A Cause of Focal or Regional Pain
Fibromyalgia is a chronic pain syndrome which affects a focal or regional part of the body including the back. It affects approximately 2% of women and 0.5% of men. A trigger point is an area which can precipitate the pain of fibromyalgia and may be the result of microtrauma to the affected muscles. Stimulation of the trigger point will exacerbate the pain. Stiffness, joint pain, and radiculopathy may be present as well, making the diagnosis and treatment of fibromyalgia more difficult.
Symptoms of Fibromyalgia
The presence of trigger points with extreme tenderness is very helpful for the diagnosis of fibromyalgia. Mechanical stimulation of these points by palpation and overstretching will reproduce intense local pain as well as the referred pain. Depression and sleep disturbances may be present as well. The exact cause of fibromyalgia remains unclear.
Fibromyalgia most likely develops as a result of muscle trauma. This may be a significant muscle trauma such as overstretching of the muscle or it may be repetitive microtrauma to the muscle. However, the exact cause is unclear.
There is no specific tests which will conclusively diagnose fibromyalgia. The best diagnosis relies on the detection of trigger points in the affected muscles and the associated jump sign when these trigger points are stimulated, in combination with the other constellation of symptoms seen with fibromyalgia.
As mentioned above, trauma to the muscle may precipitate fibromyalgia. The weekend athlete who is sedentary during the week but subjects his body to athletic strain during the weekend is at risk.
Patients with fibromyalgia often have not only the pain, but also an underlying sleep disturbance, depression and anxiety. Treatment must be aimed at all these areas. Antidepressant medication plays a role. Heat and cold is also used in addition to trigger point injections to help achieve pain relief and normal sleep patterns. Transcutaneous electrical nerve stimulation (TENS) units may be of benefit. The injection of small amounts of botulinum toxin A in trigger points near the cervical spine has been used, although this is not currently approved by the Food and Drug Administration (FDA).
With the above treatment regimen aimed at treating the pain as well as the depression and sleep disturbance, the prognosis may be quite good.
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