You have seen patients with fibromyalgia and myofascial pain syndrome, and will see more. These are both very real medical conditions, and both very different, although often confused. They may be the answer to some of your "challenging" patients.
Fibromyalgia is a systemic neuroendocrine condition with, among other things, a disrupted adrenal-hypothalamus-pituitary axis. It is nonprogressive (although it may seem so), nondegenerative, and noninflammatory. It is responsible for diffuse body-wide pain,tender points that hurt but don't refer pain, and sleep disturbances.
Chronic myofascial pain syndrome (MPS) is a musculoskeletal chronic pain syndrome. It is nonprogressive (although it may seem so), nondegenerative and noninflammatory. It is composed of many Trigger Points (TrPs), which refer pain and other symptoms in very precise, specific patterns. It often seems progressive because each TrP can develop satellite and secondary TrPs, which can form secondaries and satellites of their own. With treatment of the TrPs and underlying perpetuating factors, however, these TrPs can be "reversed" and deactivated or eliminated.
When occurring together, what I call the "FMS/MPS Complex" forms. This is a condition of interconnected symptom spirals that get increasingly worse until the spiral is interrupted. For >example, pain causes muscle contraction which causes more pain which causes more contraction, etc. The patient can sometimes have muscles that are like cement, due to myofascial splinting.
Two excellent medical texts are available on MPS, "Myofascial Pain and Dysfunction: The Trigger Point Manual Vol. I and II" by Janet G. Travell M.D. and David G Simons M.D. The first volume is important to you, as it deals with upper body TrPs. This chapter is but an introduction to them. They show the referred patterns, tell what causes them, and how to relieve them. Many of us have allergies, asthma, food intolerance and disrupted immune systems, as well as multiple chemical sensitivities. 30% of FMS/MPS patients have TMJ Syndrome. Most of us have vasomotor rhinitis, post-nasal drip, chronic sore throat, dizziness, and a whole constellation of other symptoms that lead us right to your office. To deal with FMS/MPS, you must become familiar with the TrP referred pain patterns and what causes the TrPs. Myofascial TrPs can entrap nerves and blood vessels.
Referred autonomic phenomena: vasoconstriction (blanching), coldness, sweating, pilomotor response, salivation, vasodilation, lacrimation, coryza and hypersecretion caused by TrP activity.
Referred TrP phenomena: sensory, motor and autonomic phenomena such as pain, tenderness, spasm (increased motor unit activity) vasodilation, and hypersecretion caused by TrPs.
Proprioceptive disturbances caused by TrPs: imbalance, dizziness, tinnitus, and distorted perception of the weight of objects lifted in the hands.
Allergies: We have a hypersensitized nervous system. Histamine, is a neurotransmitter, and regulated in delta sleep. Our delta sleep is often disrupted due to alpha wave intrusion. Multiple chemical sensitivities (leaky gut syndrome) and sensitivity to odors are common with FMS. We are often hypersensitive to molds and yeasts. We don't always react normally to allergy tests. When you take a good history, however, it is evident what is happening, once you become familiar with the concepts.
