What Allergists/ENTs Should Know about FMS/MPS
©Devin
Starlanyl, MD 1995-1998
Two excellent medical texts are available. "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 Trigger Points. This
message 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
Complex patients have TMJD 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 Complex, you must become familiar
with the TrP referred pain patterns and what causes the TrPs.
Myofascial TrPs can entrap nerves and blood vessels. They can also
cause proprioreceptor disturbances.
Referred autonomic phenomena: vasoconstriction (blanching),
coldness, sweating, pilomotor response, salivation, vasodilation,
lacrimation, coryza and hypersecretion can be 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.
Common FMS&MPS Complex Symptoms Seen by
Allergists/ENTs
- 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 should be 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 sensations 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 also be a sign of low-level
TrPs. Cold helps numb the itch, because it the pressure plate
receptors. Dryness makes the itch worse because it 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 Complex patients, usually in the
legs but it can occur in the arms.
- Dermographia and related phenomenon: One phenomenon that occurs
in FMS&MPS Complex 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 Family
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.
Common TrPs Encountered by Allergists and ENTs
- 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. People with SCM TrPs often have trouble glancing
downward--they can fall forward. 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. A feeling of continued
movement in car after you've stopped, and feeling of tilted "banking"
as your car corners are also part of the SCM TrP gifts to us. The
perceptual changes can be very hard to explain to your doctor.
- FMS&MPS Complex 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 FMS&MPS Complex 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 - digastric TrPs are sensitive. 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 fluro-methane is
detailed in the Trigger Point Manuals. Sine-wave ultrasound with
electrostim, acupressure or pulsed galvanic stimulation can be used
in some areas to break up TrPs.
Fibromyalgia Support - Ottawa West
S.C. Alder
Mar/99