cmp info chronic myofascial pain

Discussion in 'Fibromyalgia Main Forum' started by charlenef, Feb 21, 2009.

  1. charlenef

    charlenef New Member

    Dealing with Chronic Myofascial Pain

    By FL-Jan



    I'm writing this because so many of the symptoms described by people diagnosed with fibromyalgia sound more like chronic myofascial pain (CMP) rather than fibromyalgia. Both conditions occur together frequently. This is called FMS/CMP Complex.

    I am not a doctor or a physical therapist, but I have lived with severe CMP all of my life. I've learned from knowledgeable osteopaths (D.O.s), allopaths (M.D.s), pain management specialists (anesthesiologists with pain management training), and physical therapists with additional training in myofascial release. I've also learned a lot from reputable books and medical articles on the internet. I have mainly learned how to recognize and deal with CMP from the “school of hard knocks”. You know, the “been there, done that” thing and I’m still doing it! It is an on-going thing in its worst chronic form. Knowing when I need medical intervention was also part of my learning process.

    Chronic myofascial pain can cause debilitating pain, loss of function locally or regionally, and other seemingly unrelated symptoms. The UP side to CMP is that it can be treated effectively and the worst of the pain and other symptoms can be reduced long term, short term, or, if you’re really lucky, permanently! The only DOWN side, other than having CMP, is that doctors often don’t understand it or recognize it. They leave patients suffering unnecessarily and may just give them pain pills. Pain pills will not help CMP. They will make you groggy so you don’t care quite so much, but until the trigger points of CMP are released, the pain is unrelenting and movement of the affected area remains difficult, too. Anti-inflammatory medications will not help long term either. Again, the trigger points must be released before relief can happen.

    You may or may not have CMP, but if any of the descriptions here and in the attached links seem to describe your symptoms you should speak with your doctor about this condition. Obviously, I cannot diagnose you, but if you’re reading this, some of your symptoms probably sound like they could be myofascial in nature.

    This web page is in MY words and expresses MY understanding of the condition called CMP, sometimes called MPS, myofascial pain syndrome. The attached page linked below provides links to medical and lay person information on the internet and in books.


    Chronic myofascial pain (CMP) is caused when the fascia, the filmy material that holds all of our body parts where they belong, gets bound around some muscle fibers preventing them from getting rid of their cellular waste and receiving vital nutrients – that's the birth of an acute trigger point (TrP). The interstitial fluid (fluid between our cells) that is trapped within a TrP gelatinizes over time. Also, cellular waste is trapped. Once that happens, you can actually feel the nodule formed by a TrP in a muscle. When bad (big?) enough, a TrP prevents a muscle from completely relaxing and completely working. Hence, the taut ropy band of muscle that characterizes myofascial pain syndrome (MPS, aka CMP) develops over time. Trigger points cause severe pain and usually weakness in the affected muscle. Because the muscle stays semi-contracted, it never rests and never recovers until the trigger point is released.

    Many people start with an acute myofascial pain condition. Whiplash is a myofascial pain condition. So is the stiff neck people wake up with once in a while and relate to "sleeping wrong". Many overuse injuries are acute myofascial pain conditions, too. Remember the big muscle knot or spasm following unusual physical exertion? You know, the one that not only hurt, but restricted motion, too. Do not confuse overuse injury or myofascial pain conditions with basic pain from physical exertion (exercise pain).

    Acute myofascial pain may become chronic if the TrPs do not self-release or get treated in due time. Many whiplash victims are later diagnosed with FMS. Hmmmm. I'm not so sure – maybe the doctor should try CMP on for size! I think some people are predisposed to the chronic form of myofascial pain for unknown reasons, too.

    When any one muscle misbehaves long enough, it affects other muscles in its group that have to carry the extra load. This situation can cause satellite TrPs to form in those newly overloaded muscles, then those muscles are affected, and suddenly a patient can't use a body part at all – THINK stiff neck, frozen shoulder, thoracic outlet syndrome, carpal tunnel syndrome (not the true nerve entrapment in the wrist that really IS carpal tunnel), and more. Sometimes the patient can use the affected muscle group with extreme pain and working around the affected area by altering movements. This, in turn, causes the cascade to begin anew affecting even more muscle groups. Now it's truly chronic. Now it sucks!

