Differential diagnosis between fibromyalgia syndrome and myofascial pain syndrome
More details
Hide details
KORE – Centre of Physical Therapy and Manual Therapy in Swarzedz, Poland; The College of Education and Therapy in Poznań, Poland
Chair of Social Medicine, Poznan University of Medical Sciences, Poland
School of Higher Vocational Education in Piła, Poland
Corresponding author
Małgorzata Chochowska   

Chair of Social Medicine, Poznan University of Medical Sciences, Rokietnicka Street 5c, 60-806 Poznan, Poland
J Pre Clin Clin Res. 2015;9(1):82-86
Fibromyalgia syndrome (FMS) and myofascial pain syndrome (MFPS) can be ranked among disease entities being difficult to diagnose clinically, manifesting themselves mainly through pain in specific hypersensitivity points.

To present the current state of medical knowledge about pain spots appearing on hypersensitive points of soft tissue in the context of selected disease entities.

Summary of the knowledge:
MFPS is defined as sensory, motor and autonomic complaints, caused by the occurrence of trigger points (TrP). Yet the FMS is stated during the anamnesis on the basis of generalized pain, and pressure achiness of at least 11 out of 18 tender points (TP) of precisely determined location. Patients with FMS report numerous additional complaints – apart from the above mentioned ones; these are however highly non-specific and are not confirmed during routine medical check-ups. There are also no laboratory tests that can confirm presence of TrP being characteristic to MFPS and differentiating it from other muscles’ disease entities. Such points are identified only with the use of palpation. Unfortunately while examining a patient this way TrP – being symptoms of MFPS – can be quite easily confused with TP – being symptoms of FMS. Patients with MFPS which is developing in consequence of long-lasting global disorder of muscle tension balance and sensitivity of nociceptors as a result of chronically remaining pain, frequently suffer from achiness fulfilling the criteria of generalized pain. Moreover – in effect of static overload of soft tissues (especially of tonic muscles) – there occur hypersensitive palpable areas (points). Stimulating them cause lively reaction of the patient. Described symptoms can suggest a suspicion of FMS – the more so that making a diagnosis of MFPS does not exclude its coexistence. Having this in mind, there is a pretty large group of authors who raise a supposition that the differential diagnosis between TrP and TP should be observed in the quantitative rather than in the qualitative categories, despite the still binding definition and nomenclature.

Looking at the MFPS and at the FMS from the perspective of evolution of knowledge about them and from the point of view of period when scientific researches were conducted and their results published, it must be stated that during last years a considerable progress has been obtained in scope of better understanding of pathogenesis and pathophysiology of pain in specified points of soft tissue hypersensitivity, and the parallel clinical studies – confirming the hypotheses that were made – clearly increased the diagnostic and therapeutic capabilities of clinical practice.

