Current Pain and Headache Reports

, Volume 14, Issue 5, pp 339–345

Prevalence of Myofascial Trigger Points in Fibromyalgia: The Overlap of Two Common Problems



With the objective evidence of their existence, myofascial trigger points (MTrPs) contribute to an increasing number of chronic regional and widespread pain conditions. The widespread spontaneous pain pattern in fibromyalgia (FM) is a summation of multiple regional pains due to active MTrPs. A regional pain in FM is from local active MTrPs and/or referred from remote active MTrPs. Positive tender points specified in FM are MTrPs, either active or latent. Manual stimulation of active MTrPs located in the muscles in different body regions completely reproduced overall spontaneous FM pain pattern. Active MTrPs as tonic peripheral nociceptive input contribute tremendously to the initiation and maintenance of central sensitization, to the impairment of descending inhibition, to the increased excitability of motor units, and to the induction of sympathetic hyperactivity observed in FM. The considerable overlap of MTrPs and FM in pain characteristics and pathophysiology suggests that FM pain is largely due to MTrPs.


Myofascial trigger points Fibromyalgia 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Wolfe F, Smythe HA, Yunus MB, et al.: The American college of rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 1990, 33:160–172.CrossRefPubMedGoogle Scholar
  2. 2.
    Simons DG: Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol 2004, 14:95–107.CrossRefPubMedGoogle Scholar
  3. 3.
    Hubbard DR, Berkoff GM: Myofascial trigger points show spontaneous needle EMG activity. Spine 1993, 18:1803–1807.CrossRefPubMedGoogle Scholar
  4. 4.
    • Sikdar S, Shah JP, Gebreab T, et al.: Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil 2009, 90:1829–1838. This study reports a potential noninvasive method for the identification of an MTrP.CrossRefPubMedGoogle Scholar
  5. 5.
    Macfarlane GJ: Generalized pain, fibromyalgia and regional pain: an epidemiological view. Baillieres Best Pract Res Clin Rheumatol 1999, 13:403–414.CrossRefPubMedGoogle Scholar
  6. 6.
    Staud R, Vierck CJ, Robinson ME, Price DD: Overall fibromyalgia pain is predicted by ratings of local pain and pain-related negative affect--possible role of peripheral tissues. Rheumatology (Oxford) 2006, 45:1409–1415.CrossRefGoogle Scholar
  7. 7.
    •• Ge HY, Nie H, Madeleine P, et al.: Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain 2009, 147:233–240. This study underlies the importance of active MTrPs in the induction of FM pain and central sensitization.CrossRefPubMedGoogle Scholar
  8. 8.
    Gerwin RD: A study of 96 subjects examined both for fibromyalgia and myofascial pain. J Musculoskeletal Pain 1995, 3:121.Google Scholar
  9. 9.
    Bennett RM: Diagnostic criteria and differential diagnosis of the fibromyalgia syndrome. J Musculoskeletal Pain 2004, 12:59–64.CrossRefGoogle Scholar
  10. 10.
    Wolfe F, Simons DG, Fricton J, et al.: The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. J Rheumatol 1992, 19:944–951.PubMedGoogle Scholar
  11. 11.
    Bengtsson A, Henriksson KG, Jorfeldt L, et al.: Primary fibromyalgia: a clinical and laboratory study of 55 patients. Scand J Rheumatol 1986, 15:340–347.CrossRefPubMedGoogle Scholar
  12. 12.
    Reddy SS, Yunus MB, Inanici F, Aldag JC: Tender point injections are beneficial in fibromyalgia syndrome: a descriptive, open study. J Musculoskeletal Pain 2000, 8:7–18.CrossRefGoogle Scholar
  13. 13.