Mottled or blotchy skin: The discoloration on my skin started to be noticeable on my forearms. The tops became brown in rectangular patches. The color faded slightly with the winter, and then darkened again in the sunlight. After a few years, the blotches became angry red and itchy if exposed to the sun. Sunblock prevented this. I visited a local dermatologist, who had no answers, except to rule out infection. The clue for me came when I inadvertently left some salt gel residue from a muscle electrostimulator electrode on my forearm. I soon had a semicircle of brown mottling. Observing my movements in the garden, I noticed that I often would wipe my forehead on my arms. The photoreaction of my sweat produced the mottling. I still have that semi-circle from two years ago. The right arm is only half mottled, while the left is mottled almost to the elbow. Since I started wearing headbands in the garden, the mottling has not increased. The pituitary is responsible for secreting melanocyte-stimulating hormone. Light triggers the hypothalamus, which triggers the pituitary. This influences the mottling on the skin
Itching: When we itch, we often look for an allergic reaction. We forget about sensory itch. There are pressure plate receptors in our outer skin layer called Merkel's discs (3). They translate the tactile messages received by the skin. They have a default mechanism when they don't know what message to send. Unfamiliar pressures are translated as itch. It's my theory that due to the dysregulation of neurotransmitters in FMS and/or the mechanical constriction of fluids around the Merkel's discs, we itch a lot more than most folks. Sometimes it is enough to drive us to distraction, and disrupt our meager amounts of sleep. Itching can be a sign of low-level TrPs. Cold helps numb the itch. Cold numbs the pressure plate receptors. Dryness makes the itch worse. Dryness creates an enhanced pressure reception by the discs. I hope I can interest a dermatologist in doing some research on this. Some of the itches follow TrP referral patterns, in which case the TrP must be broken up.
Patches of skin with a network of fine veins and capillaries that are extremely painful: This is "livido reticularis". This is sometimes seen in FMS/MPS patients, usually in the legs but it can occur in the arms.
Dermographia and related phenomenon: One phenomenon that occurs in FMS/MPS is called the "flare response". It's part of the histamine (neurotransmitter) and mast cell liberation at the trigger points and other traumatic sites. One Internet Fmily member said red welts occurred with acupuncture. This can happen with any kind of TrP therapy. It is neurogenic (generated by the nerves) flare in response to even mild touch, heat, or chemical contact. There can be alterations of sensations in FMS. There can be a profound change in the tolerance of heat and cold. Skinfold tenderness increases. This means we get what is called "tactile defensiveness", or muscle tension in response to touch.
Pick up every infection that's "going around": This can come in a series--times when you get no successfully attacking germs, and times when you have to put antibiotic ointment on every scratch or it will get infected. They are both signs of immune dysfunction. The Fibromyalgia Network reported a study that found decreased natural killer (NK) cell activity in FMS. These cells are our front line warriors against outside attack. It seems that in FMS, they are present in normal amounts, but do little or nothing. NK cells require serotonin to activate them. And serotonin is regulated in delta sleep. We have alpha wave intrusion into delta level sleep, so we miss the restorative sleep and neurotransmitter regulation healthy folks get. When confronted by an "alien invader", our fibromite NK cells insist "It's not my job." I have found that if I take thymus extract, which comes in pill form, it makes the difference. Without it I can expect one cold a month, at least. With it, I may get one or two a year.
FMS/MPS Nocturnal Sinus Syndrome: This is not an official name. I use it here because I have never seen it described. This is a nighttime sinus stuffiness on one side, that moves to whatever side of your head is lower. Gravity drains the congestion to the lower side. This condition goes along with post nasal drip and often a constantly runny nose.
Runny nose: Almost all FM/MPS patients have this form of "vasomotor rhinitis". I think, and this is just my theory, that with muscle tightening, normal fluid passages are constricted, and fluid backs up in the sinuses. So we get a constant post nasal drip all night, although the membranes of the nose may feel very dry and even bleed. It isn't unusual for a massage therapist to work a trapezius point and suddenly the sinuses clear. This often happens in an area right behind the jaw, under the ear. I can often tell what side a patient sleeps on most. That's usually the side with the worst head and neck rigidity. The side they sleep on most is subjected to more of the drip...drip...drip ... like water torture, on the back of the throat, all night. The SCM TrPs and the scaleni become tight to "splint" the sore throat and digastric TrPs. I have found that very warm salt-water used as nose drops to clean off the throat and nasopharyngeal area before bed will prevent or at least minimize this difficulty without adding medications to the system. Antihistamines and decongestants can be important. If the neurotransmitter histamine is an integral part in a patient's FMS, you will probably get to know them quite well.
Trouble swallowing: If the post nasal drip isn't treated, trouble with swallowing develops due to digastric TrPs. This leads to head and neck pain, and a "swollen glands" feeling.