Stodolny J. Choroba przeciążeniowa kręgosłupa. Epidemia naszych czasów. Wydawnictwo Medyczne ZL Natura, Kielce, 2000 (in Polish).
Rakowski A. Materiały do kursu Terapii Manualnej w Modelu Holistycznym. cz. I, Centrum Terapii Manualnej, Lusówko k. Poznania, 2004 (in Polish).
Bennett R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2007; 21(3): 427–445.
Lewit K. Terapia manualna w rehabilitacji chorób narządu ruchu. ZL NATURA; Kielce, 2001 (in Polish).
Samborski W. Fibromialgia – studium kliniczne i biochemiczne. Post Nauk Med. 1998; 11: 5–6 (in Polish).
Domżał TM. Przewlekłe nieswoiste bóle krzyża – stara dolegliwość czy nowa choroba neurologiczna? Pol Przegl Neurol. 2007; 3(4): 216–227 (in Polish).
Dommerholt PT, et al. Mięśniowo-powięziowe punkty spustowe – przegląd uwzględniający dowody naukowe. Rehabil Med. 2006; 10(4): 39–56.
Simons DG, et al. Travell & Simons myofascial pain and dysfunction. The trigger point manual. Tom I. Upper half of body. Wiliams&Wilkins, Baltimore, 1999.
Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004; 14(1): 95–107.
Solga B, et al. Czy w diagnostyce fibromialgii potrzebna jest standaryzacja różnych metod dolorymetrii? Reumatologia 1994; 32(4): 375–380 (in Polish).
Samborski W et al. Ocena efektów leczenia rehabilitacyjnego chorych na fibromialgię na podstawie badania poziomu bólu oraz siły mięśniowej mierzonej nowym dynamometrem typu Cybex II. Reumatologia 1997; 35(4): 431–438 (in Polish).
Wolfe F, et al. The American College of Rheumatology 1990. Criteria for Classification of Fibromyalgia: Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990; 33(2): 160–170.
Samborski W. Fibromialgia – nowe poglądy na temat patogenezy, diagnostyki i leczenia. Reumatologia 1993; 31(1): 75–79 (in Polish).
Nice D, et al. Intertester reliability of judgments of the presence of trigger points in patients with low back pain. Arch Phys Med Rehabil. 1992; 73(10): 893–898.
Wolfe F, et al. The fibromyalgia and myofascial pain syndrome: a preliminary study of tender points and trigger points in person with fibromyalgia, myofascial pain syndrome and no disease. J Reumatol. 1992; 19(6): 944–951.
Gerwin RD, et al. Identification of myofascial trigger points: inter-rater agreement and effect of training. J Musculoscelet Pain. 1995; 3(suppl.1): 55.
Fernandez-de-las-Penas C et al. Manual therapies in myofascial trigger point treatment: a systematic review. J Bodyw Mov Ther. 2005; 9: 27–34.
Jarosz-Nowak J. Modele oceny stopnia zgody pomiędzy dwoma ekspertami z wykorzystaniem współczynnika Kappa. Matematyka Stosowana 2007; 8(49): 154–168 (in Polish).
Gerwin RD, et al. Interrater reliability in myofascial trigger point examination. Pain, 1997; 69(1–2): 65–73.
Hsieh CY. Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles. Arch Phys Med Rehab. 2000; 81(3): 258–264.
Tunks E, et al. The reliability of examination for tenderness in patients with myofascial; pain, chronic fibromyalgia and controls. J Reumathol.1995; 22: 944–952.
Travell JG, Simons DG. Myofascial pain and dysfunction. Tom II, The lower half of body. Williams&Wilkins, Baltimore, 1992.
McPartland JM, Simons D. Myofascial trigger points: Translating Molecular Theory into Manual Therapy. J Man Manip Ther. 2006; 4: 232–239.
Wheeler A. Myofascial pain disorders. Theory to therapy. Drugs 2004; 64(1): 45–62.
Ruiz-Saez M. Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects. J Manipulaive Physiol Ther. 2007; 30(8): 578–583.
Hanten WP, et al. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther. 2000; 80(10): 997–1003.
Chaitow L, Fritz S. Masaż leczniczy – badanie i leczenie mięśniowo-powięziowych punktów spustowych. Elsevier Urban&Partner, Wrocław, 2010 (in Polish).
Guzek J. Patofizjologia człowieka w zarysie. PZWL, Warszawa, 2008 (in Polish).
Hong CZ, Simons DG. Physiologic and electrophysiological mechanisms of myofascial trigger points. Arch Phys Med Rehabil. 1998; 79(7): 863–872.
Fernandez-de-las-Penas C. Musculosceletal disorders in mechanical neck pain: myofascial trigger points versus cervical joint dysfunctions: a clinical study. J Musculoskelet Pain. 2005; 13: 27–35.
Gunn C. Radiculopathic pain: diagnosis and treatment of segmental irritation or sensitization. J Musculoskelet Pain. 1997; 5: 119–134.
Rivner MH. The neurophysiology of myofascial pain syndrome. Curr Pain Headache Rep. 2001; 5(5): 432–400.
Rakowski A. Kręgosłup w stresie. GWP, Gdańsk, 2001 (in Polish).
Domżał TM. Ból przewlekły – problemy kliniczne i terapeutyczne. Pol Przegl Neurol. 2008; 4(1): 1–8 (in Polish).
Bennett R. Emerging concepts in the neurobiology of chronic pain: evidence of abnormal sensory processing in fibromyalgia. Mayo Clin Proc. 1999; 74(4): 385–398.
Journals System - logo
Scroll to top