Sunday, January 8, 2012

Chest wall pain mimic costochondritis in fibromyalgia: Successful treatment

The muscles between the ribs are formed in such a way to allow our chest to expand and relax with breathing. It performs its job many times a day. The average adult breaths about 20 times per minute, that is a lot of work. Many fibromyalgia patients and some chronic fatigue (ME/CFS) patients complain of chest wall pain and restriction of movement. Often this restriction and pain is misdiagnosed by the health care provider as costochondritis, which is inflammation of the muscles between our ribs, usually seen when there is a viral or infectious process present.

I want to make this very clear; fibromyalgia is not considered an inflammatory disorder. It is a disruption in the central nervous system that is hyper-sensitized by the presence of peripheral pain generators such as chronic myofascial pain.

More often than not FM patients have comorbid myofascial trigger points (MTPs) of, , chronic myofascial pain (AKA, myofascial pain syndrome). These MTPs shorten the muscle involved cause pain and dysfunction, radiate pain (in some cases neuropathy and other symptoms) in a consistent pattern for the location of that specific trigger point. It is my belief and the belief of other experts that the chest wall pain found in FM is from intervertebral (between the ribs) myofascial trigger points, which restrict the motion of the chest wall during inspiration. This restriction then leads to ineffective breathing.

The treatment for chest wall pain found in FM is not medications for inflammation unless there is a known inflammatory condition present, (MTPs are not inflammatory in nature either). The treatment is trigger point therapy. If you can feel the tender painful knot apply 80% pressure with stroking motion for 30-60 sec. There can be many, because the rib cage is a lush environment because of the muscle complexity necessary to operate effectively. Myofascial trigger points can be behind bone or other large muscles, the rib bone in this case. This make it difficult to treat them, however, also helpful is deep breathing exercises such as Qi Gong.

Cellular oxidative stress has been indicated in fibromyalgia, even better reason to get that chest wall moving. We explain deep breathing techniques in our book and the comorbid condition, chronic myofascial pain at length, the dos and don’ts, therapies that can help, and what to avoid.

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice.


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