    • Ge HY, Wang Y, Danneskiold-Samsoe B, et al.: The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain 2009 Nov 13 (Epub ahead of print). This study provides the first electrophysiologic evidence that tender point sites specified in FM are MTrPs, either active or latent.Google Scholar
  14. 14.
    Fernández-Carnero J, Ge HY, Kimura Y, et al.: Increased spontaneous electrical activity at a latent myofascial trigger point following nociceptive stimulation of another latent trigger point. Clin J Pain 2010, 26:138–143.CrossRefPubMedGoogle Scholar
  15. 15.
    Chou LW, Hsieh YL, Kao MJ, Hong CZ: Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle. Arch Phys Med Rehabil 2009, 90:905–912.CrossRefPubMedGoogle Scholar
  16. 16.
    Staud R, Vierck CJ, Cannon RL, et al.: Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain 2001, 91:165–175.CrossRefPubMedGoogle Scholar
  17. 17.
    Nebel MB, Gracely RH: Neuroimaging of fibromyalgia. Rheum Dis Clin North Am 2009, 35:313–327.CrossRefPubMedGoogle Scholar
  18. 18.
    Harris RE, Sundgren PC, Craig AD, et al.: Elevated insular glutamate in fibromyalgia is associated with experimental pain. Arthritis Rheum 2009, 60:3146–3152.CrossRefPubMedGoogle Scholar
  19. 19.
    Bengtsson M, Bengtsson A, Jorfeldt L: Diagnostic epidural opioid blockade in primary fibromyalgia at rest and during exercise. Pain 1989, 39:171–180.CrossRefPubMedGoogle Scholar
  20. 20.
    • Staud R, Nagel S, Robinson ME, Price DD: Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. Pain 2009, 145:96–104. This is important evidence that central sensitization in FM is maintained by noxious input from the muscle.CrossRefPubMedGoogle Scholar
  21. 21.
    Freeman MD, Nystrom A, Centeno C: Chronic whiplash and central sensitization; an evaluation of the role of a myofascial trigger points in pain modulation. J Brachial Plex Peripher Nerve Inj 2009, 4:2.CrossRefPubMedGoogle Scholar
  22. 22.
    Itoh K, Katsumi Y, Kitakoji H: Trigger point acupuncture treatment of chronic low back pain in elderly patients--a blinded RCT. Acupunct Med 2004, 22:170–177.CrossRefPubMedGoogle Scholar
  23. 23.
    Ge HY, Fernandez-de-las-Penas C, Arendt-Nielsen L: Sympathetic facilitation of hyperalgesia evoked from myofascial tender and trigger points in patients with unilateral shoulder pain. Clin Neurophysiol 2006, 117:1545–1550.CrossRefPubMedGoogle Scholar
  24. 24.
    Fernandez-de-Las-Penas C, Simons D, Cuadrado ML, Pareja J: The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck. Curr Pain Headache Rep 2007, 11:365–372.CrossRefPubMedGoogle Scholar
  25. 25.
    Bajaj P, Bajaj P, Graven-Nielsen T, Arendt-Nielsen L: Osteoarthritis and its association with muscle hyperalgesia: an experimental controlled study. Pain 2001, 93:107–114.CrossRefPubMedGoogle Scholar
  26. 26.
    Anderson RU, Sawyer T, Wise D, et al.: Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol 2009, 182:2753–2758.CrossRefPubMedGoogle Scholar
  27. 27.
    Shah JP, Danoff JV, Desai MJ, et al.: Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil 2008, 89:16–23.CrossRefPubMedGoogle Scholar
  28. 28.
    Ge HY, Serrao M, Andersen OK, et al.: Increased H-reflex response induced by intramuscular electrical stimulation of latent myofascial trigger points. Acupunct Med 2009, 27:150–154.CrossRefPubMedGoogle Scholar
  29. 29.
    Niddam DM, Chan RC, Lee SH, et al.: Central representation of hyperalgesia from myofascial trigger point. Neuroimage 2008, 39:1299–1306.CrossRefPubMedGoogle Scholar
  30. 30.
    Giamberardino MA, Tafuri E, Savini A, et al.: Contribution of myofascial trigger points to migraine symptoms. J Pain 2007, 8:869–878.CrossRefPubMedGoogle Scholar
  31. 31.
    Jensen KB, Kosek E, Petzke F, et al.: Evidence of dysfunctional pain inhibition in fibromyalgia reflected in rACC during provoked pain. Pain 2009, 144:95–100.CrossRefPubMedGoogle Scholar