    There is a quite a bit of literature about chronic myofascial pain or myofascial pain syndrome. There is some literature about FMS/CMP complex – fibromyalgia combined with chronic myofascial pain. Unfortunately, MDs have been slow to learn the difference between these two ailments. This is a real shame since they can help relieve a lot of the severe pain and other symptoms of CMP, unlike FMS. Sadly many FMS patients suffer needlessly for a long time until diagnosed and treated properly. FMS alone is bad, but CMP run rampant is pure hell.

    Many Physical Therapists, Licensed Massage Therapists, and Pain specialists understand myofascial pain very well. Hence, when working with fibromyalgia patients, they usually do a physical exam looking for TrPs and looking closely at movement, range of motion, and posture before offering treatment of any type. Many pain specialists don't bother to explain that trigger points (TrPs) are from a different entity, not FMS. However, they do TrP injections to release some trigger points, but never explain the condition to the patient. That’s a shame because there are home remedies that can relieve many TrPs before they get so severe that they require the more advanced and expensive treatment. There are also exercises and stretches that can be done to prevent the formation of TrPs. Sometimes I wonder if some doctors hesitate to give FMS patients another diagnosis because some patients seem to “become” their ailments.

    I'm quite sure a lot of doctors don't know the difference between FMS and CMP since a lot of medical literature and web sites I've seen mix up the terminology (tender points vs. trigger points) and the treatments for each. Also, many doctors are bewildered by their patient’s symptoms that “just don't seem like fibromyalgia”. If they were knowledgeable about CMP, they might recognize those symptoms!

    Sadly, many patients are sent to physical therapy for strength training when they are full of the trigger points of CMP. If the physical therapist is not aware of myofascial pain, they can cause more problems. You cannot strengthen a muscle that has TrPs. The TrPs have to be released first. The outcome of strength training while TrPs are present is a wider region of pain due to the satellite TrPs that form when we try to force the affected muscle(s) to work and other muscles take over the load.

    The saddest outcome of all are the patients put through major surgery for something they don't actually have (carpal tunnel, rotator cuff problems, even spinal fusions, and more). Chronic myofascial pain is the explanation for many of those "failed" orthopedic and back surgeries we hear about. All these patients needed was trigger point release and a treatment plan to keep the TrPs under control. Obviously, some people actually do have carpal tunnel, rotator cuff, and other orthopedic problems, but a percentage are diagnosed incorrectly.

    CMP vs. FMS


    · head and neck

    · neck, shoulders, and upper back

    · hips and legs

    · hips and lower back

    · a specific muscle region of your back (not disc or vertebral issues although they can trigger CMP)

    · chest and/or rib cage

    you should learn about chronic myofascial pain (CMP), also known by the older term, myofascial pain syndrome (MPS). A lot of MDs think they are one in the same, but they are quite different.

    When some doctors do the fibromyalgia tender point test, they mistakenly assume that the trigger points of CMP are FMS tender points since they can be in the same locations and patients will almost jump off the table when a TrP is pressed. Fibromyalgia causes diffuse pain and deep aches all over. CMP can be a body-wide problem, but rarely do ALL body-wide trigger points "attack" at the same time. CMP pain is usually regional or localized. CMP pain is severe. CMP feels more like an acute injury most of the time. The pain is frequently described as a burning or searing. The TrPs of CMP can also restrict range of motion (ROM), FMS does not.

