Fibromyalgia Information & Local Support

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Information for Ob./Gyn. Health Professionals

©Devin Starlanyl, MD 1995-1998

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. They may be the answer to some of your "challenging" patients.

Fibromyalgia is a systemic neuroendocrine 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.

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. It is not unusual, however, for pregnancy or even dysmenorrhea to activate TrPs.

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.

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, but there are some TrPs at the end of the first volume that are also important. The manuals show the referred patterns, tell what causes them, and how to relieve them.

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