Fibromyalgia is a long-term condition that causes widespread bodily pain and extreme tiredness, and affects nearly 1 in 20 people. There is no current cure and the causes of the disorder are unknown, however treatments to help manage the symptoms can improve quality of life for the patients. A theory which is as yet widely contentious amongst the medical community is that fibromyalgia-associated pain can be described in terms of myofascial trigger points (MTPs). These are areas of focal muscle tenderness and nodularity from which pain radiates, which can be either latent (in healthy individuals) or active (in fibromyalgia patients).
A research paper by Ge et al. recently published in Arthritis Research & Therapy found that manual palpation of active MTPs elicits the pain that fibromyalgia patients experience spontaneously. The locations and number of MTPs were found to be similar in fibromyalgia patients and healthy controls. An accompanying editorial by Robert Bennett and Don Goldenberg addresses both sides of the issue, with Dr Bennett discussing the evidence for the objectivity, definability and usefulness of MTPs, and Dr Goldenberg considering the lack of specific diagnostic criteria, the difficulty associated with interobserver variability and the difficulty in differentiation between MTPs and “tender points”.
The conclusions drawn in this paper and issues discussed in the editorial are important because the acceptance of the theory of MTPs by the scientific community would result in a significant paradigm shift in the diagnosis and treatment of the disorder. Whether or when this will happen remains a mystery, for the moment at least.
I appreciated the point, counter-point editorial by Bennett and Goldenberg. It quickly highlighted the poor diagnostic categorization of fibromyalgia and myofascial pain syndrome across the literature.
It seems that, as Goldenberg argues, FM is centrally mediated; yet so is any active or latent TrP to some extent. We shouldn’t discount seemingly “peripheral” interventions of a centrally mediated disease.
Math advances one proof at a time. Medicine advances with the rejection of previously supported theories.