Fibromyalgia Information & Local Support
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What Allergists/ENTs Should Know about FMS/MPS
©Devin Starlanyl,
MD 1995-1998
Two excellent medical texts are available. "Myofascial Pain and
Dysfunction: The Trigger Point Manual Vol. I and II" by Janet G. Travell
M.D. and David G Simons M.D. The first volume is important to you, as it deals
with upper body Trigger Points. This message is but an introduction to them.
They show the referred patterns, tell what causes them, and how to relieve
them. Many of us have allergies, asthma, food intolerance and disrupted immune
systems, as well as multiple chemical sensitivities. 30% of FMS&MPS Complex
patients have TMJD Syndrome. Most of us have vasomotor rhinitis, post-nasal
drip, chronic sore throat, dizziness, and a whole constellation of other
symptoms that lead us right to your office. To deal with FMS&MPS Complex,
you must become familiar with the TrP referred pain patterns and what causes
the TrPs. Myofascial TrPs can entrap nerves and blood vessels. They can also
cause proprioreceptor disturbances.
Referred autonomic phenomena: vasoconstriction (blanching), coldness,
sweating, pilomotor response, salivation, vasodilation, lacrimation, coryza and
hypersecretion can be caused by TrP activity.
Referred TrP phenomena: sensory, motor and autonomic phenomena such as pain,
tenderness, spasm (increased motor unit activity) vasodilation, and
hypersecretion caused by TrPs.
Proprioceptive disturbances caused by TrPs: imbalance, dizziness, tinnitus,
and distorted perception of the weight of objects lifted in the hands.
Common FMS&MPS Complex Symptoms Seen by Allergists/ENTs
- Allergies: We have a hypersensitized nervous system. Histamine, is a
neurotransmitter, and regulated in delta sleep. Our delta sleep is often
disrupted due to alpha wave intrusion. Multiple chemical sensitivities (leaky
gut syndrome) and sensitivity to odors are common with FMS. We are often
hypersensitive to molds and yeasts. We don't always react normally to allergy
tests. When you take a good history, however, it should be evident what is
happening, once you become familiar with the concepts.
- Mottled or blotchy skin: The discoloration on my skin started to be
noticeable on my forearms. The tops became brown in rectangular patches. The
color faded slightly with the winter, and then darkened again in the sunlight.
After a few years, the blotches became angry red and itchy if exposed to the
sun. Sunblock prevented this. I visited a local dermatologist, who had no
answers, except to rule out infection. The clue for me came when I
inadvertently left some salt gel residue from a muscle electrostimulator
electrode on my forearm. I soon had a semicircle of brown mottling. Observing
my movements in the garden, I noticed that I often would wipe my forehead on my
arms. The photoreaction of my sweat produced the mottling. I still have that
semi-circle from two years ago. The right arm is only half mottled, while the
left is mottled almost to the elbow. Since I started wearing headbands in the
garden, the mottling has not increased. The pituitary is responsible for
secreting melanocyte-stimulating hormone. Light triggers the hypothalamus,
which triggers the pituitary. This influences the mottling on the skin.
- Itching: When we itch, we often look for an allergic reaction. We forget
about sensory itch. There are pressure plate receptors in our outer skin layer
called Merkel's discs (3). They translate the tactile messages received by the
skin. They have a default mechanism when they don't know what message to send.
Unfamiliar sensations are translated as itch. It's my theory that due to the
dysregulation of neurotransmitters in FMS and/or the mechanical constriction of
fluids around the Merkel's discs, we itch a lot more than most folks. Sometimes
it is enough to drive us to distraction, and disrupt our meager amounts of
sleep. Itching can also be a sign of low-level TrPs. Cold helps numb the itch,
because it the pressure plate receptors. Dryness makes the itch worse because
it creates an enhanced pressure reception by the discs. I hope I can interest a
dermatologist in doing some research on this. Some of the itches follow TrP
referral patterns, in which case the TrP must be broken up.
- Patches of skin with a network of fine veins and capillaries that are
extremely painful: This is "livido reticularis". This is sometimes
seen in FMS&MPS Complex patients, usually in the legs but it can occur in
the arms.
- Dermographia and related phenomenon: One phenomenon that occurs in
FMS&MPS Complex is called the "flare response". It's part of the
histamine (neurotransmitter) and mast cell liberation at the trigger points and
other traumatic sites. One Internet Family member said red welts occurred with
acupuncture. This can happen with any kind of TrP therapy. It is neurogenic
(generated by the nerves) flare in response to even mild touch, heat, or
chemical contact. There can be alterations of sensations in FMS. There can be a
profound change in the tolerance of heat and cold. Skinfold tenderness
increases. This means we get what is called "tactile defensiveness",
or muscle tension in response to touch.
- Pick up every infection that's "going around": This can come in a
series--times when you get no successfully attacking germs, and times when you
have to put antibiotic ointment on every scratch or it will get infected. They
are both signs of immune dysfunction. The Fibromyalgia Network reported a study
that found decreased natural killer (NK) cell activity in FMS. These cells are
our front line warriors against outside attack. It seems that in FMS, they are
present in normal amounts, but do little or nothing. NK cells require serotonin
to activate them. And serotonin is regulated in delta sleep. We have alpha wave
intrusion into delta level sleep, so we miss the restorative sleep and
neurotransmitter regulation healthy folks get. When confronted by an
"alien invader", our fibromite NK cells insist "It's not my
job." I have found that if I take thymus extract, which comes in pill
form, it makes the difference. Without it I can expect one cold a month, at
least. With it, I may get one or two a year.
