I have had a few people ask me about Chronic Myofascial Pain or CMP lately, so I thought it would be easier to just start a new thread. I hope it is helpful and if there are any questions, I will do my best to answer them. This is based on my personal experience and what I have learned from my docs and literature, over the past 8 years.
Anyone else familiar with CMP as well, please add what you can. I am by no means an expert and there are different levels and different experiences. This may be a bit of a long read, so I will apologize for that in advance.
myo meaning muscle and fascia, meaning a web-like structure located beneath the skin and above the muscle, that holds our bones, muscles and tissue in place.
Chronic Myofascial Pain was for many years considered a syndrome by the AMA. It has recently (within the last 18 months or so) been upgraded to a disease by the AMA.
The primary cause of CMP, is from trauma or injury to the body (anypart) that has gone either untreated or undertreated for an extended period of time. The fascia becomes diseased and the reaction to that disease is a thickening and/or hardening and contraction of the fascia, that can cause nerve impingement and pressure, joint pain, muscle pain, spasm and atrophy and trigger points (hard knots or nodules) in differing areas of the body.
It is often confused with Fibromyalgia, but even though there are some similar symptoms, they are not the same condition. Many doctors still know nothing or next to nothing about CMP. They have used it, as well as Fibro, for many years as what is known in the medical field as a "wastebasket diagnosis". This is a diagnosis that a doctor gives to a patient who they can not diagnose with something specific. It is not, (nor is Fibro) a "wastebasket diagnosis". It is a very real and very complex disease. Few have any idea how to treat it. There is currently no cure for CMP. It can not be "fixed" or repaired by surgical means and most standard physical therapies only make it worse.
There are some modalities, such as myofascial release therapy, very low impact exercise, aquatherapy and opiate/opioid meds. Some docs use trigger point injections, but they do not always work for all patients. Standard or deep tissue massage is sometimes prescribed, but is not the correct type of massage for CMP. Myofascial release therapy is a very specialized massage therapy that starts out very lightly and adds gradual depth, very slowly or as the patient can tolerate it. If it isn't done in this manner, it will only cause more pain.
In my experience, the docs who understand it and know how to treat it have generally been either anesthesiologists or physiatrists (PM&R specialists). My PM doc is the latter.
These are the basics. I am sure I haven't covered everything, but if there are specific questions, please ask. I hope this was helpful. Take care, CMP/MM
The Following User Says Thank You to cmpgirl For This Useful Post: Manatee31 (07-16-2012)
Thanks Juliet, I appreciate the very kind words and thoughts. If I didn't have my faith, I don't know what would have become of me.
Anyway, in answer to your question.......CMP can be mild, moderate or severe. My PM is of the belief, as are many of his colleagues, that almost all chronic pain patients have or will develop some form of CMP. The reason being, that the majority of us have gone for long periods of time, either misdiagnosed or undertreated. Since this is a common cause of CMP, it makes sense to me.
The thick fibrous roping you are talking about could very well be large trigger points. But since you have nerve issues, it could be from nerve damage too. The nerves tell the muscles what to do, and if the nerves are damaged, the muscles can become atrophied from lack of use. (In CMP, this can happen when the diseased fascia, compresses or damages the nerves.) In more severe cases of CMP, these trigger points or hard ropy knots can be all over the body.
This kind of uncertainty is what makes CMP so hard to diagnose. In my case, I had textbook symptoms, which are so numerous and can seem so ambiguous, that I almost hesitate to list them.
I guess the best I can tell you, is to talk to your doctor and hope that he or she is not one of the many who blow off this diagnosis. But yes, I think it could very well be CMP related. (In my humble opinion)
Kind of a long round-about way of answering your question, eh? Take good care and I am thinking of you often too. Hope this helped a little. Hugs, CMP/MM
cmp, You are correct, I was just told by the osteo this has occured with me because of a problem that went undiagnoses & untreated. I was also told by my surgeon this is something that doctors do not know how to deal with. I knew enough about it from the boards so when my surgeon & told me this is what he believes si my problem I knew all this pain would be going no where fast. Spent a couple days feeling pretty down.