Warning--it hurts to work the digastric TrPs. Sometimes it's best for the patient to "milk" the area of its excess fluid, using a gentle downward stroking motion from the chin to the base of the throat. Tell them to start lightly and listen to their body.
Ringing in the ears: Deep masseter TrPs may cause ringing or a low roaring sound in the ears. The sound may vary. I get a crackling, or sometimes hear that annoying sound that the phone makes when its off the hook. The medial pterygoid TrPs can cause deep ear pain and stuffiness in the ear. The sternal portion TrPs of the SCM can also cause deep ear pain.
Chronic dry cough: This is often due to a TrP at the lower end of the sternal division of the SCM. The sternocleidomastoid is not a muscle, but a muscle group. TrPs in different areas cause different symptoms. To complicate matters, a chronic dry cough can also be due to esophageal reflux. Bruxism, chewing gum, playing a wind instrument or violin will often aggravate neck TrPs.
Fluctuating blood pressure: This is a question without an answer, only a theory. It has to do with the carotid sinuses. I have now and then heard from people with fluctuating blood pressure. This could be from TrPs in the neck interfering with the functioning of the carotid sinuses.
Problems swallowing, chewing pain, jaw clicking, TMJ, soreness inside the throat, excessive saliva secretion and sinusitis-like pain, drool in your sleep, choke on saliva:: These all can come from the internal medial pterygoid TrP.
Prickling "electric" face: This pain is most often from the platysma TrP. This TrP refers the prickling pain to the skin area over the jaw.
Red eyes, tearing eyes: These symptoms can be caused by the SCM, along with hearing impairment, and a disturbed sense of weight perception.
Popping or clicking of the jaw, TMJ (temporomandibular joint dysfunction): Jaw pain and dysfunction is usually a function of the masseter TrP, although the trapezius and temporalis TrPs are often involved
Eye pain: Cutaneous facial TrPs can cause pain in ear, eyes, nose and teeth. These TrPs are shallow, and can occur in many places on the face. Tell your patient to try some pressure-point.
TrP Pain is rarely symmetrical. The patient usually presents with complaints due to the most recent activated TrP. A lump at the TrP site could be due to damming of blood and other fluids by obstructed blood flow.
Spray and stretch release of TrPs by use of ethylchloride or fluro-methane is detailed in the Trigger Point Manuals. Sine-wave ultrasound with electrostim, acupressure or high voltage pulsed galvanic stimulation can be used in some areas to break up TrPs.
You have seen patients with fibromyalgia and myofascial pain syndrome, and will see more. They are both very real medical conditions, often occurring together, both very different, although=7F often confused. They may be the answer to some of your "challenging" patients. Fibromyalgia is a systemic neurotransmitter condition with, among other things, a disrupted adrenal-hypothalamus-pituitary axis. It is nonprogressive (although it may seem so), nondegenerative, and noninflammatory. It is responsible for diffuse body-wide pain, tender points that hurt but don't refer pain, and sleep disturbances. Chronic myofascial pain syndrome (MPS) is a musculoskeletal chronic pain syndrome. It is nonprogressive (although it may seem so), nondegenerative and noninflammatory. It is composed of many Trigger Points (TrPs), which refer pain and other symptoms in very precise, specific patterns. It seems progressive because each TrP can develop satellite and secondary TrPs, which can form secondaries and satellites of their own. With treatment of the TrPs and underlying perpetuating factors, however, these TrPs can be "reversed" and minimized or eliminated. When occurring together, what I call the "FMS/MPS Complex" forms. This is a condition of interconnected symptom spirals that get increasingly worse until the spiral is interrupted. For example, the pain causes muscle contraction which causes more pain which causes more contraction, etc. The patient can sometimes have muscles that are like cement, due to myofascial splinting. One of the most vital things for you to know is that your patient can have various muscles constricted in such a way that the bite can be pulled off. When the Trigger Points are treated, the bite will change. This is a disaster if you have equilibrated the bite to the contraction of the muscles. TrPs can be caused by a poor bite, and the reverse is also true. Equilibration and TrP treatment must occur together. Otherwise they may both be ineffective.
