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    Myofascial pain and fibromyalgia
    crystalgreeneyes posted:
    There seems to be some confusion with regard these two issues. Personally, I have been diagnosed by pain management specialist, with myofascial pain. One rheum. diagnosed fibromyalgia and another told me that myo. and fibro. are the same! Recently, while at a chiro appt. I asked about this and she said that they are "separate issues" but that many people have myo. pain as (another) component of fibro.
    I have fibro pain in my elbows, hips, knees and around my ribs. The rib pain makes me catch my breath some days. The chiro. told me that people with this type of pain are often shallow breathers. Deep breathing exercises will help with this. The really deep and most bothersome pain occurs in my right shoulder. I feel like I have a knife sticking in the area with a 50lb weight hanging on it.
    I have tried a lot of Rx drugs, anti-deps and pain relievers. I am very sensitive to drugs and I usually get really sick, my pain increases or does not decrease. I have found NOTHING at this point apart from hot showers, heating pad, relaxation tech., chiro etc. I went on a trip recently and my doc gave me a script for Flexeril (muscle relaxant) I wanted to have something on hand just in case I had a bad flare up. I took 2 mg one of the days and it really just made me feel so ill and dizzy and did nothing for the pain.
    Because of this disease I am no longer able to do my job and therefore cannot afford many natural therapeutic treatments that are available.
    What can I do? The holidays are coming up and I can tell that the stress is already building which leads to more intense pain.
    Any thoughts on this?
    My best wishes to everyone.
    An_248463 responded:

    I dont know. Nevery heard of this being (2) different issues. I have fibro just been diagnosed 4 years ago, but I believe I've had it for more that 10 years. They just found a name to all tha madness!!
    I have very terrible facial and neck pain. It hurts to touch my face, my jaw line huts so badly that I am contemplating going home, but I know I can't. My lips feel numb, blasting headache, eyes hurt and feel dry. My hair hurts. I take medication, but right now it seems to be doing nothing. I get the dizziness also. Everything you describe sounds like me. If you find out that they really are different issues, I'd like to know. I wait and ask pain clinic to just treat everything from the neck up separate from the rest of me;).

    Just trying to humor myself. God bless you on your journey. I know if seems hopeless at times, but what helps me not to give up is God. I see what he does. He allows me to still be able to work, but I wonder how much longer.
    Listen to your favorite songs, try to relax, and when the devil strikes think of you favorite uplifting songs or scripture, if you believe, hope I didin;t offend you, but GOD is always there I know he's trying to make me trust him.
    Anon_10089 replied to An_248463's response:
    They are not the same. Nancy, who posts here mostly on the weekends, knows a lot about this. The book she recommends is: FM and Chronic Myofascial Pain, by Dr Devin Starlanyl. Maybe you could check it out from a library. I would recommend finding her user name (it's Booch07) in the recent Saturday post. Click on it and read through her discussions. She has a lot of knowledge about this because she has CMP more than FM. Hopefully, this weekend she'll see this too. I just didn't want to leave you hanging for a few days!

    Heat is great for breaking up those adhesions in the muscles and nerves so keep doing that. I think that book may recommend some massage you could do yourself or you could use tennis balls or other hard surfaced things to break up the myofascial adhesions. I don't know much about it as I am definitely on the FM side. I have a couple myfascial spots but most of my pain is diffuse throught my whole body. I can't necessarily pinpoint certain spots, like an ankle or shoulder. It's more that an entire area, or whole body aches (which I know people with CMP can experience too).

    One suggestion I can think of about the Flexeril is to only take it at night but give it a try for a couple of weeks, if possible. Try to sleep off the side effects. I think I read somewhere that there was a study that found that people had lower pain after using Flexeril only at night, but it took a little while, not using it as an "as needed" kind of thing. Plus, sometimes our bodies can become less sensitive to the side effects. Maybe you could sleep off most of it and it would be tolerable. Just a thought. Or could you you cut that 2 mg pill in half?

    I really feel for you. I know you've mentioned in the past how sensitive you are to meds. I know my mom is sensitive to meds and takes tiny doses--smaller than her doctors want her to but it always works out better for her. I wonder if you've ever tried liquid meds? Or topical things? Have you googled what other sensitive people have tried? I'm just throwing things out!! I hope you can find a way to read that book. I know from some of your previous posts that you've tried many things and seemed to have hit walls and I know how frustrating that is. I think we've all been there dealing with this!

    I hope you can figure some things out to feel a bit better!
    An_248463 replied to Anon_10089's response:

    I'll try to remember to check it out this weekend. I'll also check out previous threads. I'll try just about anything. I have all over body pain in addition to this facial pain. I have had it for a long time, except now feels like I can hardly stand it anymore.

