There are days until International Fibromyalgia Awareness Day 12th May 2018





Fibromyalgia means:


Fibro = Fibrous tissue

my = muscle

algia = pain


It is estimated to affect 2–4% of the population, with a female to male incidence ratio of approximately 9:1.


There are many symptoms of Fibromyalgia and they tend to vary from person to person. The symptoms can also come and go over time, although it is unlikely they will ever disappear altogether.


Your symptoms may sometimes get better or worse, depending on factors such as changes in the weather, your stress levels and/or how physically active you are.


Pain: If you have Fibromyalgia, one of your main symptoms is likely to be widespread pain. This may be felt throughout your body, but could be worse in particular areas, such as your back or neck. The pain is likely to be continuous, although it may be better or more severe at different times.


Extreme sensitivity: Fibromyalgia can cause you to become extremely sensitive to pain all over your body, and you may find that even the slightest touch is very painful. If you hurt yourself, for example if you stub your toe, you may find that the pain continues for much longer than it normally would.  You may hear this described in the following medical terms:

·         hyperalgesia - when you are extremely sensitive to pain

·         allodynia - when you feel pain from something that should not be painful at all, such as a very light touch


If you have Fibromyalgia, you may find you are very sensitive to other things as well, such as smoke, certain foods and bright lights. Being exposed to something you are sensitive to can cause your other Fibromyalgia symptoms to flare up.


Stiffness: Fibromyalgia can make you feel stiff. The stiffness may be most severe when you have been in the same position for a long period of time, such as when you first wake up in the morning. Fibromyalgia can also cause your muscles to spasm, which is when they contract (squeeze) tightly and painfully. This can affect your sleep.


Fatigue:  Fatigue (extreme tiredness) as a result of Fibromyalgia can range from a mild, tired feeling to the exhaustion often experienced during a flu-like illness.  Sometimes, severe fatigue may come on very suddenly and can drain you of all your energy.  If this occurs, you may feel too tired to do anything at all.


Poor quality sleep:  Fibromyalgia can affect your sleep.  You may find you often wake up tired even when you have had plenty of sleep.  This is because Fibromyalgia can sometimes prevent you from sleeping deeply enough to refresh you properly.  You may hear this described as ‘non-restorative sleep’.


Cognitive problems ('Fibro-fog'): are problems with mental processes, such as thinking and learning. If you have Fibromyalgia, you may have:

·         trouble remembering and learning new things

·         problems with attention and concentration

·         slowed or confused speech


Headaches:  If you have pain and stiffness in your neck and shoulders from Fibromyalgia, you may also have frequent headaches.  These can vary from being mild headaches to severe migraines, which may also involve other symptoms, such as nausea.


Other symptoms of Fibromyalgia can include:

·         not being able to regulate your body temperature (feeling too hot or too cold)

·         restless legs syndrome (unpleasant sensations in your legs and feeling like you need to move your legs to get some relief)

·         tingling, numbness, prickling, or burning sensations in your hands and feet (paresthesia)

·         tinnitus (the perception of a noise in one or both ears that comes from inside your body)

·         unusually painful periods (in women)

·         anxiety

·         depression


Myofascial Pain and Trigger Points


What are trigger points and Myofascial pain?


Our muscles comprise a very large part of our bodies, and are a very potent source of pain.  This pain can be a very effective mimic of many other pain contacts - a very large number of what are described as "trapped nerves" are in fact muscle pains.  Sadly, this area of pain is not well understood by many health professionals. 


We all get pain in our muscles from time to time, with "cricked necks", the symptoms of 'flu and so on.  Muscle pain is also a component of the symptoms associated with many other painful contacts such as back pain and neck pain.  


In some people muscle pain can become persistent and can cause considerable problems.  In the past this was given names like Fibrositis, but now these pains are classed as Myofascial pain.  Myo- is the prefix that refers to muscle, and the fascia are the layers of connective tissue that surround the muscles.  


Trigger Points


Many, if not all, of us have areas in our muscles which have a tendency to develop spasm and pain.  These are termed latent trigger points or taut bands.  Taut bands are common in people without pain, but patients with them are more likely to develop active painful trigger points (TrP's).  A latent TrP can develop into an active TrP for a number of reasons. This can happen for a number of reasons, including Muscle damage or trauma, repetitive contraction or holding abnormal postures (we are not really designed to spend our days in one position in front of a computer screen) or sometimes other painful contacts such as neck, shoulder or back pain. Psychological stress, muscle tension, and physical factors, such as poor posture, can contribute to the process.