The area involved which in my case is a large area, has intense pain & can throb, when I say throb I mean throb where someone else can put there hands on the area & feel it. I was wondering why each time I went to therapy the same areas were constantly in spasm. The therapist themselves were alittle confused as to why. No matter how they worked on the area it continued to have problems. It makes sense to me now why my ribcage has become hypermoble if the fascia is involved. I will be going to see the pt who last worked on me for some notes & speaking to her. She is a very compassionate & smart young lady & I am going to asking her about the myofascial release. Although I am not in therapy at this time I respect her opinion & know at some point I will be returning. My shoulder is loosing range of motion after the shoulder decompression. If I raise the arm the entire area of the chest & ribs will become aggravated & the muscles start to spasm & all the throbbing & pain is intensified. It is beginning to really impact the recovery for the shoulder as to where the shoulder is beginning to hurt most of the time. If not for cmp & this board I would have been clueless. If not for Marcia (feelbad) I would have been lost. I am of course getting opinions from other doctors but thus far this is it. This was brought up awhile ago when I was seeing the rehab. doc & he thought perhaps this was what I had but was hoping it was not the case so we let it drop. I am worried about finding a doctor who can Identify with this problem & will be seeking PM according to what I have been told by the surgeon by june, the six moth post op for the shoulder surgery. For know he is the treating doctor & holds the reins so to speak & will recommend pm only after the six months, he was also insistant that I see the osteo doctor. So far no relief, but the shoulder is worse. I am ready for pm perhaps then I can get some of my life back. Thanks cmp for putting this thread up. Is there another board that discusses the myofascial problems? I am wanting to learn as much as I can. Sammy
Thanks CMP. I think the doctor I was seeing was eluding to this as a possibility. From my research it appears that this can be caused by nerve damage as well like during an injection. Is this true based upon your knowledge?
This may sound weird but sometimes my foot feels like someone is pulling it apart with their fingers and stretching it like pizza dough/elastic band of sorts.
I also get a sensation in my back like someone is wringing it out like a washcloth.
Do either of these sound familiar or am I just losing it? (Steve be nice!! )
I think I am ready to move up to a real pain management person. Did I read someonewhere that you suggested a rehab doctor??
Thank you so much for taking the time to answer our questions. It is so nice that we can learn from one another as well as lean on each other for support.
Thanks CMPgirl (my computer is acting up today and it's taking me so long to type a reply). If it weren't for your knowledge and for me reading your posts and experience, I would feel so lost.
I had a deep tissue massage in my hip which is where I still have pain and I couldn't walk for 2 days. The myofacsial release sounds so good. The Chiro has told me several times as well as the PT's who have worked on my back "to relax, I'm all knotted up". The thing is I am relaxed - my back is just a big knot. In a way I feel relief in having a diagnosis and in a way I feel "oh boy, no one will be able to help me". The nuero I am seeing this week is also an anesthesiologist and pain management specialist. I hope this is the doctor that will help me. I have conflicting feelings about taking pain meds but I need to get over myself because I'm missing out on some wonderful years of my kids' life because I am just making it through a day. I work from home mainly and once I finish for the day the idea of dinner, homework, etc. overwhelms me eg "how will I make it to 7pm". I try to work some more after my child goes to bed but I'm finding more and more that I need to rest myself but sleep eludes me and I'm up every night from the back pain.
My husband and I are thinking of buying a sleep by numbers mattress to help too.
Anyhow, I am babbling but I wanted to say thanks for sharing and making the condition easy for someone like me to understand. And thanks for all of your support and I wish you continued success in relief and happiness and a full life.
Thank you Girl for explaining everything to us. You are so right about some DRs who don't believe in this diagnoses as well as Fibromyologa. Personally i think this is only due to their laziness and not having desire to learn something new. Much easier to call it waistbasket condition and not to deal with it.
What kind treatment did they offer to you? Do you get any relieve from something? Like hot tub or hot shower? I love deep tissue massage i get from my PT after she keeps me for 45 minutes on moist heat with Tense unit.
I do love my Tense unit, kind of helps to take your mind away from pain due to electrical movements.
Sammy, I am keeping my fingers crossed for you with this new doc. As I have stated in my posts, anesthesiologists can be some of the best PM docs. They are trained in PM extensively during their residency and specialty rotations, so they tend to have a much more agressive approach to dealing with the true disease, which is pain, no matter what the underlying condition. It's the same with my doc's specialty.....He is a physiatrist or physical medicine and rehabilitation (PM&R) specialist. The sole function of a PM&R doc is to diagnose and treat pain.