    Facial pain is that star of the show right now. I can't stand to touch myself anywhere, especially my face and neck area. My ears even feel like they ache. I'll also look into that flexeril next time I go to pain management in Jan, if not before.

    Thanks again.
    franr responded:
    Hi An
    Boy do I know about the pain you have in your shoulder.I experienced the same pain last winter for 3 months.And no one expressed that pain like you did.Lucky I am on new meds which took a while. Also if you have constant sleep interruption your muscles are not resting causing them to continuously tense up. It is a vicious cycle.Stay away from flexeril it has bad side effects.The chiro should be able to break up those adhesions in the shoulder. Some have certain tools they use. Deep tissue massage is good also. Heat and warm baths work. Get one of those bed buddies to pu in the microwave. They hold the heat. .My pain management MD said if that severe pain returns he would start me on shots. That may work.The holidays are extremely hard on fibro patients. One thing try to plan out your day and not overdo I know this is hard. Rest wen you can and make sure you are getting proper sleep. Keep posting to let us know how you are doing Fran R
    missist replied to franr's response:
    I saw a rheumy who told me it was the same thing/ or that the terms myofascial pain and fibromyalgia were interchangeable. To me that was a sign that he was not going to be at all useful and I nicely suggested I take my test results to my primary for treatment--which he was happy to agree with. This is the sign of a rheumy that has no interest in you as a patient and has not bothered to educate himself beyond the basics.

    Let him take care of his fav. patients with RA and such like.

    I have always had both--and it is different. Fibromyalgia is that all over chronic pain and fatigue that feels kind of like being in a shroud of pain--its very depressing.

    Myofascial Pain is that area or two that hurt like the dickens-- that really sore spot--the feet that you can't stand to walk on, the hip that is hard to sleep on, the shoulder that makes you not want to use your whole arm--the elbow that feels painful every time you move.. etc... if you rest those areas sometimes that will help. each area that pops up with mps will need a special treatment. Good massage therapists can handle it others can make it worse. Only one way to tell which they are. Trigger release is helpful and sometimes you can find a youtube video showing a trick to release the trigger for your area of mps. Other treatment--acupuncture or injections. Ask about your specific mps spots and most likely someone here has dealt with it. Me--lately I'm stuck with hip/butt muscle pain-- drives me nuts. MRI was 'semi-useful' but really did not tell the doctor why it is hard to fix. I spend a lot of time--for over a year now trying to stretch and improve this. I can get up stairs more easily but still have pain and still find it hard to exercise the next day. I have found it is easier to stretch in my hot tub--where my weight is not a problem and the heat makes my muscles more cooperative. I have found I am much more flexible than I used to be--I can reach things futher than I could before I began this--but the area will probably not be done hurting til it is done. MPS-- best I can tell over about 30 years disappears at some point--and may crop up elsewhere. You can also have remissions which I did for several years.

    Best of luck to you!
    bette_kaffitz responded:

    Dr. Devin Starlanyl, in her most recent book, says that the current thinking is that people start out with myofascial pain. If it is not treated, you get new pain areas, they become chronic, and THAT is fibromyalgia.

    At least that's this year's version.

    My neurologist (the great one who has since left the area) told me that he believes future detection methods will establish fibro as a milder (!) form or precursor for multiple sclerosis. He found so many similarities in the two illnesses that he thinks they are 2 sides of the same illness.

    23 years ago, when I was finally diagnosed, we were told that fibromyalgia is not progressive--that it does not get worse. How could anyone go for years with practically no real sleep and not get worse? Dream on. (Like I wish I could do!)

    If you can scrape up the money somehow, one treatment that helped me a lot was accupuncture. It took away my low back pain for 2 days straight. This was a major miracle after 30 years (now 41) of constant pain. I had to stop when the scalp where the good treatments were became sensitized. It hurt to shampoo and to comb or brush my hair. That's worn off now, and I would go back, but the accupuncturist has left the area.

    Go to the library and borrow books on stress relief and other self-help techniques. My favorite is Managing Pain Before It Manages You by Margaret A.Caudill, M.D., PhD.

    One word of warning: please do NOT try any technique that asks you to tense up before you release. Too often, we have trouble un-tensing. You can just omit the tensing part of the exercise.

    Some people think of these books as buying into the old "it's all in her pretty little head" theory. Not so. The very best hospitals around the country include these techniques in a comprehensive treatment plan. Some of the ideas will seem weird to you. Skip them and try the ones you think you could benefit from. Pretend you're in a cafeteria. Pick and choose.

