Myofascial Pain or Fibromyalgia
Personal Injury Resulting in Myofascial Pain or Fibromyalgia
Clients of our Stamford, Connecticut personal injury practice often present medical problems from injuries at primary sites, such as neck (“cervical”) sprains or strains (often referred to as whiplash), back (“lumbar”) sprains or strains, and shoulder sprains or strains that may involve the shoulder girdle, and impingement or other rotator cuff (supraspinatous tendon”) injuries. As discussed in greater detail below, these injuries can cause secondary conditions known as “myofascial pain syndrome” or “fibromyalgia.”
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Some skeptics, generally employed by insurance companies, including the physician “hired guns” who perform medical examinations for the insurance companies or their defense lawyers, attempt to minimize these problems, particularly sprains and strains, by belittling these injuries and calling them merely “soft tissue” problems. Some defense medical examiners even refer to the diagnoses of myofascial pain or fibromyalgia as being “wastebasket” diagnoses. They theorize that there is no proof of the secondary injury. But experts who actually practice medicine in fields familiar with these diagnoses use a methodology involving a process of elimination and exclude other potential diagnoses. It is true that there is no test to establish these diagnoses; X-rays, CT Scans, MRIs, blood tests and other diagnostic tests are not useful. However, the patient’s medical history, negative diagnostic testing and physical exam, including the examiner’s objective findings upon palpation of the affected areas, are all important. Indeed, the examiner’s diagnosis will largely be based upon actually feeling the taut bands of muscle in the case of a trigger point; also, the examiner can both feel the tender points and watch the elicited expressions of pain and complaints of pain in the case of tender points. In the case of fibromyalgia, there are specific areas of the body where the tender points are expected to be found.
By emphasizing that the injuries involve “soft tissue” or that the diagnoses are “wastebasket diagnoses,” the naysayers try to create the impression that such personal injuries are not very serious or important insofar as they affect activities of daily living. They are wrong, because the limiting consequences of myofascial pain disorder and fibromyalgia can destroy the quality of life. Furthermore, in this context, the phrase “connective tissue” could properly be substituted for “soft tissue.” As it implies, “connective tissue” is a critically important component of the complex human body as the muscles, tendons and ligaments are responsible for actually “connecting” the 206 bones that comprise the skeletal system of the adult human and permitting the body to work through the many complex movements of humans. Indeed, even the portions of the spinal column involved in a cervical or lumbar sprain include numerous bones (there are 33 bones in the spine, which is comprised of the cervical, thoracic and lumbar segments) that are supposed to move in a specific fashion as we bend, turn, twist, run, jump and move through our activities of daily living. In some patients, the connective tissue injury causes the body to react in a way that produces hard knots or taut bands of muscles known as “trigger points” or softer spots known as “tender points.” Trigger points may be active or latent, and the latent trigger points may be differentiated from trigger points by the absence of the taut muscle fiber. These trigger points and tender points are located within the entire muscle or at the junction of the muscle and the fascia (other connective tissue) that runs throughout the body. The trigger points and tender points are themselves pain generators that cause pain to be referred to other areas of the body. These conditions can produce a chronic pain problem.
Further complicating the picture in a personal injury case is the concept of referred pain. Again, the skeptics may doubt the causal connection between a cervical sprain or a herniated cervical intervertebral disc and the existence of trigger or tender points that produce more pain at a seemingly remote sites. Yet the existence of myofascial pain disorder has been recognized for nearly 50 years. President Kennedy was treated for this problem by the late Janet G. Travell, M.D.. Dr. Travell co-authored the leading medical treatise on myofascial trigger points with Dr. David Simmons. Myofascial Pain and Dysfunction: Trigger Point Manual, Volumes I & II by Janet G. Travell, M.D. and David G. Simons, M.D.
As reflected in the links above, both myofascial pain disorder and fibromyalgia may be caused by trauma. Treatment may include a variety of modalities (methods/procedures), including but not limited to physical therapy, exercise and medication taken orally (or via trigger point injections in the case of trigger points). As noted above, the diagnosis of fibromyalgia has proven to be somewhat controversial and some biased (or simply uninformed) healthcare providers dismiss or underrate it. Such a view is generally refuted by specialists and experts who actually treat the condition. Moreover, the federal government has recognized the legitimacy of the fibromyalgia diagnosis as in June 2007 the Food and Drug Administration (“FDA”) approved the use of LyricaTM (Pfizer) as the first approved drug treatment for the disorder. That recognition should add support to the advocates for patients with the disorder, regardless of whether or not the cause was traumatic.
If you or a loved one suffers from myofascial pain or fibromyalgia and your condition was either caused or triggered by a car accident, slip and fall incident or other traumatic event, the trial lawyers who handle personal injury cases in our Stamford, Connecticut office may be able to help you. Contact us for a consultation if you think you may have a claim.