Two excellent medical texts are available on MPS, "Myofascial Pain and Dysfunction: The Trigger Point Manual Vol. I and II" by Janet G. Travell M.D. and David G Simons M.D. The first volume is important to you, as it deals with upper body TrPs. This information is but an introduction to TrPs. These texts show the referred patterns, tell what causes them, and how to relieve them. 30% of FMS/MPS patients have TMJ. Suspect TrPs, especially if there's no disc problem, just dysfunction and pain. TrP pain is rarely symmetrical. Your patient usually presents with complaints due to the most recent activated TrP. When this is eliminated, the pain pattern may shift to an earlier one, which also must be inactivated. Trigger points are activated directly by acute overload, overwork fatigue, direct trauma, and by chilling.
TrPs are also activated indirectly by other TrP s, visceral disease, arthritic joints, and by emotional distress. Active TrPs vary from hour to hour and day to day. The signs and symptoms of TrP activity long outlast the precipitating event. When a nerve passes through a muscle between taut bands, or when a nerve lies between the taut band and bone, the unrelenting pressure exerted on the nerve can produce neuropraxia, loss of nerve conduction, but only in the region of compression. The patient has two types of pain symptoms--aching pain referred from the TrPs in the muscle, and nerve compression effects of numbness and tingling hypoesthesia and sometimes hyperesthesia. Patients with nerve entrapment prefer cold on the painful region. Patients with myofascial pain prefer heat and say cold aggravates the pain.
The most common TrP perpetuating factors are skeletal asymmetry and disproportion. Also important are nutritional inadequacies, whatever can impair muscle metabolism, chronic infections, psychological factors, allergy, and impaired sleep. Most common TrP perpetuating factors I've found are FMS and inappropriate treatment programs.
TrPs that refer burning, prickling or lightning-like jabs of pain are likely to be found in cutaneous scars. Scar TrP deactivation can often be accomplished by intracutaneous injection with 0.5% procaine or by repeated topical application of topical anesthetic, dimethisoquin HCl ointment (Quotane). TrPs may also be found in joint capsules and ligaments. Periosteal TrPs often produce autonomic reactions, such as sweating, blanching, and nausea. TrP sites can vary slightly from patient to patient. Many muscles have multiple TrP locations. A lump at the TrP site could be due to damming of blood and other fluids by obstructed blood flow. The major factor in TrP pain is always mechanical, even if triggered by stress. Limitation of range of motion is worse in the morning, and may recur after periods of immobility(such as dental work) or over-activity during the day. The chronic stress of the resultant sustained contraction, or excessive fatigue during repeated contractions, may cause a vulnerable region of the muscle to become strained, repeating this same process.
Bruxism: Teeth clenching is the default mechanism of the brain. When it doesn't know what to do as a response to mixed or erratic signals, it clenches the jaw. Sort of a cerebral twiddling of the cranial thumbs. Check out the masseter TrPs and temporalis TrPs.
Unexplained toothaches: This confusing symptom can be caused by several TrPs, chiefly in the temporalis, digastric and masseter muscles. Each TrP has its own particular toothache pattern. A TrP-induced toothache is usually intermittent. During a long dental procedure, which often activates these TrPs, you should take periodic rests to exercise and relieve the jaw muscles. Anterior digastric TrPs refer pain to the two front lower teeth.