    I do hope that some of the ideas you get here can help. As with every other facet of this illness, you will have to try it to see if you like it. Good luck!

    crystalgreeneyes replied to An_248463's response:
    Thank you for your kind reply. I have noticed that my headaches have virtually disappeared since I have been seeing the chiro twice a week (a family member is footing the bill for this) otherwise I wouldn't even have that.
    Your face and neck pain sounds very difficult. Have you had testing done to make sure it isn't any other issue such as TMJ disorder or trigeminal neuralgia? Anything is possible with FMS and my experience has shown me that all symptoms are usually just lumped together with fibro. instead of being individually investigated.
    TMJ - temporomandibular joint disorder is often caused by misalignment of teeth or habits of chewing primarily on one side and other issues. Your dentist can check this for you. The 5th cranial nerve (trigeminal) is located on the side just in front of the ear. There is a very large mass of nerves there which, if affected can lead to referral of pain all over the face, eye area and head.
    On my last visit the rheum. asked how I did with the cortisone injection?? I had filled the script for it but decided not to have it administered after all because I was too afraid of the side effects and there are many. I feel that she doesn't really want to deal with me because I can't tolerate the meds. When I saw another rheum., she shrugged and said that myo. and fibro pain are the same and that she DID NOT treat fibromyalgia.
    I hope this is helpful and that you find some relief. I used to have a few days of relief here and there but not any more. If I could take something, anything to relieve the pain, if only for a few hours, I would be grateful. Insomnia and stress makes it worse, I do know but regardless, I believe in chiropractic treatment even for people who don't have FMS, it has many benefits.
    Take care. Thank you to everyone who responded.
    crystalgreeneyes replied to Anon_10089's response:
    Thank you for your reply. The chiropractor I am now seeing has been very helpful. She also does acupuncture. I have had it once so far. She says that I am extremely tender and that ACT can be very helpful but with my level of tenderness I would not be able to withstand the pain. It's a possibility for the future. She gave me a sample of a natural remedy for anxiety (Rescue Remedy drops) which helped and a pure mineral spray (topical) which allows magnesium to be absorbed into the painful areas. This is quite affective also. It's called Ancient Mineral Magnesium Oil and can be ordered online. She also mentioned injections which are administered by the ND, also from natural sources, which have been very affective for some people. Another possibility but again the cost of the consultation is $175. and this is prohibitive. I did take the Flexeril at night and I felt awful in the morning. High sugar fruits such as grapes and watermelon are my worst enemies and I love fruit. I eat a lot of green veggies.
    I know Nancy has myo. pain and is very knowledgeable and gives great advice to everyone but I appreciate everyone's input here.
    My best wishes to everyone.
    Anon_10089 replied to crystalgreeneyes's response:
    Hi, again-

    It sounds like you're on the right track. I think those muscle adhesions can take some time to work out because they take time to develop. But I have been, very recently and currently, in a place where I wish I could have immediate relief so I know the "it takes time" mantra is not comforting!

    The topical magnesium is interesting. I saw once on Pinterest a way to make your own topical magnesium but the ingredients might be just as expensive as buying it, I don't quite remember. Maybe something to google.

    I'm the same way with fruits. I have to be careful with them. It kind of irritates me when people claim that juicing or eating a diet high in fruit is so healthy. It can be for some, but it would make me feel awful. I do really well on a diet high in good fat and low in sugar and grains. I have way more energy. But, of course, I love fruit too!

    I don't really like Flexeril either. It really dries me out and so I think part of the problem with it is that it dehydrates people. I figured you had taken it at night, I threw that out just in case!
    booch007 responded:
    Good morning ,

    I dont have much time on the computer now, so I didn't read the responses here.

    You are ME.....

    I also used Chiro for what seemed forever and I was tossed between the two labels.

    This is what i know. People with FM have CMP, people who have CMP don't neccessarily have FM. (As I do not).

    They are two different issues but mirror the same symptoms. My key therapy is Trigger Point Injections (TrP inj). And all the FM tools in the toolbox.

    A Chiro years ago said..hey you have trigger points. I said OUCH don't touch that it hurts like hell..just adjust me.
    I then did research and found the therapy. I chose neurology as my MD for this, as I had many nerve impingements with the trigger points making the muscle contract over a nerve and create the burning and numbness that we feel.

    The book FM and Chronic Myofascial Pain (First book) by Dr Devin Starlanyl explains it so well. It is called a survival manual and it is. So many self help things.

    I got it on for 19.99 MOST valuable of all the books I own. I also bought the neurology book the doctor wa using to undertand more what had happened to my body.....

    Now for CMP I take a muscle relaxant, tramadol for the pain (was using too much motrin..which is still helpful for breakthrough pain) I take 250mg Magnesium twice a day. I needed the 50,000 u Vit D and now take 2,000 a day od Vit D plus a B Complex.

