When I was diagnosed with fibromyalgia I was also diagnosed with myofascial pain dysfunction syndrome. I found that if my physical therapist or masseuse could not work out the “knots” in my muscles, my physical medicine & rehabilitation physician could offer help with trigger point injections.
Trigger points are discrete, focal areas of taut muscle bands. They are highly irritable, and when compressed can produce referred pain and tenderness, muscular dysfunction, and autonomic nervous system symptoms. Contrast this to tender points, which produce pain only when palpated and do not refer pain so that you feel it in other parts of the body.
Trigger points cause a common painful disorder known as myofascial pain dysfunction syndrome. This disorder is different from fibromyalgia syndrome, which involves multiple tender spots or tender points. These pain syndromes often occur together and may interact with one another, producing both tender points and trigger points. Trigger points are classified as active, latent, or satellite.
What is the difference? An active trigger point causes pain at rest, is tender to palpation, and has a referred pain pattern similar to the patient’s pain complaint. Referred pain is an important characteristic of a trigger point and differentiates it from a tender point, which is associated with pain at the site of palpation only. A latent trigger point does not cause pain at rest.
Trigger points are associated with a “twitch response.” The twitch response is elicited when firm pressure is applied with the fingers perpendicular to the trigger point in a snapping manner, or when a needle is injected directly into the trigger point.
This all sounds very technical but I do know they are very helpful, at least for me. If you are going to have TP injections make sure you stretch out your muscles after the injection. Remember muscles have a memory and are used to be in a shortened position.
How about you, do you find trigger point injections helpful in dealing with pain or fibromyalgia?
Trigger points can be treated with many means, not just the injections (e.g. TENS, cold/stretching/heat, myofascial release, acupuncture/dry needling). The most evil thing about them is that they can cause many other symptoms besides the pain, including some truly nasty ones like projectile vomiting.
However, in many cases there is a metabolic problem underlying the trigger points. I don’t have fibromyalgia or chronic pain, but I have trigger points in practically every muscle from scalp to toe, likely caused by my hormonal deficiencies. If activated they cause various symptoms from headaches to gastroparesis.
TENS is quite helpful for me, but it can’t be used in some of my worst areas, like the scalp or the chest. And local treatment for such a systemic problem is not very sensible, anyway…
Maija – Your comment about your trigger points being caused by hormonal deficiencies is very interesting to me. I have trigger points all over the place too but mainly in my back and neck. I used to see a massage therapist (when I could afford it) and she would massage the knots out of my trigger points but they would always return immediately. I also have hormonal deficiencies though, so I would like to know what other info you know about the relation between the two. Thanks!
Vanessa: I would highly recommend the book “Myofascial Pain and Dysfunction: The Trigger Point Manual”. Sadly it’s super expensive and normal libraries are unlikely to have it, but a university library likely would (I borrowed the first part from the dental library of Helsinki university; the second part had been stolen and was unavailable from the whole metropolitan).
The book mentions hypothyroidism and hypoglycemia as common causes of trigger points. I have both. I have a feeling my adrenal insufficiency and other hormonal deficiencies likely play a part, too (well, the adrenal insufficiency does cause the hypoglycemia, but I do think it does something else, too). Many things like some vitamin and mineral deficiencies, diabetes and some meds (e.g. statins, possibly neuroleptics) can also contribute. In general, anything that impairs muscle metabolism can cause trigger points.
But generally if you have lots of trigger points, the reason is likely to be systemic. And while local treatment can help, it just feels a bit fruitless. I’m hoping that increasing my thyroid medication would put them in check, but I’m not too hopeful, since previous increases have had no effect. At least TENS I can use all the time…