger points (19)⁠.

Pressing on the trigger points reproduce the fibromyalgia pain

Trials have shown that pressing on trigger in fibromyalgia sufferers reproduces their fibromyalgia symptoms (20,21)⁠.

Most of the so called fibromyalgia tender points are actually trigger points

One of the diagnostic criteria for fibromyalgia is that there are 18 spots to check for tenderness. These points are all common sites for trigger points. When scientists checked fibromyalgia sufferers they found that the majority of the points used to diagnose fibromyalgia were actually trigger points (4)⁠ .

The mechanism for sensitisation has been tested

Scientists noted that people with trigger points tended to be more sensitive. They tested this by measuring the sensitivity to heat in people with trigger points in their upper trapezeus muscles. What they did was measure how sensitive to heat they were on their forearm, then inject the trigger points with anaesthetic to temporarily stop them bombarding the nervous system with pain, then re-check the sensitivity. They found that stopping the pain from the upper trapezeus trigger points significantly lowered the sensitivity of the forearm (4)⁠.

Injecting trigger points with anaesthetic relieved fibromyalgia

Lastly scientists tested their theory by injecting the trigger points of fibromyalgia sufferers with anaesthetic and found that it relieved the symptoms of fibromyalgia (2)⁠. Of course it is not practical to inject trigger points with anaesthetic, which is why we provide our strategies to eliminate trigger points properly.

Appendix: Summary of clinical trials of massage for fibromyalgia

NOTE: You may need to scroll the table below left/right for more information

Trial

Type of massage

Duration, frequency, number

Outcome

27

Friction massage vs stretching vs analgesics

Uncertain

Friction massage not beneficial. Friction massage is a painful massage not suited for trigger points

28

Compared Swedish massage with TENS machine

Ten 30 minute sessions @ 2 per week

Massage resulted in less pain, less fatigue, better sleep and lower anxiety

29

Connective tissue massage

15 sessions @ 1.5 per week

Massage gives pain relief, relieved anxiety and improved quality of life. After treatments finished improvements gradually diminished over 6 months

30

Swedish massage compared with standard physician care

Ten sessions over 24 weeks

Massage showed improvement, but only small numbers in trial

31

Combination of styles

30 minutes, twice a week for 5 weeks

Less, pain, less anxiety and better sleep

32

Myofascial release massage

Weekly 90 minute session for 20 weeks

Improved pain and quality of life

33

Myofascial release

Ten 60 minute sessions over 20 weeks

Less tender spots, improved physical function

34

Swedish massage vs myofascial release

90 minute session weekly for 4 weeks

Both produced pain reduction and improved movement. Myofascial release had better results

35

Full body Shiatsu

Sixteen 40 minute sessions @ twice a week

Improved pain, tenderness and sleep

26

Mechanical massage device called Cellu M6

Fifteen weekly 35 minute sessions

Improved pain and function, and reduced number of trigger points

Appendix: What the research says about individual trigger point therapies

Below is a summary of the findings of several scientific reviews of trigger point therapies (25-31)⁠⁠.

The goal of trigger point therapy

As said previously, the goal of trigger point therapy, according to the scientists, is to deactivate the trigger points. None mention having the goal of eliminating trigger points.

Dry needling

Most trials show that dry needling provides some short term pain relief and improved function. The risks and potential to cause pain are obvious. The mode of how needles work is still speculation. Where dry needling had been compared with laser the laser has given slightly better results.

Laser

Laser

Trial results for laser have been marginally better than those for dry needling, but still only temporary relief. Scientists attribute it’s effect to increasing micro-circulation, improving oxygenation and helping remove waste products. However, this is something that can easily be achieved, if not better, by any competent massage therapist.
The big concern with laser is the sheer number of applications of therapy sessions needed for only temporary benefits. For example one trial (32)⁠ used 10 daily applications of laser on patients with upper back and neck pain to get a reduction in pain and tenderness for three weeks. Further, according to one review (33)⁠ applications of laser should be given from 2-3 times a week though to 5 times a week, with a total of 30 applications of therapy for long term cases. Keep in mind this is just to achieve deactivation, not to eliminate the problem. Assuming each laser consultation costs $50 and takes an hour out of your day that’s $1,500 and 30 hours of your life just for some temporary pain relief, leaving you to front up again next time the problem is aggravated.

