Myofascial Pain Syndrome vs Fibromyalgia: What’s the Difference?

Pain conditions can be challenging to differentiate. When is it a strain, when is it a ligament issue, when is it nerve-related, and when is it a matter of tissue damage? When is it a systemic issue or an immune problem? At what point does a long-term injury become a chronic problem? And what about psychosomatic pain? Some conditions are often mistaken for one another due to an overlap in symptoms or a misunderstanding of definitions.

For example, both fibromyalgia and myofascial pain syndrome are known for widespread and chronic muscle pain, as well as symptoms of fatigue. But one is systemic, while the other is localized. Recognizing the differences between myofascial pain syndrome vs fibromyalgia is essential for proper treatment and long-term pain management success.

What Is Myofascial Pain Syndrome (MPS)?

Myofascial pain syndrome (MPS) is not a formal diagnosis but a standard combination of pain symptoms related to powerful regional muscle pain. Myofascial pain is localized but can be widespread – for example, the root of the pain can be along one side of the neck and back, but the referred muscle pain might spread down through the arm or into the head. Cases of myofascial pain syndrome involve knotted or tight muscles, which can be identified through a physical examination.

These are called trigger points and represent the root of the pain. While we can recognize and differentiate myofascial pain syndrome from other examples of muscle pain via a differential diagnosis – i.e., by ruling out other potential causes of pain – the causes and mechanisms behind myofascial pain syndrome are still poorly understood, and more research is needed. Some theories point towards abnormalities in the communication between nerve cells and muscles due to injury.

Some medical professionals believe these trigger points are a form of focal dystonia, where only a specific few muscle fibers are being involuntarily contracted. In most cases of myofascial pain syndrome, the pain symptoms begin as a typical overuse injury or an example of tissue inflammation. In contrast to common tendonitides or ligament pain conditions, like patellar knee pain or tennis elbow, myofascial pain begins in the muscle itself. The back and neck are common examples.

This initial pain becomes chronic and does not go away, even with rest. The pain begins at a root point and radiates outward – touching or applying pressure to the root point exacerbates the referred pain. One explanation for why people experience myofascial pain syndrome is the formation of trigger points through injury. When overused, the idea is that specific muscles begin to tighten and form physical knots in response to chronic inflammation.

Central sensitization is a symptom that both myofascial pain syndrome and fibromyalgia potentially share. This strain level is challenging to heal, partly because the muscle may constantly be in use (perhaps due to manual labor or a repeated injury) and function. After all, myofascial pain syndrome can cause an increase in stress, anxiety, and sleep disturbances due to recurring pain, which impacts recovery and delay healing.

These muscle knots then cause referred pain throughout the rest of the surrounding tissue and further strains as the rest of the body tries to compensate for the weakened, injured portion of the muscle. Most of the symptoms associated with myofascial pain syndrome are related to the trigger point and surrounding areas. A physical examination and differential diagnosis, ruling out other potential causes and explanations for regional muscle pain and involuntary cramping, are needed to identify cases of myofascial pain syndrome.

What Is Fibromyalgia (MF)?

While fibromyalgia (MF) also involves muscle pain, it is a systemic health problem. Fibromyalgia is characterized by widespread fatigue and muscle pain throughout the body, as well as other physical issues, ranging from restlessness and insomnia to depression, anxiety, mood swings, and generally heightened pain perception or hyperalgesia. People who experience fibromyalgia have a more challenging time with physical activities, and their pain is not limited to a body part, region, or specific muscle.

Fibromyalgia also often co-occurs with specific other pain conditions, especially temporomandibular joint syndrome (extreme facial and jaw pain) and irritable bowel syndrome. While myofascial pain syndrome usually occurs after physical injury, the onset of fibromyalgia can be much more random. It can even be triggered by general life stress or a traumatic event. Physical injuries or overuse injuries are also common triggers.

While fibromyalgia has been identified in all age groups, it affects mostly middle-aged or older people — specifically, older women. Fibromyalgia may also be related to autoimmune problems, as patient tend to be more likely to struggle with symptoms of rheumatoid arthritis (RA) or lupus. Because it doesn’t have apparent physical symptoms, fibromyalgia is much more complex to identify than myofascial pain syndrome.

There is no muscle knotting, no hard bumps. There are rarely any signs of skin flushing and no bruising or visible tissue damage. Individuals experience significantly increased pain signaling and high fatigue, but pain and fatigue are subjective. Doctors usually identify fibromyalgia through a thorough combination of physical exams, blood work, x-rays, and a patient’s medical history to rule out other potential causes.

Comparing Myofascial Pain Syndrome vs Fibromyalgia

To recap: myofascial pain syndrome and fibromyalgia feature increased pain sensitivity, more significant symptoms of general fatigue and anxiety, and sleeping problems. However, myofascial pain syndrome usually features physical muscle knots which feel tender and painful and referred pain around the knotting. Fibromyalgia may have certain regional pain areas that hurt worse than others, but the pain is often generalized, and pain signals are overall felt more strongly.

Patients with fibromyalgia are also more likely to experience symptoms of RA, IBS, and other co-occurring conditions. Because both pain conditions are chronic, treatment programs require a long-term, holistic approach. A patient’s diet, physical activity, environmental stressors, sleeping habits, and medication use are considered when formulating a treatment plan, and pain management plays a unique long-term role in helping deal with immediate pain and long-term debilitating symptoms.

Regional medication, trigger-point therapies, and most painkillers are not usually effective for fibromyalgia. However, there are unique treatment options for both conditions. Myofascial pain syndrome can be treated with trigger-point injections and localized painkillers. Fibromyalgia treatment, on the other hand, may feature antidepressants and anticonvulsants.