Motor coordination problems: The sternocleidomastoid is much of the problem here. SCM TrPs can cause dizziness, imbalance, neck soreness, swollen gland feeling, runny nose, maxillary sinus congestion, "tension" headaches, eye problems (tearing, "bug-eyes", blurred or double vision, inability to raise the upper lid, and a dimming of perceived light intensity), spatial disorientation, postural dizziness, vertigo, sudden falls while bending, staggering walk, impaired sleep, nerve impingement, and >disturbed weight perception. It can cause secondary TrPs that invoke dental pain. People with SCM TrPs often have trouble glancing downward--they can get so disoriented that there is nausea and vomiting. Chronic dry cough, pain deep in the ear canal, pain to the throat and back of the tongue and to a small round area at the tip of the chin can be part of the SCM TrP package. Localized sweating and vasoconstriction can be a problem, as well as pain in a "skull cap" area of the head. What SCM TrPs don't cause is a pain in the neck, although they figuratively become one due to their wide-ranging symptoms.
FMS/MPS Nocturnal Sinus Syndrome: This is not an official name. I use it here because I have never seen it described. This is a nighttime sinus stuffiness on one side, that moves to whatever side of your head is lower. Gravity drains the congestion to the lower side. This condition goes along with post nasal drip and often a constantly runny nose. This often refers teeth pain.
Runny nose: Almost all FMS/MPS patients have this form of "vasomotor rhinitis". That's a runny nose with no "biological" cause. I think, and this is just my theory, that with muscle tightening, normal fluid passages are constricted, and fluid backs up in the sinuses. So we get a constant post nasal drip all night, although the membranes of the nose may feel very dry and even bleed. Bruxism, chewing gum, playing wind instrument or violin will often aggravate neck TrPs.
Problems swallowing, chewing pain, jaw clicking, TMJD, sore ness inside the throat, excessive saliva secretion and sinusitis-like pain, drooling in sleep, choking on saliva-- these all can come from an internal medial pterygoid TrP, which is often overlooked.
Prickling "electric" face pain over the jaw area: This pain is most often from the platysma TrP. This TrP refers the prickling pain to the skin area over the jaw.
Popping or clicking of the jaw, TMJD(temporomandibular joint dysfunction): Jaw pain and dysfunction is usually the fault of one or more masseter TrPs, although trapezius and temporalis TrPs are often involved. Itchy ears can also be caused by the masseter TrP. The itch, which can drive you to distraction, can be relieved by acupressure on that TrP.
Tooth pain: Cutaneous facial TrPs can cause pain in ear, eyes, nose and teeth. These TrPs are shallow, and can occur in many places on the face. Try acupressure. If the TrPs are there, they will let you know.
Headaches: The SCM is a common cause of headaches. So, indirectly, are any of the causes of sore throat, for often a sore throat refers pain to the head. The posterior cervical TrP is also suspect if it entraps the occipital nerve. This will cause a numbness, or a tingling, burning pain--like a band around head. Many upper body TrPs can be involved in headaches.
Patients with FMS/MPS may react in unusual ways to bite splints. Sometimes splinting makes things worse. Patients have been known to bite right through a splint in one night. One of our Internet "fibrodocs" (David Nye MD Midelfort Clinic Eau Claire Wisc.) recommends the use of a hockey mouth guard if this happens. Just soak it in very hot water to make it pliable so that it will fit the shape of the mouth better.
For FMS/MPS patients, even teeth cleaning can be severely painful, because FMS is a pain amplification syndrome. Studies indicate that some of our touch receptors have become pain receptors. Tense muscles from the pain of cleaning may cause the jaw to hurt for over a week. You might try numbing the bottom teeth where most of the scaling is necessary. This can eliminate most of the pain of cleaning. Have the patient work the masseter for the next few days. It is also helpful if there are frequent stops to move the jaw during cleaning and other dental work. Some patients take a muscle relaxer, such as Skelaxin, before and after cleanings, to allow for more stretching of the jaw. FMS/MPS patients can even experience pain during X-ray--those squares cut in right in, especially under the tongue.
Root canals can be torture. We feel pain earlier in the case of a threatened nerve. We feel extreme pain longer, often when other patients would feel none at all. Sometimes it is impossible to eliminate all of the pain. It is vitally important to get all the roots. Several people have reported cases of "myofascial neuralgia" after a root canal--with pain that lasted a month or more. We have had a few members of the Internet group complain about teeth cracking after this procedure.