Manual trigger point therapy

Manual therapies

There are various types of manual therapies that involve pressure, massage and stretching of muscles. The trial results for them tend to be similar to those of laser and dry needling. However, according to one review (26)⁠ one study did show residual benefit after six months.

References

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  2. 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;15(5):393–9.
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  21. Alonso-Blanco C, Fernández-De-Las-Peñas C, Morales-Cabezas M, Zarco-Moreno P, Ge HY, Florez-García M. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain. 2011;
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  24. Kalichman L. Massage therapy for fibromyalgia symptoms. Rheumatol Int. 2010;30(9):1151–7.
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  27. Amanollahi A, Naghizadeh J, Khatibi A, Hollisaz MT, Shamseddini AR, Saburi A. Comparison of impacts of friction massage, stretching exercises and analgesics on pain relief in primary fibromyalgia syndrome: A randomized clinical trial. Tehran Univ Med J. 2013;70(10):616–22.
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  29. Brattberg G. Connective tissue massage in the treatment of fibromyalgia. Eur J Pain. 1999;3(3):235–44.
  30. Alnigenis M. Massage Therapy in the Management of Fibromyalgia: A Pilot Study. J Musculoskelet Pain. 2001;9(2):55–67.
  31. Field T, Diego M, Cullen C, Hernandez-reif M, Sunshine W. Fibromyalgia pain and substance P decrease and sleep improves after massage therapy. J Clin Rheumatol. 2002;8:72–6.
  32. Castro-Sánchez AM, Matarán-Pearrocha GA, Granero-Molina J, Aguilera-Manrique G, Quesada-Rubio JM, Moreno-Lorenzo C. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evidence-based Complement Altern Med. 2011;2011.
  33. Castro-Sánchez A et. al. Effects of myofascial release techniques on pain , physical function , and postural stability in patients with fibromyalgia : a randomized controlled trial. Clin Rehabil. 2011;25(9):800–13.
  34. Liptan G, Mist S, Wright C, Arzt A, Jones KD. A pilot study of myofascial release therapy compared to Swedish massage in Fibromyalgia. J Bodyw Mov Ther. 2013;17(3):365–70.
  35. Yuan SLK, Berssaneti AA, Marques AP. Effects of Shiatsu in the management of fibromyalgia symptoms: A controlled pilot study. J Manipulative Physiol Ther . 2013;36(7):436–43.
  36. Boyles R, Fowler R, Ramsey D, Burrows E. Effectiveness of trigger point dry needling for multiple body regions: A systematic review. J Man Manip Ther . 2015;23(5):276–92.
  37. Denneny, Diarmuid et al. Trigger point manual therapy for the treatment of chronic noncancer pain in adults: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100(3):562–77.
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  40. Cagnie B, Castelein B, Pollie F, Steelant L, Verhoeyen H, Cools A. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in Patients with Neck Pain: A Systematic Review. Am J Phys Med Rehabil. 2015;94(7):573–83.
  41. Espejo-Antúnez L, Tejeda JFH, Albornoz-Cabello M, Rodríguez-Mansilla J, de la Cruz-Torres B, Ribeiro F, et al. Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. Complement Ther Med . 2017;33(December 2018):46–57.
  42. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain : A systematic review of the literature. 2006;9:120–36.
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  44. Uemoto L, Garcia MAC, Gouvêa CVD, Vilella O V., Alfaya TA. Laser therapy and needling in myofascial trigger point deactivation. J Oral Sci. 2013;55(2):175–81.

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Dr Graeme

About Dr Graeme

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



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