The definition of fibromyalgia includes widespread pain in all four quadrants (areas) of the body. What happens when you have fibromyalgia-like pain located in only one or two quadrants of the body? Limited forms of the syndrome have distinct features and terms used to describe them. Myofascial pain syndrome encompasses many regional pain conditions ranging from temporomandibular joint dysfunction in the jaw to a low back pain syndrome. The diagnosis of myofascial pain syndrome requires that at least one trigger point be present and that, when it is pressed, pain is referred to another site. This chapter will review regional myofascial pain, relate it to fibromyalgia pain pathways, and discuss its management and prognosis. Our current concepts of tender points, trigger points, and regional pain amplification were developed by two of the best-known physical medicine thinkers, Janet Travell and David Simons. Beginning in the early 1940s, Dr. Travell became well known as John F. Kennedy’s physician, who nursed him back to health in the 1950s when back pain restricted his ability to walk. Later, she became Lyndon Johnson’s White House physician. Travell and Simon’s textbook on myofascial pain remains a classic and was updated by them as recently as 1992. Dr. Travell (who died in 1997 at the age of 95) and Dr. Simons formed close working relationships with rheumatologists, and their influence permeates every fibromyalgia study relating to tender points and regional pain. Neurologists, neurosurgeons, and orthopedists diagnosed and treated localized muscle and nerve pain long before there were rheumatologists. At about the same time that rheumatologists were becoming recognized and organized into a certifiable subspecialty, an equally small group of doctors were organizing themselves into a specialty known as physical medicine and rehabilitation. These doctors (who call themselves physiatrists) do not perform surgery, are not internists or family physicians, and do not manage autoimmune diseases. They concern themselves with areas not addressed by rheumatologists such as stroke, cardiac, and spinal cord injury rehabilitation. Physical medicine doctors usually practice in a hospital or hospital-like environment and work closely on a daily basis with physical therapists, occupational therapists, speech therapists, social workers, psychologists, and other allied health professionals.
LOW BACK PAIN;
