Myofascial Pain Syndromes

General Illness Information


Common Name: Fibromyalgia (Fibromyositis)

Description: Fibrositis (fibromyalgia syndromes, myofascial pain syndromes) are a group of disorders characterized by chronic widespread aches and pains in the muscles, muscle sheath and connective tissues of tendons, muscles, bones and joints, with associated tenderness.

The pain and stiffness (fibromyalgia) may affect the whole body or may be restricted to certain parts of the body, as in myofascial pain syndromes. Fibromyalgia throughout the body is more common in women than in men. Men are more likely to develop myofascial pain or fibromyalgia in a particular area e.g. a shoulder ,from a work related or sports  muscle strain injury.

It is a common condition seen in 4 to 11% of the population and is  more prevalent in women. It can  affect any age group. It is not serious or life-threatening, but persistent symptoms can be very disruptive.

Causes: Unknown. However, fibromyalgia may be triggered by mental or physical stress, inadequate sleep, an injury, exposure to dampness or cold, certain infections and possibly related to imbalance in brain chemicals or auto-immune disorder.

It is not a psychological disorder.


  • Avoid risk factors when possible.
  • Get adequate sleep.
  • General conditioning exercises

Signs & Symptoms

  • Aches and pains in muscles and joints. Pain worsens with fatigue, straining or overuse. Pain usually worse in the morning and with weather changes.
  • Stiffness and weakness.
  • Sudden, painful muscle spasms (“charley horse”) that worsen with activity.
  • Nodules or localized areas that are tender to the touch (trigger points). Pressure applied to these sites ( trigger points) reproduces the patient’s symptoms.
  • Painful muscle areas.
  • Generalized fatigue and tiredness.
  • Difficulty with sleep. Usually associated with early morning awakening and unrefreshed sleep.
  • Depression.
  • Reduced physical endurance.
  • Anxiety.
  • Chronic headache.
  • Pain improved by mild physical activity or vacations (stress-relieving situations).

Risk Factors

  • Medical history of disorders that produce joint inflammation, such as rheumatoid arthritis or polyarteritis.
  • Viral infections.
  • Fatigue or overwork.
  • Poor nutrition.
  • Sleep disturbances
  • Muscle injury
  • Stress.

Diagnosis & Treatment

Diagnosis of fibromyalgia is based on the pattern and location of the pain. Physical examination to determine the presence of tender points on specific sites and also identifying “trigger points”.
There are no laboratory tests to confirm the diagnosis of fibromyalgia. However,  blood tests should be done to rule out other causes of the muscle aches and pain such as rheumatoid arthritis or polymyalgia

A sleep electroencephalogram (EEG) may reveal a specific pattern suggestive of fibromyalgia.

General Measures:

  • Heat. Take hot showers, and let the water spray on painful areas. Heat lamps, electric heating pads, whirlpool or plain tub baths and hot compresses may be useful.
  • Gentle massage to painful areas.
  • Stretching and conditioning exercises
  • Learn relaxation techniques.
  • Alleviate stress.
  • Biofeedback is helpful for some patients who use it to relax contracted muscles.
  • Maintain social interaction even though the pain may be distracting at times.


  • For minor discomfort, you may use non-prescription drugs such as aspirin, acetaminophen or ibuprofen.
  • Non-steroidal anti-inflammatory drugs may be prescribed- these are generally not very helpful.
  • Cortisone and local anesthetic injections into “trigger points”
  • Antidepressants in low dosages and for short periods may be prescribed. Commonly prescribed antidepressant for this condition are the selective serotonin reuptake inhibitors(SSRI) e.g. fluoxetine (Prozac), sertaline (Zoloft), paroxetine (Paxil).


Stay as active as possible, even when you are in pain. Stretching exercises may be helpful. General conditioning exercises are also very helpful.


No special diet, but avoid substances that interfere with sleep, such as caffeine and alcohol

Possible Complications :

  • Muscle atrophy, disability.
  • Abuse of pain-killing medications
  • Depression.


Spontaneous recovery in some persons. Other persons may have flare-ups and remissions indefinitely. The disease is uncomfortable, but not life-threatening. Symptoms can be relieved with treatment.



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