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Latest News

Treating One Area Can Reduce Overall Fibromyalgia Pain

by Kristin Thorson, Fibromyalgia Network Editor 
Posted: October 25, 2010

Can treating your most troublesome shoulder muscle lead to a significant drop in your overall fibromyalgia pain? Yes, according to a study published online this month in the European Journal of Pain, and the same results were found for treatment of just one painful joint.1

Research during the past year shows that fibromyalgia patients have many muscles with tight, rope-like bands containing firm knots called myofascial trigger points.2,3 These trigger point areas hurt even when a person with fibromyalgia is resting. And when pressed, they also radiate pain to other muscles.

Osteoarthritis or trauma to a joint is another source of discomfort, besides trigger points, that may occur in people with fibromyalgia. One population-based study in Sweden found that joint pain was seven times more common in fibromyalgia patients than the rest of the nearly 45,000 individuals who were screened for health conditions.4

Based on the high incidence of trigger points and joint pain, Maria A. Giamberardino, Ph.D., and her team at Chieti University in Italy, designed a study to find out if effectively treating one nagging trigger point or painful joint would effect the overall impact on the body-wide pain of fibromyalgia. Only one area, a trigger point in the shoulder or a bothersome joint, was relieved of pain. In addition, only techniques that treat the local area were used.

A series of two to four injections with anesthetic was used to treat a trigger point in one group of fibromyalgia patients. For the group of patients whose focus was pain in one joint, a combination of two anti-inflammatory medications were applied topically to the area with the aid of a tiny electrical current to help the drugs penetrate the tissues. The treatment effects after 30 days were compared to fibromyalgia patients with similar local pains that received a placebo instead of trigger point or joint pain therapies.

Treating either the trigger point or the joint in the two groups of fibromyalgia patients led to a substantial reduction in pain at the local area addressed. In addition, the patients who received treatment, compared to those in the placebo group, reaped a 20 to 30 percent reduction in body-wide discomfort. This was assessed by an examiner who was unaware of which group (trigger point, joint pain or placebo) the patients belonged to.

"Local treatment of the peripheral muscle/joint sources not only relieves local symptoms but also significantly improves the widespread fibromyalgia symptoms," writes Giamberardino and coworkers. More specifically, they state that diffuse pain and tenderness throughout the body was greatly improved by addressing just one area.

Giamberardino suggests that the first step in treating fibromyalgia might be to target trigger points, painful joints, and other similar conditions that hurt. She points out that this could lead to a lower dose of oral drugs, minimizing the side effects that medications might cause for patients.

Alternatively, she comments that the addition of local treatments plus orally administered medications what work systemically "could lead to better symptom control at the same doses, with obvious advantages for the patients. This is particularly important for a syndrome like fibromyalgia where management options available so far are still of limited effectiveness in a large percentage of cases."

Three medications are currently FDA-approved for treating fibromyalgia pain (Lyrica, Cymbalta and Savella), but they only provide noticeable pain relief for roughly one-third of patients.5 This study shows that treatment of regional areas that hurt (such as trigger points or joints) with a variety of topical and non-drug therapies may be well worth the effort to achieve better control over fibromyalgia symptoms.

1. Affaitati G, et al. Eur J Pain [Epub ahead of print] Oct.1, 2010.
2. Ge HY, et al. PAIN 147(1-3):233-40, 2009.
3. Ge HY, et al. J Pain 11:644-51, 2010.
4. Kato K, et al. Arch Intern Med 166:1649-54, 2006.
5. Hauser W, et al. J Pain 11:505-21, 2010.

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