    CMP is often misdiagnosed as muscle spasms, muscle pulls, bursitis, and tendonitis. Trigger points (TrPs) can refer pain quite a distance from their actual location, too, which confuses doctors and patients. Depending upon where the TrPs are located, they can cause problems that are frequently diagnosed as TMJ (from teeth grinding), carpal tunnel syndrome, severe tension headaches or migraines, and nerve entrapment. The latter is a big problem because patients get referred to a neurologist rather than a physical therapist that specializes in myofascial release therapy or a pain management specialist for trigger point injections. All of us have heard of people who had "failed" carpal tunnel surgery. The surgery is often a failure because the problem wasn't really in the wrist. TrPs in the chest, sides of the neck, and under the arms can cause nerve entrapment which in turn causes pain in the wrist, hands, and/or lower arm and elbow. NOTE: TMJ from teeth grinding or clenching is myofascial in nature and the TrPs can be relieved. However, the cause must be relieved to stop the cycle.

    Tinnitus, sinus trouble, dizziness, and many other non-pain symptoms and conditions can actually be caused by CMP, too. In my 20s, doctors had me taking antihistamines and decongestants daily for allergies causing sinus trouble. In 1992, I had my first experience with myofascial release therapy on my head and neck. Lo and behold, during my second treatment my sinuses opened up and drained like crazy. I’ve not required treatment for sinus issues since that time.

    Real costochondritis is an inflammation of the rib cartilage, not just general pain in the chest and/or rib cage. The act of breathing hurts because it pulls the cartilage with each inhale and releases it with each exhale. Symptoms can seem as though the pain is spread all across the rib cage, but early on, before it gets that bad, one can usually tell it’s just where the cartilage connects the ribs to the body. Myofascial pain trigger points in the chest and over the ribs, both front and back, can cause similar symptoms and be misdiagnosed as costochondritis. The rest and NSAIDs the doctor prescribes does not help the condition if it is CMP. In fact, resting can make TrPs worse.

    TrPs in the chest can be felt if you "let your fingers do the walking". Walk your fingers across your chest just below the collar bones to start, pressing gently with each "step". If you hit a nodule or an extremely painful localized spot, it’s probably a trigger point. If you press harder on that spot and it is a TrP, it will usually refer pain into your shoulder and/or possibly down your arm. If you do this same thing across the lower ribs and hit a similar exquisitely painful spot, it will probably refer pain at least ½ way around your body. I've had costochondritis and can tell the difference between that and CMP - it is quite obvious to me because I’ve lived both. Unfortunately, doctors that are unfamiliar with CMP and have never had or really explored costochondritis frequently misdiagnose CMP TrPs as that painful cartilage inflammation problem. They also tend to label other painful areas as bursitis (hips or shoulders) or tendonitis (shoulders and elbows) without hands-on investigation beyond the patient's description of their pain. That is what is good about the links below, including the one from the American Family Physician. They all describe what the doctor should see, hear, and feel in order to diagnose CMP correctly. They also explain treatment options. Your job will be to get your doctor to read the articles!

    This isn't to say that people never have true TMJ from jaw misalignment, costochondritis, carpal tunnel, bursitis, and/or tendonitis, they are just not as common as acute or chronic myofascial trigger points.

    Learning how to self release the trigger points of myofascial pain before they really go crazy is the second best thing you can do for yourself. The severe pain of CMP can be completely relieved in some cases or at least temporarily for long periods. Once treated, there are things you can do at home to maintain yourself and help to prevent those TrPs from firing up again. The very best thing you can do is learn what the perpetuating factors for a given trigger point are and correct them if possible (posture, limping, poor pillow, repetitive motions, etc.).


    My CMP Arsenal to Stay in this Game Called Life

    The following remedies are listed from least invasive to most invasive, preventive to treatment. Funny, but it seems the more invasive the method, the more expensive it is! Do NOT do any of the physical things below if you have any condition that can be made worse by doing them (spinal fusions, etc.)

