Effects of Treatment of Myofascial Trigger Points on the Pain of Fibromyalgia

  • Maria Adele GiamberardinoEmail author
  • Giannapia Affaitati
  • Alessandra Fabrizio
  • Raffaele Costantini


Myofascial pain syndromes (MPSs) from trigger points (TrPs) and fibromyalgia syndrome (FMS) are common musculoskeletal pain conditions that frequently coexist in the same patients. In recent decades, it has become evident that these entities greatly influence each other’s clinical expression. FMS is mainly rooted in the central nervous system, while TrPs have a peripheral origin. However, the nociceptive impulses from TrPs may have significant impact on symptoms of FMS, probably by enhancing the level of central sensitization typical of this condition. Several attempts have been made to assess the effects of treatment of co-occurring TrPs in FMS. We report the outcomes of these studies showing that local extinction of TrPs in patients with fibromyalgia produces significant relief of FMS pain. Though further studies are needed, these findings suggest that assessment and treatment of concurrent TrPs in FMS should be systematically performed before any specific fibromyalgia therapy is undertaken.


Myofascial trigger points Local injection Fibromyalgia Fibromyalgia syndrome Pain syndrome Peripheral pain generators Myofascial pain Pressure pain threshold Musculoskeletal pain Central sensitization Comorbidity Taut band Anesthetic Management Pathophysiology Tender point Antidepressants Local pain Referred pain 



No potential conflicts of interest relevant to this article were reported.