People with FMS/MPS have more than the usual difficulty adjusting to dentures. It is important that dental problems are fixed promptly. Dentures must fit, and any imbalances in the bite must be corrected. Trigger Points on both sides should get treatment due to the interrelation of the musculature and jaw structures. For TMJD, applying moist heat on the masseter TrP a few times a day may ease the pain. Tell your patient to avoid chewing gum or hard chewy foods, and to chew foods evenly as possible on both sides of the mouth. Spray and stretch with Fluori-Methane to inactivate TrPs is described in detail in the Trigger Point Manuals. Ischemic compression using acupressure techniques is also often effective. Equilibration has a direct effect on TrPs, which have a direct effect on equilibration.
Dental problems can often refer head pain or sinus pain. The pain amplification of FMS often has a direct effect in the dental chair. The dentist is a vital and integral part of the FMS/MPS health care team. With awareness of FMS/MPS symptomology and preventative care, much pain and trauma may be avoided.
It is of utmost importance that any dental procedure be stopped frequently to allow the patient to stretch and relax the jaw muscles to prevent trigger point aggravation.
You have seen patients with fibromyalgia and myofascial pain syndrome, and will see more. They are both very real medical conditions, and both very different, although often confused. They may be the answer to some of your "challenging" patients.
Fibromyalgia is a systemic neuroendocrine condition with, among other things, a disrupted adrenal-hypothalamus-pituitary axis. It is nonprogressive (although it may seem so), nondegenerative, and noninflammatory. It is responsible for diffuse body-wide pain, tender points that hurt but don't refer pain, and sleep disturbances.
Chronic myofascial pain syndrome (MPS) is a musculoskeletal chronic pain syndrome. It is nonprogressive (although it may seem so), nondegenerative and noninflammatory. It is composed of many Trigger Points (TrPs), which refer pain and other symptoms in very precise, specific patterns. It seems progressive because each TrP can develop satellite and secondary TrPs, which can form secondaries and satellites of their own. With treatment of the TrPs and underlying perpetuating factors, however, these TrPs can be "reversed" and minimized or eliminated. It is not unusual, however, for pregnancy or even dysmenorrhea to activate TrPs.
When occurring together, what I call the "FMS/MPS Complex" forms. This is a condition of interconnected symptom spirals that get increasingly worse until the spiral is interrupted. For example, the pain causes muscle contraction which causes more pain which causes more contraction, etc. The patient can sometimes have muscles that are like cement, due to myofascial splinting.
Two excellent medical texts are available on MPS, "Myofascial Pain and Dysfunction: The Trigger Point Manual Vol. I and II" by Janet G. Travell M.D. and David G Simons M.D. The second volume is important to you, as it deals with lower body TrPs, but there are some TrPs at the end of the first volume that are also important. The Manuals show the referred patterns, tell what causes them, and how to relieve them.
Pregnancy: Stretches and other physical therapy to promote myofascial elasticity are important during this time, as well as extra vitamins. Benedryl is one of the only remedies for sleep suitable in pregnancy. Unfortunately, for some of us, it causes insomnia. Many of us have the alpha-delta sleep anomaly and get little restorative sleep. Disruption of delta sleep may be tied to hormone dysregulation. Many of us also have nutritional problems, due to a malabsorption condition in the GI tract.
Myofascial Overgrowth: People with FMS/MPS have a tendency to form cysts, fibroids, heavy scarring and adhesions. Even our cuticles and pierced earring holes overgrow. This is something to keep in mind when surgery is contemplated. Some surgeons do Trigger Point injections during surgery in the area around the surgical site.
Hysterectomies: Many FMS/MPS patients have had hysterectomies to relieve pain. Often just the uterus is removed, but in many cases the ovaries are taken out later to relieve hormonal swings and ovarian pain which refers to the groin and legs.