    Keep moving: Lying or sitting around for long periods causes more muscle stiffness and more trigger points
    Stretching: routines to help prevent TrP formation including periodically getting up from my desk or halting a repetitive motion job (vacuuming, mopping, raking) to stretch and move all body regions. Do NOT stretch to the point of pain. Over time, you will need to hold a stretch longer and farther to get full benefit. Don’t rush it. Slowly, gently!!!
    Body Ball (available at Wal-Mart for about $13.99): Lie over the ball face up with arms outstretched to your sides to stretch out chest and/or back after desk work, housework, etc. Using it in this fashion stretches muscles in the opposite direction of how we usually do things, everything in front of us, reaching forward, leaning forward, head forward posture. Since gravity does the stretch, we have less chance of hurting ourselves. Once you are comfortable with the ball, you can try moving ever so slightly in various directions to mobilize the muscles of the pelvis, hips, back, chest, and arms. Try putting your arms over your head…
    Doorway: No Body Ball available? Stand in a door frame. Grab each side with your hands at shoulder height. Gently lean forward keeping your legs and waist straight. Hold it. Let gravity do the stretch to open up the chest and ease the upper back.
    BioFreeze roll-on (or other topical muscle pain relief remedy)
    Trigger point self-release methods
    The Trigger Point Therapy Workbook, by Clair Davies: a must to learn what TrPs cause particular symptoms and how best to treat them.
    Thera-Cane: the book above explains how and where to use it. Takes some practice and is my last choice of tools.
    Tennis ball in a tube sock: Put a tennis ball in a tube sock, hang it over your shoulder and position the ball over the area of the back where pain seems to be originating; Lean against the ball while sitting in a solid backed chair or couch or while standing against a wall. Move gently around to massage the area, applying a bit more pressure as you can tolerate it. It really helps work out some trigger points of CMP.
    My fingers: _______________
    Lidoderm Patch: expensive prescription patch that slowly releases anesthetic to help localized pain (only stays attached in areas not subject to a lot of movement – buttocks, low back, upper back, hips)
    Muscle Relaxant: Prescription for any one of several available that works for you; Can be very helpful to relieve knotting up during sleep if taken before bedtime; May be helpful to take prior to PT or home exercises.
    Antidepressant Therapy for Pain Management: I take Elavil via the pain management protocol recommended by pain management specialists – not just 10mg to aid good sleep, but a personalized dose about 2 hours before bedtime to aid restorative sleep and has cut my number of severe pain days in 1/2 and the duration of severe pain episodes by 2/3. The choice of medication and dosing should be customized for each patient and just the right dose may take a few months to achieve.
    TENS unit: _____________
    Myofascial release therapy: performed by a specially trained physical therapist, massage therapist, chiropractor, or osteopath
    Trigger point injections: Given by a Pain Mgt Specialist or other trained physician; if not done correctly, directly into the TrP, the injections can cause more TrP pain than you started with!

    Mesotherapy, medicinal use (not cosmetic)

    Three mesotherapy treatments on my low back and left sacroiliac area over a period of 5 months and I have no more low back pain! After blowing my L5-S1 disc and dislocating the left sacroiliac joint in June 2005, I was left with horrible chronic pain once the initial acute pain abated with standard treatments. My life as I knew it was put on hold. My doctor was having trouble with his lumbar spine at the same time. He told me his doctor was going to try mesotherapy on him. If it worked, he would do mesotherapy treatment on my low back. We both got great results, but my results are much better than his – he’s jealous!

    After experiencing what mesotherapy can do and learning more about this method of treatment, I asked my doctor to treat my neck and across my trapezius muscles to see if we could lessen my head pain. It worked!!! I have occasional short bouts, less than a day, of severe head pain related to severe low pressure weather systems, but I no longer have daily severe pain! I had two treatments on this area over a 2 month period in summer 2006. I have not required further treatments for head pain to date! Wow, where was this treatment 20 years ago?