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

  1. 1.
    •• Mense S, Gerwin RD (Eds): Muscle Pain. Diagnosis and Treatment. Heidelberg, Dordrecht, London, New York: Springer; 2010: 365 pp. This book provides a comprehensive description of musculoskeletal pain conditions, particularly myofascial pain syndromes from trigger points and fibromyalgia, and critically discusses their overlap, interaction, and implications for therapy. Google Scholar
  2. 2.
    Cummings M. Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol. 2007;21:367–87.PubMedCrossRefGoogle Scholar
  3. 3.
    Borg-Stein J. Management of peripheral pain generators in fibromyalgia. Rheum Dis Clin North Am. 2002;28:305–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep. 2001;5:412–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Podichetty VK, Mazanec DJ, Biscup RS. Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgrad Med J. 2003;79:627–33.PubMedCrossRefGoogle Scholar
  6. 6.
    Mense S, Simons DG, Russell IJ, editors. Muscle pain. Understanding its nature, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 385.Google Scholar
  7. 7.
    Giamberardino MA, Affaitati G, Fabrizio A, Costantini R: Myofascial pain syndromes and their evaluation. Int J Clin Pharmacol Ther 2011; in press.Google Scholar
  8. 8.
    Simons DG, Travell JG, Simons LS (Eds): Travell & Simons' Myofascial Pain and Dysfunction. The Trigger Point Manual, Vol 1. Upper Half of Body, 2nd edn. Baltimore: Williams & Wilkins; 1999:1038 pp.Google Scholar
  9. 9.
    Alvarez DJ, Rockwell PG. Trigger Points: diagnosis and management. Am Fam Physician. 2002;65:653–60.PubMedGoogle Scholar
  10. 10.
    Majlesi J, Unalan H. Effect of treatment on trigger points. Curr Pain Headache Rep. 2010;14:353–60.PubMedCrossRefGoogle Scholar
  11. 11.
    Graff-Radford SB. Myofascial pain: diagnosis and management. Curr Pain Headache Rep. 2004;8:463–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Vecchiet L, Giamberardino MA, Saggini R. Myofascial pain syndromes: clinical and pathophysiological aspects. Clin J Pain. 1991;7:16–22.Google Scholar
  13. 13.
    Affaitati G, Fabrizio A, Savini A, et al. A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds. Clin Ther. 2009;31:705–20.PubMedCrossRefGoogle Scholar
  14. 14.
    Vecchiet L, Giamberardino MA, de Bigontina P, Dragani L: Comparative sensory evaluation of parietal tissues in painful and nonpainful areas in fibromyalgia and myofascial pain syndrome. In Proceedings of the 7th World Congress on Pain, Progress in Pain Research and Management. Edited by Gebhart GF, Hansmond DL, Jensen TS. Vol 2. Seattle: IASP Press; 1994: 177-185.Google Scholar
  15. 15.
    Shah JP, Phillips TM, Danoff JV, Gerber LH. A in vivo microanalytical technique for measuring the local biochemical mileu of human skeletal muscle. J Appl Physiol. 2005;99:1977–84.PubMedCrossRefGoogle Scholar
  16. 16.
    Kuan TS. Current studies on myofascial pain syndrome. Curr Pain Headache Rep. 2009;13:365–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Srbely JZ. New trends in the treatment and management of myofascial pain syndrome. Curr Pain Headache Rep. 2010;14:346–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Scott NA, Guo B, Barton PM, Gerwin RD. Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med. 2009;10:54–69.PubMedCrossRefGoogle Scholar
  19. 19.
    Ho KY, Tan KH. Botulinum toxin A for myofascial trigger point injection: a qualitative systematic reviews. Eur J Pain. 2007;11:519–27.PubMedCrossRefGoogle Scholar
  20. 20.
    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;33:160–72.PubMedCrossRefGoogle Scholar
  21. 21.
    Wolfe F, Clauw DJ, Fitzcharles MA, et al.: Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011 Feb 1. Epub ahead of print.Google Scholar
  22. 22.
    Abeles AM, Pillinger MH, Solitar BM, Abeles M. Narrative review: the pathophysiology of fibromyalgia. Ann Int Med. 2007;146:726–34.PubMedGoogle Scholar
  23. 23.
    Bennett RM. Clinical manifestations and diagnosis of fibromyalgia. Rheum Dis Clin North Am. 2009;35:215–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Robinson ME, Craggs JG, Price DD, et al.: Gray Matter Volumes of Pain-Related Brain Areas are Decreased in Fibromyalgia Syndrome. J Pain 2010 Dec 9. Epub ahead of print.Google Scholar
  25. 25.
    Giamberardino MA: Update on Fibromyalgia Syndrome. PCU 2008; XVI(4):1-6.Google Scholar
  26. 26.
    Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008;67:536–41.PubMedCrossRefGoogle Scholar
  27. 27.
    Sommer C: Fibromyalgia: a clinical update. PCU 2010; XVIII(4):1-4.Google Scholar
  28. 28.
    Xu YM, Ge HY, Arendt-Nielsen L: Sustained nociceptive mechanical stimulation of latent myofascial trigger points induces central sensitization in healthy subjects. J Pain doi 10.1016/j.pain.2010.03.010.
  29. 29.
    Cakit BD, Taskin S, Nacir B, et al. Comorbidity of fibromyalgia and cervical myofascial pain. Clin Rheumatol. 2010;29:405–11.PubMedCrossRefGoogle Scholar
  30. 30.
    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;147:233–40.PubMedCrossRefGoogle Scholar
  31. 31.
    •• Alonso-Blanco C, Fernández-de-Las-Peñas C, Morales-Cabezas M, et al.: Multiple Active Myofascial Trigger Points Reproduce The Overall Spontaneous Pain Pattern in Women With Fibromyalgia and are Related to Widespread Mechanical Hypersensitivity. Clin J Pain. 2011 Feb 28. Epub ahead of print. This article demonstrates the high prevalence of active TrPs in multiple muscles of FMS patients, as compared to control patients, and the correlation between TrP activity and FMS pain and hypersensitivity. Google Scholar
  32. 32.
    Ge HY. Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems. Curr Pain Headache Rep. 2010;14:339–45.PubMedCrossRefGoogle Scholar
  33. 33.
    • Ge HY, Wang Y, Danneskiold-Samsøe B, et al.: The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain. 2010;11:644-651. This article shows that most of the TePs sites in FMS are TrPs. It underlines the role of TrPs as peripheral generators of fibromyalgia pain and suggests that their inactivation may be an important option for the treatment of FMS. Google Scholar
  34. 34.
    • 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 article emphasizes the important role of peripheral impulse input in maintaining central sensitization in FMS by showing a reduction of local and distant hyperalgesia upon anesthetic injection of the trapezius tender point. Google Scholar
  35. 35.
    •• Affaitati G, Costantini R, Fabrizio A, et al.: Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain 2011; 15:61-9. This article provides clear evidence of the effects of local treatment of TrPs (not coinciding with the sites of TePs) on pain symptoms of fibromyalgia using a standardized experimental approach. Google Scholar
  36. 36.
    Castro-Sánchez AM, Matarán-Peñarrocha GA, Granero-Molina J, et al. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011;2011:561–73.Google Scholar
  37. 37.
    Staud R. Is it all central sensitization? Role of peripheral tissue nociception in chronic musculoskeletal pain. Curr Rheumatol Rep. 2010;12:448–54.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Maria Adele Giamberardino
    • 1
    Email author
  • Giannapia Affaitati
    • 1
  • Alessandra Fabrizio
    • 1
  • Raffaele Costantini
    • 2
  1. 1.Pathophysiology of Pain Laboratory, Ce.S.I., “G. D’Annunzio” FoundationUniversity of ChietiChietiItaly
  2. 2.Institute of Surgical PathologyUniversity of ChietiChietiItaly

Personalised recommendations