Fibromyalgia is a poorly understood medical condition characterized by trigger points—areas within skeletal muscle that are painful and tender. Pain may be severe, and fibromyalgia is often associated with significant disability. In theory, muscular trigger points develop as injured muscle fibers contract into spasm. These contracted areas become chronically oxygen-deprived and send pain impulses through sensory nerves to the dorsal horn of the spinal cord, where spinal reflexes are activated. Spinal reflexes in turn send impulses outward through motor nerves to the ischemic muscle segments, causing further contraction. In this way, a cycle of spasm, pain and more spasm is set in motion.
Criteria for Diagnosis
The diagnosis of fibromyalgia is one of exclusion because no markers have been identified. The American College of Rheumatology has identified the following two criteria as being diagnostic for fibromyalgia:
- Three or more months of widespread pain present above and below the waist on the right and left side of the body and along the midline
- Report of pain at a minimum of 11/18 specified locations (tender trigger points) throughout the body when palpated with 4 kilograms of digital pressure
Many patients seem to respond well to manipulative physical therapies designed to “release” spastic trigger points. Refractory patients may benefit from trigger point injections of local anesthetic with or without added steroid. Evidence also suggests that injection of botulinum toxin (Botox) into refractory trigger points may relax areas of spastic muscle for periods of weeks or months.
MAPS Approach to Fibromyalgia
We focus on actively relieving severe physical pain. Our process includes a thorough history; a detailed, pain-oriented physical examination; psychological screening; and a complete review of medical records in order to exclude other diagnoses and to identify associated conditions such as depression and anxiety. We then combine physical techniques, EMG biofeedback and therapeutic pool rehabilitation in a coordinated program designed to relax muscular trigger points, retrain injured muscles, and improve conditioning.
We simultaneously provide intensive patient education in order to improve coping skills, change dysfunctional attitudes and teach methods for controlling symptoms without medical care in the home setting. We may prescribe medications or interventions when appropriate, including trigger point injections for selected patients.
Outcomes and Aftercare
Outcomes for our interventions are measured using standardized SF-36 questionnaire data that is collected before and after treatment. Upon completion of the program, the patient is encouraged to participate in structured aftercare, which takes place within our associated health club facility.