TENDER POINTS FIBROMYALGIA VS TRIGGER POINTS MYOFASCIAL PAIN SYNDROME- A NEED FOR CLARITY IN TERMINOLOGY AND DIFFERENTIAL-DIAGNOSIS

Objective: This study reviews the clinical. distinctions between fibro myalgia (FM) and myofascial pain syndrome (MPS), which represent two s eparate and distinct soft-tissue syndromes. The major aim of this arti cle is to clarify the terminology associated with these syndromes and clearly define the parameters of differential diagnosis and treatment. Data Sources: Pertinent articles in the chiropractic and medical lite rature are reviewed with an emphasis on the literature published from 1985-1994. Study Selection: Studies were selected that emphasized diff erential diagnosis of FM and MPS, as well as individual articles on ei ther FM or MPS. Data Synthesis: The literature on fibromyalgia and myo fascial pain syndromes has grown considerably since 1985. It is now cl ear that there are several important differences between FM and MPS. T he most important criteria for differential diagnosis are the presence of tender points (TePs) and widespread, nonspecific, soft tissue pain in FM, compared with regional and characteristic referred pain patter ns with discrete muscular trigger points (TrPs) and taut bands of skel etal muscle in MPS. The etiology of TePs is still unknown and it is un certain which specific soft tissues are tender in FM patients. Myofasc ial TrPs are found within a taut band of skeletal muscles and have a c haracteristic ''nodular'' texture upon palpation. TrPs are thought to develop after trauma, overuse or prolonged spasm of muscles. Local tre atment applied to TePs is effective, yet specific treatment of TrPs is often dramatically effective. Conclusion: FM and MPS are two differen t clinical conditions that require different treatment plans. FM is a systemic disease process, apparently caused by dysfunction of the limb ic system and/or neuroendocrine axis. It often requires a multidiscipl inary treatment approach including psychotherapy, low dose antidepress ant medication and a moderate exercise program. MPS is a condition tha t arises from the referred pain and muscle dysfunction caused by TrPs, which often respond to manual treatment methods such as ischemic comp ression and various specific stretching techniques. Both of these cond itions are seen routinely in chiropractic offices; therefore, it is im portant for field practitioners to understand these distinctions.