Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle

Abstract

Background: Myofascial Pain Syndrome (MPS) is a common, overlooked, and underdiagnosed condition and has significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease.

Methods: Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro, and medRxiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews.

Findings: 799 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence.

Conclusions: MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue ("fascial armoring"). Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. A "global percutaneous needle fasciotomy" that respects tensegrity principles may treat MPS/fibromyalgia more effectively. "Functional-somatic syndromes" can be seen as one entity (myofibroblast-generated-tensegrity-tension), sharing a common rheuma-psycho-neurological mechanism.

Fig 1. Flowchart of scoping review.

Fig 2. Illustration of a fascial tensegrity framework.

To grasp the framework of needling, the reader may try and imagine a geodesic dome connected not by straight solid bars, but imagine it connected by extremely thin sheets of spandex/elastane. Each sheet can change its spring constant. Then imagine continuously applying external forces to this dome from different directions. Insertion of needles in many “scattered” points while at rest will allow the system to realign appropriately and accordingly to the inherent internal forces or pullies, e.g., the skeleton. Now the reader may imagine this dome only in the shape of a human, and it can move. An illustration to assist the reader in imagining a healthy geodesic dome connected by spandex sheets (fascia). With permission from PACIFIC DOMES Inc. www.eventdome.wordpress.com/. Reprinted from https://eventdome.files.wordpress.com/2010/07/bm-multi-colored.jpg, under a CC BY license, with permission from Sequoia Miller from Pacific Domes Inc., original copyright.

Fig 3. Illustration of tension in a fascial tensegrity framework.

Normal external strain applied will tense the fascia and distribute the tension through the network of nodes. With permission from Dome guys international www.domeguys.com. Reprinted from https://domeguys.com/home/burning-man-2012-domeguys-international-kcj_-34/ under a CC BY license, with permission from Russell Phillips, President DomeGuys International LLC, original copyright 2021.

Fig 4. Illustration of sedentarism in a fascial tensegrity framework.

Chronic over-strain causes pathological changes in fascia or changes of myofibroblast and smooth muscle fibers inside the fascia. The fascia fails to distribute forces properly and keep the integrity of the structure. Structures on the dome and inside the dome are affected. With permission from Erowid.org. Reprinted from https://www.erowid.org/culture/burningman/show_image.php?i=1999_burningman/1999_bm_thunderdome3.jpg under a CC BY license, with permission from original copyright 2021.

Fig 5. Illustration of needling in a fascial tensegrity framework.

After ’re-setting’ the system with needling or other techniques: Regeneration and formation of new connections over time should be determined by natural forces and pullies. New areas in the fascia serve as points of focus for changes and realignment. Structures can relax and return to the minimum energy state. Fascia is always subjected to remodeling pressures and responds to the local mechanical state. However, if spatial deposition of fibers is altered with respect to physiological conditions, the rebuilding will be pathological [22] Mobilization encourages correct healing in order to avoid formation of fibrosis [22]. Original photo by the author.

Fig 6. Illustration of imbalance in a fascial tensegrity framework.

A pathological entity in the form of a tensegrity abnormality, it is both systemic and asymmetrical or seemingly “unilateral”. With permission from, and taken by, Aaron Neilson-Belman AaronNeilsonBelman.com. Reprinted from https://hippievanman.com/preview/burning-man-2011/ under a CC BY license, with permission from Aaron Neilson-Belman, original copyright 2013–2020.

Fig 7. Overlap of conditions in the domain of common medicine.

Not all connections are represented in this scheme. The term “Healthy” is open to interpretation. MPS- myofascial pain syndrome (i.e., fascial armoring).