Abstract
IntroductionIt has previously been reported that local and referred pain from active myofascial trigger points (MTPs) in the neck and shoulder region contribute to fibromyalgia (FM) pain and that the pain pattern induced from active MTPs can reproduce parts of the spontaneous clinical FM pain pattern. The current study investigated whether the overall spontaneous FM pain pattern can be reproduced by local and referred pain from active MTPs located in different muscles.MethodsA spontaneous pain pattern in FM was recorded in 30 FM patients and 30 healthy subjects served as controls. Local and referred pain patterns induced from active (patients) and latent (controls) MTPs were recorded following manual stimulation. The existence of MTPs was confirmed by intramuscular electromyographical registration of spontaneous electrical activity.ResultsLocal and referred pain areas induced from key active MTPs in FM were larger than pain areas from latent MTPs in healthy controls (P < 0.001), but were similar to the overall spontaneous FM pain area in FM (P > 0.05). The induced pain area was positively associated with current spontaneous pain intensity in FM (P < 0.01). The locations of key active MTPs in FM patients were found to have latent MTPs in healthy subjects. The muscles containing key active MTPs in FM are often observed in the muscles of extensor digitorum, trapezius, infraspinatus in the upper part of the body and of quadratus lumborum, gluteus medius in the lower part of the body.ConclusionsThe overall spontaneous FM pain pattern can be reproduced by mechanical stimulation of active MTPs located in different muscles, suggesting that fibromyalgia pain is largely composed of pain arising from muscle pain and spasm. Targeting active MTPs and related perpetuating factors may be an important strategy in FM pain control.Trial registrationISRCTN ISRCTN43167547.
Highlights
It has previously been reported that local and referred pain from active myofascial trigger points (MTPs) in the neck and shoulder region contribute to fibromyalgia (FM) pain and that the pain pattern induced from active MTPs can reproduce parts of the spontaneous clinical FM pain pattern
Overall spontaneous FM pain and MTP-evoked pain A two-way analysis of variance (ANOVA) revealed a significant difference in spontaneous FM pain and evoked pain areas between FM and controls groups (F = 114.4, P < 0.001, Figure 1), but no significant differences were observed in the area between spontaneous pain and MTP-evoked pain within the FM group and control group (F = 0.0044, P = 0.947, Figure 1)
In FM patients, the local and referred pain patterns evoked from key active MTPs were similar to the overall spontaneous pain pattern (Figure 3)
Summary
It has previously been reported that local and referred pain from active myofascial trigger points (MTPs) in the neck and shoulder region contribute to fibromyalgia (FM) pain and that the pain pattern induced from active MTPs can reproduce parts of the spontaneous clinical FM pain pattern. Manual provocation of active MTPs reproduced substantial parts of the clinical pain pattern experienced by FM patients [7,8] These evidences suggest that active MTPs contribute significantly to the overall spontaneous pain pattern in FM. In FM patients, active MTPs may be observed in different muscles [10] and at multiple locations in a single muscle [7], apart from active MTPs in predetermined tender point sites in FM [8,10].
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