There are a number of possible mechanisms for the activation of trigger points.  Abnormal tension develops in small areas of the muscle which can develop localised spasm.  This can then cause the accumulation of waste products, hydrogen ions and inflammatory chemicals in the muscle fibres, and possibly the tension in the muscle band may impede the blood flow into the muscle causing a reduction in oxygen supply to the muscle.  This causes pain, and this pain is transmitted back to the spinal cord along nerves. This can set up a reflex arc rather like a knee jerk, acting through a system called spindle fibres which may cause further muscle spasm.  There is evidence of considerably increased electrical activity at the trigger point called end-plate noise - it is not certain whether this represents the increased nerve activity itself or an abnormality of the connections between the nerve and the muscle.  The nerves and their central spinal cord connections can become abnormally sensitised, increasing the tendency for the pain and spasm.  This can become a self-maintaining vicious cycle.  This process is very well explained in a short (6 minute) video on YouTube that you may find helpful, which you can access from here or the link below.


A trigger point (TrP) may feel like a “knot” or “band” in the muscle.  The pain from a trigger point will often not be felt directly around the trigger point itself but may radiate or refer to other areas.  These radiation patterns form consistent patterns which with experience can be recognised.  For instance, many headaches which refer from the back of the head to behind the eye or into the lower forehead can arise from trigger points at the top of the muscles at the back of the neck, or many patients describe pain and funny feelings into their forearm or hand that is often from a trigger point in the Brachioradialis muscle just below the elbow.  These referral patterns often do not follow the pathways that nerves travel.


In some cases latent trigger points in the area of radiation of painful trigger points can themselves be activated in a "domino" process.


Much work on trigger points and their referral patterns, and the potential treatments for them, was done in Europe in the 1920's by Kellgren and others, and this was expanded by researchers such as Janet Travell and David Simons, who wrote a major textbook called the Trigger Point Manual.  In the 1970's and onwards doctors became very interested in the links between Western knowledge about trigger points and the Chinese system of Acupuncture, and it was demonstrated that many of the trigger points are the same as traditional acupuncture points. Over 70% of trigger points correspond to traditional acupuncture points used to treat pain.


Patients with Myofascial pain usually report regionalized aching and poorly localized pain in the muscles and joints. They also may report sensory disturbances, such as numbness in a characteristic distribution. Patients often report disturbed or unrefreshing sleep.


How can Myofascial pain be treated?


Self management techniques are extremely important.  Sedentary individuals are more prone to develop active TrPs than are individuals who exercise vigorously on a daily basis.


There are a number of things that you can do which can help to reduce the symptoms of Myofascial pain:

  • Exercise regularly.  Aerobic fitness of the muscles is a very important factor in helping Myofascial pain.  

  • Improve your posture.

  • Reduce your body weight.

  • Eat a healthy, well-balanced diet.

  • Learn stress-management techniques and relaxation techniques.

  • Use proper techniques at work, and during exercise and sports


Treatment for Myofascial pain syndrome typically includes medications, trigger point injections (or acupuncture treatments directly to the muscles) or physical therapy. No conclusive evidence supports using one therapy over another. 


Trigger point injection treatments (with local anaesthetic, sometimes with added locally acting steroid) aim to interrupt the nerve reflex, relax the trigger point and possibly improve local blood flow, in order to try to break the vicious cycle of maintenance of the pain.  Rarely, some practitioners use Botulinum Toxin (Botox) for this.  Research has shown that a significant part of the benefit is from inserting the needle into the trigger point.  This has led to the development of "dry needling" of trigger points, and interest in how this relates to some acupuncture techniques.


Other physiotherapy techniques directed at the trigger points can involve "spray and stretch" and massage.  Sometimes TENS can be helpful.


Medications are variably helpful.  As well as painkillers and sometimes anti-inflammatory medications, sometimes drugs such as antidepressants can have helpful effects.


Myofascial Pain and Fibromyalgia


Although Myofascial pain and Fibromyalgia have some overlapping features, they are separate entities; Fibromyalgia is a widespread pain problem, not a regional condition caused by specific TrPs. 

There is a very useful short video presentation on YouTube by Dr Jonathan Cutner in the causes and treatment of trigger points which you may find helpful.







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Foggy's: Dashboard notice for Blue Badge holders to display in their car - FB

UK Fibromyalgia:  "The Fibromyalgia Magazine" Subscription

FMA UK: Patient Booklet

FMA UK: Children and Young People

FMA UK: The Fibromyalgic Pregnancy and Beyond

BMJ Group: Fibromyalgia Summary

Arthritis Research UK: Complementary and alternative medicine for Rheumatoid Arthritis, Osteoarthritis and Fibromyalgia

Arthritis Research UK: Fibromyalgia

Practical Living with Fibromyalgia By Maurice S Clarke

NHS Gloucestershire Hospitals: Myofascial Pain and Trigger Points Myofascial Trigger Point



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