making sense of FM and overlapping conditions

Discussion in 'Fibromyalgia Main Forum' started by momofzandf, Feb 5, 2010.

  1. momofzandf

    momofzandf New Member

    I have FM, Hashimotos, and possibly CFS, (the lab test they ran indicated it) and I have a severe herniated disc in my low back. I started Physical Therapy and have explained that I do have back pain, but the worst pain is pain in my posterior hip, my butt cheek to be exact, that is painful when I sit, stand, lay etc. Most of the focus has been on the back, the heat, massage, and PT. My hip pain got better, but returned, so they focused the massage over the hip, and then they found a spot that was extremely tender, and they worked on that. The therapist said I had a “myofacial response” to the massage meaning there was some redness indicating irritation or inflammation of the muscle in there. I initially thought it was from the FM--- not the disc and she said no. Then I thought about it and still thinking about how this all works.

    FM pain is not from inflammation or irritation, correct? This is why anti-inflammatory and typical pain meds don’t work for FM pain? IFM pain responds to touch/pressure, because of a misfire of signals, not because of pain caused by inflammation or injury?

    Myofacial syndrome, MPS, which I believe now is called a disease, is different. FM and MPS can overlap, and its suspected MPS can lead to FM.

    The pain in the hip is extreme tenderness and it feels like a knot. In the past, I had severe rib/chest pain that I could not breathe without pain. All x-rays and test were normal. A massage therapist found a spot in my rib area that was very ropey and tender, and worked on this, and it took weeks but the pain went away. I also have tender spots below both armpits, and one in my right shoulder. These spots are not the FM spots they use for diagnosis.

    This is where I am getting very confused. Are these areas MPS areas? If so, maybe the hip at least can be treated with trigger point injection. That would give me enough relief to exercise better. Also, I believe the physical therapy is supposed to be used with some sort of spray technique?

    Of course I have my long laundry list of areas, but this hip thing is what is slowing me down the most.

    Since so many of these conditions overlap and coincide, how do you get the right treatment?
  2. richvank

    richvank New Member

    Hi, mom.

    It sounds as though you have several things going on.

    From what you've reported, I would say that myofascial pain syndrome is one of them. As you may know, this condition is characterized by the presence of trigger points. These are different from the tender points of fibromyalgia, but of course, as you mentioned the same person can have both of these conditions together.

    A trigger point has the characteristic that if you push on it, the pain occurs somewhere else, i.e. it is referred pain. A tender point, as in FM, on the other hand, causes pain at the same place one pushes. That's how you can distinguish MPS from FM.

    There is no really good treatment for FM yet, but MPS can be successfully treated by trigger point therapy. There are several ways to release trigger points. One can apply pressure on it (or squeeze it firmly but not too hard, if one can get access on two sides of it) for a few minutes, until it "melts" away, or one can spray it with a refrigerant (difficult now because of the Montreal protocol to protect the ozone layer from fluorocarbons) or apply ice to it to cool it, or an authorized practitioner can inject an anesthetic at the trigger point. It sounds as though you had some of this work done.

    Janet Travell and David Simon wrote the "bible" in this field, called the Trigger Point Manual. It comes in two big red volumes, for the upper and lower body, respectively, and it has detailed diagrams showing where the various trigger points can be located, and where they refer pain. There are many possible trigger point locations, in just about every muscle.
    This is a very good book. Janet Travell was the White House physician during the Kennedy and Johnson presidencies. She really knew her stuff!

    If you also have CFS (I don't know what test you had for this, but Hashimoto's frequently occurs with CFS), then you might consider testing for partial methylation cycle block and glutathione depletion, and if you have them, you and your physician might consider the Simplified Treatment Approach. If you want more information on this, you can find it in my past posts to this board, or you could email me at richvank at aol dot com and I will send you some stuff. I am not financially involved with either the test or the treatment. The test costs $300, and the treatment consists of certain targeted nutritional supplements and costs less than $3 per day. It isn't the complete treatment for most cases of CFS, but it has helped about two-thirds of the people who have tried it, some quite significantly.

    Best regards,

    Rich
  3. momofzandf

    momofzandf New Member

    hmmm...how far does the pain need to refer? If they push on the trigger point in the buttock, where else should I feel pain?


    I found this online "Trigger points in buttocks muscles cause symptoms that are often diagnosed as bursitis and inflammation of the hip joint. "
    http://www.blatmanpainclinic.com/Myofascial-Pain-Syndrome.htm[This Message was Edited on 02/05/2010]
  4. richvank

    richvank New Member

    Hi, mom.

    Kerrilyn has given you an excellent response, in my opinion. There is nothing like interacting with someone whose condition is very similar to your own, who has experience treating it, and that sounds like the situation with her.

    In answer to your question, it depends on where the trigger point is. There are three muscles there, namely the gluteus maximus, the gluteus medius, and the gluteus minimus.

    This may be getting into asking for "too much information," but since your identity is unknown here, I will ask: where on the butt cheek are we talking about? If it's in the back at the bottom of the cheek or in the back somewhat higher up on the cheek, that's the gluteus maximus. The other two are more on the side. The gluteus minimus is still on the cheek, but higher up on the side, and the gluteus medius is still higher up, near the hip. If you get one of the books we've mentioned, you can see the drawings. Anyway, trigger points in the gluteus minimus can refer pain to the butt cheek as well as down the back or side of the leg, down as far as the calf. For trigger points in the other two, as Kerrilyn said, the pain is referred mainly to locations within the butt cheek itself, in some cases maybe a little higher or a little lower, but mainly in that area.

    I hope that helps.

    Rich
  5. momofzandf

    momofzandf New Member

    I have sacrolization /lumbarization of S1 with a pseudoarthrosis on the left where the pain is....and left hip "os acetabuli" which they told me was a normal variant, yeah normal variant causing pain. I also have mild degenerative changes in my SI joints. Yes, my pelvis and back is a mess.
  6. richvank

    richvank New Member

    Hi, mom.

    O.K., you do indeed have a lot going on! I still think from what you reported that MPS is part of it, but sounds like some joint issues, too. If you've never looked into prolo (proliferative) therapy or platelet-rich plasma therapy, you might consider those approaches. They can be very helpful for joint and lower-back problems, in the hands of an experienced practitioner.

    Best regards,

    Rich