Menstrual Problems: FMS is a pain amplification syndrome. Some of our touch receptors have changed to pain receptors. Your patient really hurts. During menses, it is not unusual for the patient to be able to feel what area of the uterus is sloughing off. It is like being skinned alive on the inside, every month. Menstrual problems such as severe cramping, delayed periods, irregular periods, long periods with a great deal of bleeding, membranous flow, late periods, missed periods and passing blood clots are common in FMS/MPS. Part of these problems can be caused by coccygeus, iliocostalis, rectus abdominis, pyramidalis, and other pelvic and low back TrPs. There is also a high TrP in the adductor magnus which refers a diffuse pain/soreness throughout the pelvic area, and can mimic PID. There are also the thick secretions to be dealt with, and a lot of hormone problems (neurotransmitters again). Even the multifidi refer pain to the abdominal area.
Since 50% of the children of people with FMS/MPS also develop the conditio n (there is an inherited tendency towards FMS), female children of parents with FMS/MPS should be monitored carefully during their first menses. If severe dysmenorrhea occurs, the patient should be checked out for signs of FMS/MPS.
I have found that if patients use tennis-ball acupressure (it hurts, but it is flushing out the TrPs), there will be less constriction in the abdominal area, and less bloating. It is especially important to work the line where the leg joins the trunk. They can do this by lying on the floor and placing the tennis ball between them and the floor. If it is extremely sore, that means the TrP is there, and with it, constricted myofascia. There can be nerve entrapment by TrPs as well, leading to neuropraxia. If there is nerve involvement, ice will often help ease the pain. If the pain is muscular alone, the patient will find heat more comforting.
Vaginal Discharge: Vaginal discharge, sometimes with itch, is common. So is mittelschmerz. This pain, as in menstrual pain, often triggers the adductor longus and iliopsoas TrPs. These TrPs can respond to galvanic muscle stim, sine-wave ultrasound with electrostim, spray and stretch, and craniosacral release.
Yeast Problems: Frequent yeast infections, an itch on the roof of the mouth after eating tangy cheese, and bloating after drinking beer can be some signs that your patient has a yeast problem. Many people with FMS/MPS have reactive hypoglycemia. The "Zone" diet for this works well. I also find that allergy shots for molds are very helpful.
Hyper-sensitivity: Hyper-sensitive nipples and/or breast pain is commonly due to pectoralis TrPs. Many of us have latent pectorals and sternalis points. "Doorway stretches" help these points.
Medication Reactions: Many FMS/MPS patient have unusual reactions to medications due to altered metabolism. Sometimes just a small portion of a normal medication dose will have very strong effects. Other times we can take whopping doses of a medication and feel no effects at all.
Thick Secretions: A lot of us have thick secretions. Guaifenesin ends this problem, and the way it thins secretions may be part of why it is so effective in "reversing" the effects of FMS. I've heard that it has been used to help promote conception.
Pendulous Abdomen: Active TrPs in the abdominal muscles, especially in the rectus abdominus, may cause a lax, pendulous abdomen with gas. Your patient can't pull in their gut because the TrPs inhibit contraction. A fat pad forms right over the abdomen. That fat pad is hard to get rid of, due to the TrPs. The first thing to do is to find and eliminate the back muscle TrPs that refer pain to the abdomen. These can cause burning, fullness, bloating, and swelling. Only then can you hope to eliminate the belly TrPs.
Pain with Intercourse: this is often due vaginal TrPs and pelvic floor TrPs. For aching discomfort and cramps during coitus, check abdominal and low back TrPs. For sharp pain, check piriformis TrP with pudendal nerve entrapment. Vulvar vestibulitis, vulvodynia, hyperesthesia, and general pelvic muscle aches are also common. Progesterone will affect the levels of serotonin, and serotonin levels may vary from day to day as the amount of delta sleep varies. Expect mood swings and difficulties with neurotransmitter fluctuation, and hormonal irregularities.
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