MTPs may occur in any skeletal muscle in multiple or single locations. These evidences suggest that active MTPs contribute significantly to the overall spontaneous pain pattern in FM. Manual provocation of active MTPs reproduced substantial parts of the clinical pain pattern experienced by FM patients. Accordingly, a single intramuscular anesthetic injection into the mid-point of the upper trapezius muscle, a typical site of active MTP in FM, significantly increases local pain thresholds and decreases remote secondary heat hyperalgesia in FM patients and injections of anesthetic into multiple MTPs reverse mechanical hyperalgesia and decrease overall pain intensity in patients with whiplash and FM.
An anesthetic epidural blockade with lidocaine completely eliminates spontaneous pain and tender points and/or myofascial trigger points (MTPs) in FM patients, suggesting the importance of peripheral nociceptive inputs in FM. Increasing evidence suggests that nociceptive inputs from muscle tissues and myofascial trigger points (MTPs) in particular are important in the initiation and/or maintenance of FM pain and central sensitization. The widespread pain, which constitutes the overall spontaneous pain pattern in FM, is not uniformly distributed all over the body. A defining characteristic for fibromyalgia (FM) is chronic widespread pain of musculoskeletal origin.
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