In practise they frequently get used interchangable and there is big overlap. It is a “chicken and egg” type debate as to whether sore tissues “wind-up” the central nervous system to a state which perpetuates symptoms and is targeted with centrally acting drugs (like neurontin, lyrica, trycyclic antidepressants. If the system is generally run down then normally inoccous stimuli become painful.
Alternatively, treating the sore areas with massage, joint manipulation, heat, soft tissue mobilisation, dry needling, postural alignment, accupunture, can help to stem the flow of painful information to the nervous system.
It’s usually a combination approach together with improving exercise tolerance (which stimulates the bodies natural pain control system).
As for clinicians feeling your pain – it won’t happen but you need to feel the managing clinician has an insight into the condition, understands the multiple components, and has strategies to target each element.

Many patients with fibromyalgia drop out of the medical system with dis-illusionment and unacceptible drug side effects.

There’s increasing interest in nutritional supplementation, sunlight, vitamine D in the management of these cases.

Hope this clarifies this issues raised and informs decisions you make about care.

Good Luck

David

I was recently diagnosed with Central Pain Syndrome by my Rheumatologist. His nurse called it Central Mediate Pain and Myofascial syndrome. Is there a difference with these three terms or are they one in the same?

I have been treated for this with Neurontin, Ultram and Mobic with additional Cyclobenzaprine when my condition spirals out of control. It is very difficult to live and function with this condition. I have more symptoms of fibromyalgia then I do Myofascial syndrome but I don’t think my Dr. is recognizing the agony that I go through.

Hi Maria

I agree… and the challenge is to determine whether the peripheral signs are predominantly centrally driven or have a local component. This can ofen only be determined be applying (and failing) to achieve improvement with local techniques.3-4 treatments should be sufficient to assess for response to peripheral techniques.
Observing for signs of central pain pattern dominance is also key.
1. fluctuating sites of pain
2. Shift to non-traumatised areas
3 Sleep disturbance
4. Fatigue
5 Poor tolerance for aerobic exercise
6, Poor history of exercise participation
7. Hypermobility
8 Non response to NSAID’S

are other factors to look out for.
We also need to be on the look out for “evolving myofascial pain syndromes where the pain is initiates from specific local (defined) events but spirial’s out of control – A much neglected phenomenon in my experience!!

Thanks for the feedback

David

Hi David,

In my experience, treating a fibromyalgia patient (centrally sensatised) with local therapy techniques doesnt always have the desired results. Centrally mediated pain requires centrally mediated treatment (ie: pacing, education, general strenghthening, aerobic exercise, stretching- endorfin releasing activities)Cognitive behaviour therapy, etc…

In my opinion, localised treatment is only benefitial if, as well as fibromyalgia, there is another nociceptive mediated issues!

That is only my opining!!