Fibromyalgia Information & Local Support
Information for Neurologists
You have seen patients with fibromyalgia and myofascial pain syndrome, and
will see more. They are both very real medical conditions, and both very
different, although often confused. Patients with FMS and/or MPS may react
differently to surgery and its associated care.
Fibromyalgia is a systemic neurotransmitter condition with, among other
things, a disrupted adrenal-hypothalamus-pituitary axis. It is nonprogressive
(although it may seem so), nondegenerative, and noninflammatory. It is
responsible for diffuse body-wide pain, tender points that hurt but don't refer
pain, and sleep disturbances. It is a pain amplification syndrome. Some of our
receptor endings have changed, so we feel pain more intensely. We have
allodynia, so be prepared for more intense post-surgical pain, as well as
longer healing time due low growth hormone and associated healing factors.
Chronic myofascial pain syndrome (MPS) is a musculoskeletal chronic pain
syndrome. It is nonprogressive (although it may seem so), nondegenerative and
noninflammatory. It is composed of many Trigger Points (TrPs), which refer pain
and other symptoms in very precise, specific patterns. It seems progressive
because each TrP can develop satellite and secondary TrPs, which can form
secondaries and satellites of their own. With treatment of the TrPs and
underlying perpetuating factors, however, these TrPs can be
"reversed" and minimized or eliminated.
When occurring together, what I call the "FMS&MPS Complex"
forms. This is a condition of interconnected symptom spirals that get
increasingly worse until the spiral is interrupted. For example, the pain
causes muscle contraction which causes more pain which causes more contraction,
etc. The patient can sometimes have muscles that are like cement, due to
myofascial splinting. Immobility will usually cause symptoms to worsen, and
muscles to contract. Sometimes patients will not be able to endure the hard
hospital beds. Some of us even find water beds too hard, and need additional
Two excellent medical texts are available on MPS, "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 second volume is important to you, as it deals
with lower body TrPs. This chapter is but an introduction to them. The Manuals
show the referred patterns, tell what causes them, and how to relieve them.
Many of your patients may suffer from allodynia or hyperesthesia, and there
are specific symptoms of FMS&MPS Complex that should put up a red flag.
- Morning stiffness:
- This is primarily due to the immobility of the night. Any time we stay in
one position for any length of time, our body stiffens in that position due to
inflexible myofascia. This stiffness may take hours to work out.
- Muscle twitching:
- Eye twitching is often the first noticeable twitch in FMS&MPS Complex,
and it's very common. Check the periorbital TrPs, especially around the upper
eye ridge. You will probably find some real screamers. Also check the
sternocleidomastoid, the temporalis and the trapezius TrPs for possible causes
of the eye twitch. You may also find other head TrPs. Other muscles twitching
can become bothersome. Sometimes it can be a continuous twitch. Sometimes one
or two muscles will fire off now and then. Fasiculations and waves of twitches
can be due to low-level TrPs. This has been described as having your nerves
plugged in to twinkling Christmas lights. Other people have severe twitches
that disrupt their functioning. These can become painful cramping.
- Trouble falling asleep, trouble staying asleep,light sleeping, interrupted
sleep, wake up feeling tired and unrefreshed :
- These are symptoms of the alpha-delta sleep disorder, which often occurs
with FMS&MPS Complex.
- Difficulty getting out words you know, especially nouns and pronouns:
- This is part of the "cognitive deficits" package we get with
FMS. Names and nouns get awfully hard to find. It's frustrating.
- Difficulty distinguishing right from left and/or difficulty finding places
or following directions:
- They say that there will never be a rally for fibromyalgia because none of
us could find where it was held.
- Short-term memory problems, confusional states:
- We often can't do a number of steps in sequence. I found that I was unable
to deal with appointments on the half-hour while working on my book. My mind
wouldn't register them as half-hour. I'd come a half-hour early or a half-hour
later. The concept was too much for me to grasp, because of the extra work
- Severe problems estimating distance and depth perception:
- This can cause driving to be extra exciting, especially if
sternocleidomastoid TrPs are involved. They can cause severe dizziness when the
field of vision is changed rapidly, and many other proprioceptor disturbances.
Any pattern on light and dark, such as window blinds, escalator steps, trees
along a road or patterns in fabrics can cause dizziness or even a seizure-like
- Free-floating anxiety, panic attacks, rapid mood swings, irritability with
unknown cause, trouble concentrating, inability to recognize familiar
- This is all part of what we term "fibrofog", and can be part of
the neurotransmitter imbalancing. This can be worsened by reactive
hypoglycemia, which must be modified by diet (see patient handouts).
- Sensory overload:
- This is what I call the feeling that information and stimulation is coming
at you so fast you can't deal with it. We either go into a "fugue"
state -- we stare into space for a while until our brain catches up (this can
happen mid-sentence) -- or we close down some sensory input. In the latter
case, we shut off car radios, leave noisy rooms and avoid cities. We need our
- Too little serotonin may trigger depression. Acute pain that diminishes in
the course of a natural healing process is something that most of us can live
with. Recurrent or persistent pain, especially due to an unrecognized or
untreatable cause can threaten our future function and well-being, which can
lead to frustration, depression and progressive disability.
- Sensitivity to cold, sensitivity to heat, sensitivity to humidity,
sensitivity to barometric pressure and approaching storms:
- these are part of body "thermostat" regulation problems. One
minute we're hot, and the next minute we have the chills. I've not had as many
chilly periods since I started taking timed-release niacin. That opens up the
peripheral circulation. Bodywork helps as well, although it won't do much about
the thermostat problems. The hypothalamus at base of brain is our thermostat,
so this is part of the disrupted HPA axis. The hypothalamus sends a message to
the body to contract or dilate blood vessels, via neurotransmitters. Some of us
run a low-normal temperature, and some of us have chronic low-grade fevers.
Take a good history. We often have abnormal electromyographic results due to
nerve entrapment by TrPs, and even abnormal EEGs, although these vary, like the
symptoms, from hour to hour and day to day. There are often white blotches in
the MRIs. Once you see this pattern of signs and symptoms and understand the
concepts of FMS and MPS, they will become easier to recognize.
Fibromyalgia Support - Ottawa West