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Last updated: Fri, Feb 7, 2025
FMS and MPS provide an interesting contrast in terms of their respective fates as medically-accepted syndromes.
FMS patients commonly have a constellation of problems, including widespread pain and tenderness along with problems sleeping and often with depression or anxiety. In the past such patients were often suspected of hypochondria, health-related phobia, or a mood disorder.1 (I don't assert that they no longer are suspected of these things. See Psychological Analysis of Pain Behaviors.) Although FMS has none of the chemical signs of rheumatism, it found a home within the specialty of rheumatology. In 1990 the American College of Rheumatology proposed a common definition for the syndrome. The definition centered on tender points—FMS would be defined as tenderness in 11 of 18 specified places, mostly in the neck and upper back.
This definition was important in improving the quality of research on the condition. Lacking a definition, it was not possible to know whether research was being performed on comparable subjects. Subsequently, research has clearly shown that FMS is a disease of central sensitization of the nervous system. FMS sufferers have a lower-than-normal threshold of pain. Based on what we've seen about the functioning of the nervous system (see Pain Phenomena of the Spine and Periphery and Pain Phenomena Involving the Brain), this doesn't mean that the sufferers tolerate pain less well--it means that they experience more pain.
Several types of evidence point to central sensitization in FMS. The evidence includes brain imaging studies and studies of the neurochemical and inflammatory chemical makeup of the patients' cerebrospinal fluid. Sleep complaints of FMS patients have been confirmed by polysomnography.
Brain imaging found that FMS sufferers have lower activity in the rostral ACC than do normal people. (“Rostral” means “toward the nose.”) The rostral ACC is important in descending inhibition of pain, so these findings may explain not only why FMS patients have tender spots, but also why they have a lower pain threshold in general than normal people. The affected area of the ACC is also important in empathy, in interpreting “environmental incongruities,” and in correcting errors, so FMS sufferers may be disabled in other ways in addition to feeling more pain.
It isn't yet settled whether painful muscles are part of the cause of FMS as well as a symptom. While there is no proof that FMS is caused by muscle irregularities, there is some inconclusive evidence that it may be. Examination of muscle biopsies from FMS patients have found evidence of microscopic pathologies there. Most FMS patients first experience localized or regional pain, which later becomes widespread.
FMS patients have a lower level of conditioned pain modulation or CPM than normal (see Conditioned Pain Modulation (CPM) or Diffuse Noxious Inhibitory Control (DNIC)). It is hypothesized that this deficit may be a causal factor both in FMS and in other chronic pain conditions.
One researcher reports that about a third of FMS patients report that another family member (usually a female) has a similar chronic pain condition or is also diagnosed with FMS.2 It is believed therefore that there is a genetic susceptibility to FMS, although no responsible gene has yet been identified.
Along with some other chronic pain conditions, a loss of brain gray matter in certain brain areas has been found in FMS patients.
Because FMS patients generally have a variety of medical problems, including pain, poor sleep quality, fatigue, and psychiatric symptoms, several approaches are commonly used together in their treatment. Part of the success in the story of FMS is that three different medications have been approved by the FDA specifically for treatment of FMS. The acronym for one approach to FMS treatment is ADEPT Living—attitude, diagnosis, education, physical, treatments, and living. Medical treatments for FMS, again in common with other chronic pain conditions, are only partially effective, and so attitude and education are significant parts of the therapy.
The story of FMS is a relative success in the field of chronic pain. There are clear diagnostic procedures and there are well-accepted treatment approaches, even though there is no cure and treatments are only partially effective.
Contrast FMS to myofascial pain syndrome, MPS. One expert in the field says this about that: ...informal observation supports the view that some clinicians diagnose MFP [myofascial pain syndrome] in a very high proportion of patients with musculoskeletal pain, whereas others use the diagnosis much less frequently (and still others essentially do not consider MFP to be a legitimate medical diagnosis.)
3
In the middle of the 20th century trigger points were discovered to be associated with muscular pain, and injection of these trigger points with anesthetics was found to temporarily eliminate the pain associated with them. Unfortunately, this relief is usually only temporary, and reliable identification of the trigger points is difficult. As of 2011, the term “myofascial pain” didn't appear in the index of either "Essentials of Musculoskeletal Medicine" or "Campbell's Operative Orthopaedics," two texts directed at orthopedists.
Recent research has perhaps improved the outlook for MPS as a broadly accepted medical syndrome. Ultrasound techniques have been developed that are able to reliably identify the trigger points. These same techniques have shown poor blood flow into the area of the trigger point. Chemical analysis has shown that the fluid in the area of trigger points is acidic. (Acidity can be a result of muscle metabolism without sufficient oxygen.) The fluid is also high in inflammatory and neuroactive chemicals. We've seen that such conditions promote long term sensitization of the central nervous system.