Fibromyalgia of the Cervical Musculature

The Clinical Syndrome

Fibromyalgia of the cervical spine is one of the most common painful conditions encountered in clinical practice. Fibromyalgia is a chronic pain syndrome that affects a focal or regional portion of the body. The sine qua non of fibromyalgia of the cervical spine is the finding of the myofascial trigger points on physical examination. Although these trigger points are generally localized to the cervical paraspinous musculature, trapezius, and other muscles of the neck, the pain of fibromyalgia of the cervical spine is often referred to other areas. This referred pain is often misdiagnosed or attributed to other organ systems, leading to extensive evaluations and ineffective treatment.

The trigger point is the pathognomonic lesion of fibromyalgia pain and is thought to be the result of microtrauma to the affected muscles. Stimulation of the myofascial trigger point will reproduce or exacerbate the patient’s pain. Often, stiffness and fatigue will coexist with the pain of fibromyalgia of the cervical spine, increasing the functional disability associated with this disease and complicating its treatment. Fibromyalgia of the cervical spine may occur as a primary disease state or may occur in conjunction with other painful conditions, including radiculopathy and chronic regional pain syndromes. Psychological or behavioral abnormalities including depression frequently coexist with the muscle abnormalities associated with fibromyalgia of the cervical spine. Treatment of these psychological and behavioral abnormalities must be an integral part of any successful treatment plan for fibromyalgia of the cervical spine.

Although the exact etiology of fibromyalgia of the cervical spine remains unknown, tissue trauma seems to be the common denominator. Acute trauma to muscle as a result of overstretching will commonly result in the development of fibromyalgia of the cervical spine. More subtle injury to muscle in the form of repetitive microtrauma can also result in the development of fibromyalgia of the cervical spine, as can damage to muscle fibers from exposure to extreme heat or cold. Extreme overuse or other coexistent disease processes such as radiculopathy may also result in the development of fibromyalgia of the cervical spine.

In addition to tissue trauma, a variety of other factors seem to predispose the patient to the development of fibromyalgia. The weekend athlete who subjects his or her body to unaccustomed physical activity may often develop fibromyalgia. Poor posture while sitting at the computer keyboard or while watching television has also been implicated as a predisposing factor to the development of fibromyalgia. Previous injuries may result in abnormal muscle function and predispose to the subsequent development of fibromyalgia. All of these predisposing factors may be intensified if the patient also suffers from poor nutritional status or coexisting psychological or behavioral abnormalities including depression. Nutritional supplementation coupled with a wellness product alternative may be helpful in treating this condition. Ask your doctor for a program.

Palpatation of a trigger point will result in a positive jump sign.

Signs and Symptoms

The sine qua non of fibromyalgia of the cervical spine is the identification of myofascial trigger points. The trigger point is the pathologic lesion of fibromyalgia and is characterized by a local point of exquisite tenderness in affected muscle. Mechanical stimulation of the trigger point by palpation or stretching will produce not only intense local pain but also referred pain. In addition to this local and referred pain, there will often be an involuntary withdrawal of the stimulated muscle that is called a jump sign. This jump sign is characteristic of fibromyalgia as is stiffness of the neck, painful range of motion of the cervical spine and pain referred into the upper extremities in a non-dermatomal pattern.

Although the patterns of referred pain have been well studied and occur in a characteristic pattern, this referred pain is often misdiagnosed and attributed to diseases or organ systems in the distribution of the referred pain. This often leads to extensive evaluation and ineffective treatments. Taut bands of muscle fibers are often identified when myofascial trigger points are palpated. Despite this consistent physical finding in patients suffering from fibromyalgia, the pathophysiology of the myofascial trigger point remains elusive. Many theories have been advanced as to their etiology. Common to all of these theories is the belief that trigger points are the result of microtrauma to the affected muscle. This microtrauma may occur as a single injury to the affected muscle or may occur as a result of repetitive microtrauma. Chronic Deconditioning of the agonist and antagonist muscle unit has also been implicated as a cause.

Testing

The exact pathophysiologic processes responsible for the development of fibromyalgia of the cervical spine remains elusive. Biopsies of clinically identified trigger points have not revealed consistently abnormal histology. The muscle hosting the trigger points has been alternatively described as “moth eaten” or as containing “ waxy degeneration.” Increased plasma myoglobin has been reported in some patients with fibromyalgia but this finding has not been reproduced by other investigators. Electrodiagnostic testing of patients suffering from fibromyalgia has revealed an increase in muscle tension in some patients. Again, this finding has not been reproducible. However, regardless of the pathophysiology of fibromyalgia by clinicians, there is little doubt that the clinical findings of trigger points in the cervical paraspinous muscles and associated jump sign exist in combination with a clinically recognizable constellation of symptoms.These signs are consistently diagnosed as fibromyalgia by clinicians.

The diagnosis of fibromyalgia is made on the basis of clinical findings rather than on specific diagnostic laboratory, electrodiagnostic, or radiographic testing. For this reason, a targeted history and physical examination with a systematic search for trigger points and identification of a positive jump sign must be carried out on every patient suspected of suffering from fibromyalgia. Because of the lack of objective diagnostic testing, the clinician must also rule out other coexisting disease processes that may mimic fibromyalgia including primary inflammatory muscle disease and collagen vascular disease. The judicious use of electodiagnostic and radiographic testing will also help identify coexisting pathology such as herniated discs and rotator cuff tears. The clinician must also identify coexisting psychological and behavioral abnormalities that may mask or exacerbate the symptoms associated with fibromyalgia and other coexisting pathologic processes.

Differential Diagnosis

The diagnosis of fibromyalgia is made on the basis of clinical findings rather than specific diagnostic laboratory, electrodiagnostic or radiographic testing. For this reason, a targeted history and physical examination with a systematic search for trigger points and identification of a positive jump sign must be carried out on every patient suspected of suffering from fibromyalgia. Due to the lack of objective diagnostic testing, the clinician must also rule out other co-existing disease processes that may mimic fibromyalgia. These conditions include primary inflammatory muscle disease, multiple sclerosis, cervical spine and disc disease and collagen vascular disease. Electrodiagnostic and radiographic testing will help identify coexisting pathology such as herniated discs and rotator cuff tears. The clinician must also identify coexisting psychological and behavioral abnormalities that may mask or exacerbate the symptoms associated with fibromyalgia.

Treatment

The treatment of fibromyalgia of the cervical spine involves the use of techniques that will help eliminate the trigger point that may serve as the source of the perpetuation of this painful condition. It is hoped that interruption of the pain cycle by the elimination of trigger points will allow the patient to experience prolonged relief. The mechanism of action of each of the above modalities is poorly understood, and thus an element of trial and error in developing a treatment plan is the expected norm. Because underlying depression and a substrate of anxiety are present in many patients suffering from fibromyalgia of the cervical spine, the inclusion of antidepressant compounds as an integral part of most treatment plans represents a reasonable choice. In addition to this treatment modality, a variety of adjuvant methods are available for the treatment of fibromyalgia of the cervical spine. The therapeutic use of heat and cold is often combined with trigger point injections and antidepressant compounds to effect pain relief. Some patients will experience decreased pain with application of transcutaneous nerve stimulation or electrical stimulation to fatigue affected muscles. Although not currently approved by the Food and Drug Administration, the injection of minute quantities of botulinum toxin, type A directly into trigger points has gained favor in the treatment of persistent fibromyalgia of the cervical spine in patients who have not responded to traditional treatment modalities.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.