Trigger Points in Pain

by Miryam Williamson, author of Fibromyalgia: A Comprehensive Approach (1996)
and The Fibromyalgia Relief Book (1998)
Copyright  1999 Miryam Williamson. Permission is granted to copy and distribute
this article as long as it remains intact and is not sold.
 Janet Travell, MD, who died in August, 1997, was the White House physician when John F. Kennedy was president. He probably had fibromyalgia (FM), although his illness wasn't recognized as such. Dr. Travell specialized in myofascial pain syndrome (MPS) and musculoskeletal disorders. With David Simons, MD, she wrote the two-volume textbook Myofascial Pain and Dysfunction: the Trigger Point Manual.

Myofascial trigger points.  Not to be confused with fibromyalgia's tender points, trigger points are the result of injury or muscular stress. They usually cause pain, sometimes at the site of the trigger point and sometimes at a distance from the site.  If it's a real trigger point, the pain occurs at the same location every time the point is pressed.  Myofascial pain, if left untreated, can develop into fibromyalgia in people with the genetic predisposition.  Some people refer to myofascial pain as "localized fibromyalgia." Not everyone with myofascial pain develops fibromyalgia, but most people with fibromyalgia have myofascial pain and trigger points.  Trigger points can often be released with treatment.  Myofascial release massage, myotherapy, injection of the trigger point with a local anesthetic or even a dry needle, and acupuncture are all techniques known to relieve myofacial pain. Without treatment, myofascial trigger points can be a perpetuating factor for fibromyalgia.

Other conditions. Other diseases and disorders can also serve as perpetuating factors: allergies, lupus, endometriosis, and any form of arthritis are among the most common of these.

Stress. Finally, chronic stress is a very common perpetuating factor in FM. This is not to say that stress causes fibromyalgia, or that FM is a psychiatric ailment because stress is part of the picture. But it does mean that anything one can do to minimize stress and learn to manage whatever stress cannot be avoided is valuable in relieving the symptoms of fibromyalgia.

Conclusion.  All of these factors should be taken into account in developing a program to manage FM. Some involve diagnostic tests; some involve the help of auxiliary health care professionals such as physical therapists, occupational therapists, nutritional therapists, and psychotherapists. Careful  attention to perpetuating factors can make treatment of FM much more su'cessful than it is when the only treatment technique is to use drugs to mask FM's symptoms.

return to Fibromyalgia perpetuating factors

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Symptoms are pain any place

Q. What is the best treatment?

The best treatment for myofacial trigger point is massage with ice then strectch and finally massage with a hot water bottle. Rubbing with olive oil works wonders. TENS electrical stimulation is very effective treatment. Almost every type of treatment including trigger point injections give some relief. Homeopathic causticum 200 daily for 3 months helps. Doxycycline 100 mg alternate day for 3 weeks helps.