Pepper, I absolutely agree that the nerve damage can be a direct cause of CMP. If you read up on it, the primary cause of CMP is trauma or injury to any part of the body that goes untreated or "under"treated for a long period of time. This includes nerve trauma. And let's face it, so many of us CPer's have been undertreated for years. CMP also causes what is called referred pain. This is a very stange and difficult thing to explain, but basically what it means is that you can have a trigger point (or knot) one place in the body, and it can cause the actual pain sensation in a completely different area of the body. I know it sounds wierd, but if you look it up, it explains it a lot better than I could. I have read medical articles that have noted cases where people who have referred pain can have trigger points in the back and have them cause excruciating pain in their jaw!
Tarajb, I too had the painful experience of a recommended deep tissue massage that practically sent me flying off the table. That was when I found out about myofascial release therapy. It is so different from traditional massage. You have to be really careful to make sure that the person you go to, has complete training in true myfascial release. Most PT's and LMT's have a little training, but that is not enough for it to be done right.
Moldova, The special type of massage that I mentioned above, has helped me a lot over the years. I also take every opportunity to use the pool at the YMCA or at my neighbor's house, in the summer. I can't do anything too aggressive or strenuous, but the weightlessness is a huge relief. Hot tubs are great too. The thing is, you have to be so careful with CMP, not to add any stress to the already distressed muscles and joints. It really turns your life upside down. But the meds, for me, are the most important tool. Without them, I could do nothing. For me, they are the first line of defense, so to speak.
Thanks for all of your replies and questions. I would be more than happy to discuss whatever anyone wants. I can't guarantee I will be able to help with everything, but I will do my best. And since some of you have asked this, there is not a specific board here or anywhere else that I know of, dedicated to this disease. It is a real shame, because I have seen so many people who have been diagnosed in recent years, that it really does warrant someplace to be discussed and supported.
I have seen where they have said it is a combo of RSD/CMP in my reading in regards to a celebrity. Are they? I am confused.
Also, my original injury was lower back and right leg. Then I had a nerve block which caused me severe lumbar pain. Now less than a year later, I am having horrible, horrible deep achy burning pain in my upper back. The past couple of times I have used the Tens on the upper back, it is throwing it into spasms so bad. Does this sound familiar to you? I know you are not a doctor just someone who has lived thru this. I am thinking it does from what I am reading.
Pepper, While a TENS works well for some, in my personal experience, it caused me more pain than relief. When the muscles and the fascia are diseased and atrophied, electrical stimulation can be very painful. It's purpose is supposed to be to make the muscle "sit up and take notice" so to speak. But when that muscle is so tight and has no elasticity left in it, for me, it is like puoring rubbing alcohol on an open wound.
As I have said, there is really no aggressive way to treat CMP. It requires a very gentle hand. It's just the nature of the disease. I have literally had to completely change the way I live, day to day. There is so much that I can no longer do. As much as I would like to be able to someday do the things I used to do, I am a prisoner of my own body. I am not saying that everyone who is diagnosed with CMP is in the same boat as me. I just happen to have a very severe case of it. There are many levels of CMP, and each person has to learn through trial and error, what their body will accept and what it won't. That is why it is soooooo important to really listen to what your body is telling you. It's the only true way to know how much or how well you can function. My overall theory is.....if it hurts, stop doing it.
I haven't really read anything about the combo of RSD and CMP. But it would not surprise me to find out that many have both. CMP is never a "sole" diagnosis. There is always at least one underlying condition, if not several.
I'm glad you are doing the research. Just keep in mind that the older research and theories can be wrong. There used to be a lot of supposition about it, and much of it has since been proven to be untrue. A lot of literature says it is not progressive, but I am living proof that it is.
Hang in there my friend. It is through information and education that we improve our quality of life. Way to go! Keep up the research! It's one of the best tools we have. Hugs, CMP/MM
Thank you so much for bringing this subject to light. I actually had a couple of people asked me if anyone had brought up CMP with me before on another group. And then this new doctor brought up this to me as a possibility. Then you were posting about the same subject to Sammy. I almost feel like the LORD was leading me to read up on it. Maybe he is trying to prepare me for Friday's appt with the surgeon.
Again thanks for answering my questions, it does appear to be a possibility for me.