Chest wall pain mimic costochondritis in fibromyalgia: Successful Treatment
The muscles between the ribs are formed in such a way to allow our chest to expand and relax with breathing, and they perform their job many times a day, because adults breathe about 20 times per minute.. Many fibromyalgia (FM) patients and some chronic fatigue (ME/CFS) patients complain of chest wall pain and restriction of movement. Often this restriction and pain is misdiagnosed by the health care provider as costochondritis, which is inflammation of the muscles between our ribs usually seen when a viral or infectious process present.
I want to make this very clear; fibromyalgia is not considered an inflammatory disorder. Pain is thought to be due to a hyper-sensitized central nervous system bombarded by the presence of peripheral pain generators such as chronic myofascial pain.
More often than not, FM patients have comorbid myofascial trigger points (MTPs) related to chronic myofascial pain (AKA, myofascial pain syndrome). These MTPs shorten the muscle involved, cause pain and dysfunction, radiate pain, and in some cases cause neuropathy and other symptoms. The referral pattern is consistent pattern for the location of that specific trigger point. It is my belief, and the belief of some experts, that chest wall pain found in FM is from trigger points (also abbreviated TrPs) in the muscles of the chest wall and rib cage. If present, they restrict chest wall motion during inspiration. This restriction then leads to ineffective breathing.
The treatment for chest wall pain found in FM is not medications for inflammation unless there is a known inflammatory condition present, (MTPs are not inflammatory in nature either). The treatment is trigger point therapy. If you can feel the tender painful knot apply 80% pressure with stroking motion for 30-60 sec. There can be many due to the lush environment provided by the complex network for proper breathing. Myofascial trigger points can be behind bone or other large muscles, the rib cage in this case. This makes it more difficult to treat them, however, deep breathing exercises such as Qi Gong are quite helpful to relieve restrictions.
Cellular oxidative stress has been indicated in fibromyalgia, even better reason to get that chest wall moving. We explain deep breathing techniques in our book and the comorbid condition, chronic myofascial pain at length, “dos and don’ts”, therapies that can help, and what to avoid.
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