    It is years (10) that I have received injections every 2 weeks. They reset the muscles and help me live a full life. The injections in the beginning are tough and many don't use this as their avenue of choice. I am a nurse and need to function the best i can. This was the fit for me. In the beginning it woke up so many seized muscles I had spinal popping as I walked and my head all of a sudden could turn so much better! It was amazing. When I had the turning of the head thing happen, I was hooked....

    So maybe look into the book and educate the docs and look into TrP injections and see if that is a fit for you. Some don't have to be as aggressive as I, but i want all I can get. I have a wellness window of 8ish hours to be fully functional. Unless there is a flare in there. We do get them as well. I call it a shut down day. I rest, heat and meds and give in to my body as thanks for what it allows me to do.

    I wish you all the best. Dr Starlanyl has a new book that just came out as well, it adds to the research done before and some was eye opening i just got the book back from my doctor. SEE they need to learn too.

    Hugs from me, Nancy B
    fibrokathy replied to booch007's response:
    I have read Starlanyl's first book and understand the differences between CMP and FM. With the right treatment, you can rid yourself of CMP (trigger points).

    Nancy, I am curious about your trigger point therapy. Why do you have to get trigger points every 2 weeks? If a trigger point is eliminated through a trigger point injection or some other means like spray and stretch, would this be sufficient to take care of the problem area? Do your trigger points keep surfacing due to the way you move your body in your nursing job?

    A couple of months ago, I saw my physiatrist and she offered to give me a couple of trigger point injections (with lidocaine) in my trapezius muscles that felt like rocks. The shots hurt, but helped to loosen things up a little bit. My doctor told me that she usually injects only a couple of areas each time. I think next time I will ask to inject my neck muscles.

    From Starlanyl's research, trigger points are hard nodules that when pressed refer pain to other areas. I don't have that. I have tender areas esp. in the neck, shoulder, and upper back that are tender and muscles can get very tight. I need to designate time each day for stretching otherwise my muscles remain tight. Pelligrino has some great stretching exercises in his book.
    booch007 replied to fibrokathy's response:
    Hey Kathy,
    Sorry so late in getting back to this.

    I get injections so frequent because of my job, I am high functioning and symptomatic to many active points. A trigger point in the scapular area refers to the throat or ear for me. All are different. My DH marks me the night before and he can get me quite sick by activating the latent ones. Headache, nausea....swallowing issues.

    This MD I pay cash for, I was using the WCB for this therapy but I can't take all the work needed for it and documentation. IT is what it is! So I pay. Session is 30 minutes and I will tell you "If it doesn't wasn't a good shot". The area is ischemic( inflamed from lack of oxygen and high energy output spasming) To break that is like a lightening bolt from the metal needle. The "twitch and release response.
    , is what I like to feel.

    For me spray and stretch really hurt more with less response. This is the BEST therapy for me. 30 minutes of being a pin cushion and then in 2 days I am up and moving so much better. Almost forgot my morning meds once as i was just "going"....WOW. It happens.

    So much therapy has made me estute to the muscls I have issue with and I am changing right now with the change of job I just had. So I watch and guide the doc. I am in a good place.

    Now I am decorating this weekend and shots are Monday so I will push and then get the and hope for a good reponse.

    the muscle are dysfunctional and I will always MAKE trigger points. The key is to have more latent than active as you don't feel them or have cause and effect with range of motion issues. I hydrate like a fountain during therapy and actually everyday, magnesium and plenty of green vegetables as antioxidants. I will do what ever, to be an inch better. An inch a month is a FOOT by years end!!

    Good luck on the path to be better.

    hugs, NancyB
    fibrokathy replied to booch007's response:
    Thanks, Nancy, for the trigger point info. You definitely know what you need to make you feel better. After all this time, I am still learning. I am more fibro rather than MPS.

    I have applied to participate in a study for fibro here in SE Michigan. It is a double-blind randomized study and involves nerve stimulation. It is Phase III. I am excited and I hope it is a "go". The doctor involved in the study was waiting to hear if it would be in our area or it they would go national.
    fibrokathy replied to fibrokathy's response:
    I think there is a lot of confusion between fibro and myofascial pain syndrome. I don't think medical schools are doing a very good job in teaching them this. Devin Starlanyl does a very good in her books in explaining the two separate conditions.

    If you have MPS. you need manual therapy to rid yourself of the trigger points. Lyrica, Savella, and Cymbalta probably will not do anything for you. If you have fibro, these drugs only have a 30% of working for you. I follow expert, Daniel Clauw, and he claims the fibro drugs are good for some people but not for most.

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