Understanding The Role Of Fascia In Fibromyalgia

Fascia is the layer of tissue that surrounds the muscles, blood vessels and nerves throughout the entire human body. It is a multilayered connective tissue that is made up of collagen fibers oriented to travel parallel to the movement of the body to provide a strong yet flexible binding. It is very elastic and can stretch and return instantly to the original shape, which is what allows the body to move, bulge and twist as the various muscle groups act in opposition to create movement.

There are two different ways to classify the fascia of the human body; however the two systems of nomenclature are similar except in the recognition of the third layer. Both systems label visceral fascia, which may be called parietal fascia, as the fascia or connective tissue that suspends and contains the internal organs within the body. This is seen as a thin layer of membranes that are formed by connective tissue within the body cavities.

Both systems also recognize the next layer which is known as the deep fascia or fascia of muscles. This is much denser and more fibrous and holds the individual muscles, muscle bundles, bones, nerves and blood vessels in place in the body. The third layer which is only recognized in one system is the superficial fascia which blends with the lower layers of the skin, the dermis, to connect the deep fascia to the skin covering the body.

There is considerable debate on the role or function of the fascia working as two or three layers, depending on the classification system used. Historically researchers believed that the fascia itself was passive and created no movement on its own. However, more recently some researchers have shown that some fascia may actually have the ability to contract and relax, enhancing or supporting muscle movement. This may be linked with fibromyalgia since the fasciae may pull muscles across each other rather than just passively providing a reduction in the friction as muscles slide over underlying and adjacent muscles.

Fascia Inflammation 

To understand how fascia may play a role in fibromyalgia, it is important to consider the concept of central sensitization. This occurs when a specific stimulus, in the case of fibromyalgia it is regional pain, is repeated on a continual level. When this pain stimulus is present all the time the central nervous system may become hypersensitive to any pain sensations, responding inappropriately or to pain receptors that are misfiring on a continual basis.

Unfortunately researchers do not yet understand just how this process occurs in relation to the fascia and the development of fibromyalgia. However, there is increased activity or excitability of the dorsal horn of the spinal cord, which is responsible for signaling to the brain that a negative or painful sensation is being experienced.  The messages that the dorsal horn is receiving are not related to a determined muscle pathology, so a specific muscle condition is not the cause. Instead research seems to indicate that changes in hormone production, particularly the growth hormone produced in the Hypothalamic-Pituitary-Adrenal axis (HPA) may trigger inflammation of the fascia and result in the pain sensations.

Myofascial Pain Syndrome 

Myofascial Pain Syndrome (MPS) is different than fibromyalgia but may be diagnosed together with fibromyalgia. In this condition the fascia and the muscles form hard nodules under the skin that cause pain both in a localized and regional areas of the body. These nodes or knots are called trigger points and they are most common in places where an injury has occurred to the body. This presence of a trigger point is seen as key in both the diagnosis and distinction of MPS. 2

It is believed by many researchers that the body’s constant bombardment of pain signals from both syndromes, MPS and fibromyalgia, lead to changes in the way that the central nervous system, including the brain and spinal cord, respond to pain messages. Since the fascia is involved in MPS if a diagnosis of fibromyalgia follows or is concurrent then the fascia will likewise be involved.

There are differences in symptoms of MPS and fibromyalgia, although some symptoms are common. Pain is a common symptom as are sleep problems, headaches, memory problems and difficulties with balance or dizziness. In addition MPS includes symptoms of numbness, extreme joint pain and decreased range of motion. However, MPS is not typically associated with the chronic fatigue and mental health issues that are associated with fibromyalgia.

The Connection

Both fibromyalgia syndrome and myofascial pain syndrome are considered to be chronic pain conditions. However, the presence of the specific trigger points in MPS often leads to a more rapid diagnosis and more effective treatments. However, more research into the overlap between these two conditions and how concurrently they exist is important in assisting patients in a comprehensive pain management program.

In a study that compared patients with myofascial trigger points and fibromyalgia and those with myofascial trigger points without fibromyalgia interesting issues were noted. The patients with both trigger points and fibromyalgia reported that stimulation of the MPS trigger points in the upper trapezius produced the same sensation as the chronic neck pain experienced with their fibromyalgia. Researchers hypothesized that the presence of the trigger points of MPS increased the hypersensitivity of the fibromyalgia patients to pain, particularly neck and spinal pain. 3

Ongoing research into the role of inflammation of the fascia or the presence of trigger points and MPS contribute to the development and complication of treatment of fibromyalgia needs to be ongoing. Patients should report all symptoms to their pain management specialist, rheumatologist or neurologist to ensure that, if both syndromes are present, they are both managed to control hypersensitivity to pain responses.

References

1 Liptan, G. L. (2010). Fascia: A missing link in our understanding of the pathology of fibromyalgia. Journal of Bodywork and Movement Therapies , 3-12.

2 Forst, R. (2005). Myofascial Pain Syndrome. Internist , 1207-1217.

3 Ge, H., Nie, H., Madeleine, P., et al. (2009). Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain , 233-240.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015