  32. 32.
    Wood PB, Schweinhardt P, Jaeger E, et al.: Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci 2007, 25:3576–3582.CrossRefPubMedGoogle Scholar
  33. 33.
    Arendt-Nielsen L, Sluka KA, Nie HL: Experimental muscle pain impairs descending inhibition. Pain 2008, 140:465–471.CrossRefPubMedGoogle Scholar
  34. 34.
    Pielsticker A, Haag G, Zaudig M, Lautenbacher S: Impairment of pain inhibition in chronic tension-type headache. Pain 2005, 118:215–223.CrossRefPubMedGoogle Scholar
  35. 35.
    Sandrini G, Rossi P, Milanov I, et al.: Abnormal modulatory influence of diffuse noxious inhibitory controls in migraine and chronic tension-type headache patients. Cephalalgia 2006, 26:782.CrossRefPubMedGoogle Scholar
  36. 36.
    Kosek E, Ordeberg G: Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. Pain 2000, 88:69–78.CrossRefPubMedGoogle Scholar
  37. 37.
    Srbely JZ, Dickey JP, Lowerison M, et al.: Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain 2008, 139:260–266.CrossRefPubMedGoogle Scholar
  38. 38.
    Niddam DM, Chan RC, Lee SH, et al.: Central modulation of pain evoked from myofascial trigger point. Clin J Pain 2007, 23:440–448.CrossRefPubMedGoogle Scholar
  39. 39.
    Anders C, Sprott H, Scholle HC, et al.: Surface EMG of the lumbar part of the erector trunci muscle in patients with fibromyalgia. Clin Exp Rheumatol 2001, 19:453–455.PubMedGoogle Scholar
  40. 40.
    Ge HY, Zhang Y, Boudreau S, et al.: Induction of muscle cramps by nociceptive stimulation of latent myofascial trigger points. Exp Brain Res 2008, 187:623–629.CrossRefPubMedGoogle Scholar
  41. 41.
    Gerwin RD: The taut band and other mysteries of the trigger point: An examination of the mechanisms relevant to the development and maintenance of the trigger point. J Musculoskeletal Pain 2008, 16:115–121.CrossRefGoogle Scholar
  42. 42.
    Giske L, Vøllestad NK, Mengshoel AM, et al.: Attenuated adrenergic responses to exercise in women with fibromyalgia--a controlled study. Eur J Pain 2008, 12:351–360.CrossRefPubMedGoogle Scholar
  43. 43.
    Sprott H, Salemi S, Gay R, et al.: Increased DNA fragmentation and ultrastructural changes in fibromyalgic muscle fibres. Ann Rheum Dis 2004, 63:245–251.CrossRefPubMedGoogle Scholar
  44. 44.
    Light AR, White AT, Hughen RW, Light KC: Moderate exercise increases expression for sensory, adrenergic, and immune genes in chronic fatigue syndrome patients but not in normal subjects. J Pain 2009, 10:1099–1112.CrossRefPubMedGoogle Scholar
  45. 45.
    Lucas KR, Polus BI, Rich PA: Latent myofascial trigger points: their effects on muscle activation and movement efficiency. J Bodyw Mov Ther 2004, 8:160–166.CrossRefGoogle Scholar
  46. 46.
    Martinez-Lavin M: Fibromyalgia as a sympathetically maintained pain syndrome. Curr Pain Headache Rep 2004, 8:385–389.CrossRefPubMedGoogle Scholar
  47. 47.
    Furuta S, Shimizu T, Narita M, et al.: Subdiaphragmatic vagotomy promotes nociceptive sensitivity of deep tissue in rats. Neuroscience 2009, 164:1252–1262.CrossRefPubMedGoogle Scholar
  48. 48.
    Khasar SG, Burkham J, Dina OA, et al.: Stress induces a switch of intracellular signaling in sensory neurons in a model of generalized pain. J Neurosci 2008, 28:5721–5730.CrossRefPubMedGoogle Scholar
  49. 49.
    Light KC, Bragdon EE, Grewen KM, et al.: Adrenergic dysregulation and pain with and without acute beta-blockade in women with fibromyalgia and temporomandibular disorder. J Pain 2009, 10:542–552.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and TechnologyAalborg UniversityAalborgDenmark

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