    In my case, my doctor has chosen to use a combination of Toradol, Robaxin, and Procaine. Toradol is a strong NSAID. I am deathly allergic to NSAIDs, but I can tolerate the drug via this method because it stays in the local area where it is injected into the mesoderm, the deep skin and fat layer. In this way, the medications slowly release into the problem area and do not affect the patient systemically. The doctor uses a very short, fine gauge needle and injects minute amounts over the entire area to be treated, a total of only 3cc of all three medications combined. We have discovered that we have to space treatments apart by several weeks or I do get a local reaction to the NSAID. With every treatment, they have me stay for 30 minutes and monitor my breathing, BP, and pulse to be sure I’m not going to have an allergic reaction. But no matter, this is nothing short of a miracle for me! I could go on about stopping a severely stiff and painful neck in minutes with 20 pinprick injections, but read on…

    Mesotherapy – Treatments & Various Uses a links page to the history of mesotherapy, uses, pain management, & more (Mesotherapy Worldwide)
    Mesotherapy (Societe Francaise de Mesotherapie)
    Mesotherapy Treatment (College Pharmacy)
    Mesotherapy Today (Mesodiffusion) [a good explanation]
    Mesotherapy (American Vein & Laser Centers) [another good explanation]
    General Medicine (Mesotherapie & Estetik)

  2. JaneSmith

    JaneSmith New Member

    I'm sure it took you a long time to write your post. It's excellent and many thanks for doing that. I'm 57 and have all of the above since 15. I haven't had a doctor that can help and I take care of myself with exercise, supplements and good sleep otherwise, I'm in big pain trouble. Still I've lived most of my life in some type of pain and in all places of the body from one day to another. Unless, you've experienced what we've been through, nobody can really imagine living like us.


  3. charlenef

    charlenef New Member

    I suffer big time with cmp I pretty much bedridden nothing I have tried has helped me to get me moving again.I wish I could take credit for my post but I copied and pasted it.I think the hardest thing is Dr dont have the training for this disease.We are shuffled around to other Dr that hurt us.I do stretch daily and use trigger point therapy but if I over do it I suffer worse.Hugs Charlene
  4. charlenef

    charlenef New Member

  5. Gingareeree

    Gingareeree New Member

    I've long thought that I had myofascial pain syndrome rather than FM. Dr. pretty much jumped to FM conclusion even w/o doing a tenderpoint test. He referred me to a Rheumy(I never went).I think he didn't know what Dx was so he wanted to push me off to another Dr. I have had acupuncture and do regular trigger point massage. That has really helped! Jeanne
  6. estasredit

    estasredit New Member

    I have, with some difficulty due to pain, read the entire post as i have been diagnosed with this and knew nothing about it. I have learned a lot from you and i am very grateful. I have been seen in a pain clinic and had trigger point release injections (just a dry needle with no anesthetic or pain med) which had no effect and i have also had steroid injections which went about 6" deep into my back in places. There were seven of these steroid injections on the same day and they would have been very painful but i had hypnosis treatment to prevent pain before they started. The hypnosis for the needle pain worked but sadly the steroid injections didn't. I am still in chronic pain and dependent on morphine for the pain. I am due to see an osteopath shortly so my hopes are now with him.

    Thank you again for your enlightening post.

  7. tabby8

    tabby8 New Member

    This is me! I have also long suspected that chronic myofascial pain was my main issue, and have recently been officially diagnosed. This is an extremely informative article that could help many others here who have fibromyalgia, especially if they have trigger points that are going untreated. Thanks, charlenef.

  8. jaynesez

    jaynesez New Member

    for posting this, as I've been harping on tp's quite regularly here. Many on here have posted regarding severe pain here or there, and it's obvious from their descriptions that it is tp's. I suffer from FM & severe CMP too, and it's not pleasant! In 2003 I had a spinal fusion (L-4 thru S-1) and my muscles never released, so six years later they are like blocks of concrete. Then, to make matters even more fun, I got into a bad car accident in 2007 which traumatized my neck, shoulders, & upper back muscles. I've been through PT six times, have had numerous tp injections (in one visit alone got 12!) and now have a massage therapist that I try to see every two weeks to help with the pain. I have the TP manual, the theracane and tennis balls, but after working at a desk eight hours a day I'm in too much pain to do anything, except lie down to escape the force of gravity. I'm trying to hang on as long as possible, but don't see how I can ever hope to recouperate my muscles while still working all day!
    Anyways, good post, and I certainly feel your pain!