National Display of Information on FM

Awareness is wonderful and I am grateful for this, but I am dismayed that a network program, "The Doctors" would not do a better job researching their program topic. As you will see if you click on the link provided, they call the "tender points" of FM "trigger points." Trigger points are myofascial areas of knotted up muscle fibers in a taut band of muscle. They are EASILY felt unless behind bone or other muscles, or the band of muscle affected is too tight, in which case myofascial massage is necessary to loosen the muscle to locate the (TrP).

Myofascial TrPs are palpable, rendering an objective measurement of disease. When these TrPs are treated with pressure therapy, injections, or dry needling, the "twitch response" is visualized by the practitioner and felt by the patient. This has not been described in the "tender point model" of FM, or the diagnostic criteria set by the American College of Rheumatology (ACR).

Let me interject that a newer study by Hy, Wang and others, "The Predetermined Sites of Examination for Tender Points in Fibromyalgia Syndrome Are Frequently Associated With Myofascial Trigger Points. J Pain. 2009 Nov 13. [Epub ahead of print]" suggests that possibly all FM patients also have CMP (chronic myofascial pain from trigger points). If and when this study is replicated, it brings question, "Were the ACR patients screened for the presence of myofascial trigger points?" "Did the examiners know enough about TrPs to know to look for them or that cause significant pain, dysfunction and referral of symptoms?" "Did they know presence of these TrPs provides criterion that takes FM out of the subjective complaints only arena?" When the study is replicated, it will bring about many questions that I personally would like to see answered. What we know for certain right now is that FM, and CMP, can and often do co-exist in the same patient, yet paradoxically not all patients with myofascial trigger points have FM, they are two separate entities.

As I have described before, and backed by solid research, FM is a central sensitization problem brought on by a dysfunction of the HPA (hypothalamus-pituitary-adrenal) axis. Chronic myofascial trigger points and pain (CMP) is a peripheral nerve to muscle problem. (Hong, et al). FM, CFID, migraine, IBS, irritable bladder and several other common co-existing conditions that escape me right now, also have a strong central nervous system component. As an example the pain of a cervicogenic migraine, is helped a great deal by myofasical therapy. When any of these disorders co-exist with CMP, the peripheral message of painful trigger points to the brain keeps the brain in a hypersensitive state," causing a "wind up" phenomenon and dysfunction of the HPA-axis (also seen in CFID/CFS/ME) is off and running. Think about the patient that has FM, CFID, CMP, migraine, IBS, and irritable bladder. You may be one, I am.

In disturbs me that so much misinformation is being disseminated, well intended, but could lead to a misdiagnosis and inappropriate treatment. It is this misinformation that causes unnecessary frustration to both the doctor and the patient.