Common TrPs Encountered by Allergists and ENTs
- Motor coordination problems: The sternocleidomastoid is much of the problem
here. SCM TrPs can cause dizziness, imbalance, neck soreness, swollen gland
feeling, runny nose, maxillary sinus congestion, "tension" headaches,
eye problems (tearing, "bug-eyes", blurred or double vision,
inability to raise the upper lid, and a dimming of perceived light intensity),
spatial disorientation, postural dizziness, vertigo, sudden falls while
bending, staggering walk, impaired sleep, nerve impingement, and disturbed
weight perception. People with SCM TrPs often have trouble glancing
downward--they can fall forward. They can get so disoriented that there is
nausea and vomiting. Chronic dry cough, pain deep in the ear canal, pain to the
throat and back of the tongue and to a small round area at the tip of the chin
can be part of the SCM TrP package. Localized sweating and vasoconstriction can
be a problem, as well as pain in a "skull cap" area of the head. What
SCM TrPs don't cause is a pain in the neck, although they figuratively become
one due to their wide-ranging symptoms. A feeling of continued movement in car
after you've stopped, and feeling of tilted "banking" as your car
corners are also part of the SCM TrP gifts to us. The perceptual changes can be
very hard to explain to your doctor.
- FMS&MPS Complex Nocturnal Sinus Syndrome: This is not an official name.
I use it here because I have never seen it described. This is a nighttime sinus
stuffiness on one side, that moves to whatever side of your head is lower.
Gravity drains the congestion to the lower side. This condition goes along with
post nasal drip and often a constantly runny nose.
- Runny nose: Almost all FMS&MPS Complex patients have this form of
"vasomotor rhinitis". I think, and this is just my theory, that with
muscle tightening, normal fluid passages are constricted, and fluid backs up in
the sinuses. So we get a constant post nasal drip all night, although the
membranes of the nose may feel very dry and even bleed. It isn't unusual for a
massage therapist to work a trapezius point and suddenly the sinuses clear.
This often happens in an area right behind the jaw, under the ear. I can often
tell what side a patient sleeps on most. That's usually the side with the worst
head and neck rigidity. The side they sleep on most is subjected to more of the
drip...drip...drip ... like water torture, on the back of the throat, all
night. The SCM TrPs and the scaleni become tight to "splint" the sore
throat and digastric TrPs. I have found that very warm salt-water used as nose
drops to clean off the throat and nasopharyngeal area before bed will prevent
or at least minimize this difficulty without adding medications to the system.
Antihistamines and decongestants can be important. If the neurotransmitter
histamine is an integral part in a patient's FMS, you will probably get to know
them quite well.
- Trouble swallowing: If the post nasal drip isn't treated, trouble with
swallowing develops due to digastric TrPs. This leads to head and neck pain,
and a "swollen glands" feeling.
Warning - digastric TrPs are sensitive. Sometimes it's best for the patient to
"milk" the area of its excess fluid, using a gentle downward stroking
motion from the chin to the base of the throat. Tell them to start lightly and
listen to their body.
- Ringing in the ears: Deep masseter TrPs may cause ringing or a low roaring
sound in the ears. The sound may vary. I get a crackling, or sometimes hear
that annoying sound that the phone makes when its off the hook. The medial
pterygoid TrPs can cause deep ear pain and stuffiness in the ear. The sternal
portion TrPs of the SCM can also cause deep ear pain.
- Chronic dry cough: This is often due to a TrP at the lower end of the
sternal division of the SCM. The sternocleidomastoid is not a muscle, but a
muscle group. TrPs in different areas cause different symptoms. To complicate
matters, a chronic dry cough can also be due to esophageal reflux. Bruxism,
chewing gum, playing a wind instrument or violin will often aggravate neck
TrPs.
- Fluctuating blood pressure: This is a question without an answer, only a
theory. It has to do with the carotid sinuses. I have now and then heard from
people with fluctuating blood pressure. This could be from TrPs in the neck
interfering with the functioning of the carotid sinuses.
- Problems swallowing, chewing pain, jaw clicking, TMJ, soreness inside the
throat, excessive saliva secretion and sinusitis-like pain, drool in your
sleep, choke on saliva: These all can come from the internal medial pterygoid
TrP.
- Prickling "electric" face: This pain is most often from the
platysma TrP. This TrP refers the prickling pain to the skin area over the jaw.
- Red eyes, tearing eyes: These symptoms can be caused by the SCM, along with
hearing impairment, and a disturbed sense of weight perception.
- Popping or clicking of the jaw, TMJ (temporomandibular joint dysfunction):
Jaw pain and dysfunction is usually a function of the masseter TrP, although
the trapezius and temporalis TrPs are often involved
- Eye pain: Cutaneous facial TrPs can cause pain in ear, eyes, nose and
teeth. These TrPs are shallow, and can occur in many places on the face. Tell
your patient to try some pressure-point.
TrP Pain is rarely symmetrical. The patient usually presents with complaints
due to the most recent activated TrP. A lump at the TrP site could be due to
damming of blood and other fluids by obstructed blood flow.
Spray and stretch release of TrPs by use of fluro-methane is detailed in the
Trigger Point Manuals. Sine-wave ultrasound with electrostim, acupressure or
pulsed galvanic stimulation can be used in some areas to break up TrPs.
Fibromyalgia Support - Ottawa West
S.C. Brown
Dec/14