3) Primary Fibromyalgia – generalized body aches, sleep disturbance, fatigue, depression, generalized body aches for more than 3/12, usually on both sides of the body, and both above and below the waist, and also the axial skeleton involvement, tender points at 11 out of 18 according to the American College of Rheumatology criteria (N), however, subsyndromal cases may have about 5 out of 11 classical sites, associated allodynia, hyperalgesia, hypersensitivity, sensitive to smells, sounds, light, odors, pressure and temperature fluctuations, bright lights, noises, touch, and even smells may be converted to pain, flickering lights, staccato or repetitive noise intolerable, Tx – antidepressants, analgesics, exercises, oral interferon, NMDA receptor blockers
4) Myofascial Pain Syndrome – MFPS – local or regional muscular pain, burning, stabbing, aching, nagging quality, usual sites are neck, mid thorax region, chest wall, elbow, lumbar region, abdominal pain, hip pain, foot pain, pain aggravated by strenuous use of muscle, passive stretching of the muscle, pressure on the trigger point, placing the muscle in a shortened position for a prolonged period, sustained contraction of the involved muscle, repeated contraction of the involved muscle, cold, damp weather, viral infection, stress, exposure to cold drafts, myofascial pain is reduced by rest, slow, steady, passive, stretching of the involved muscle, moist heat applied over the trigger point, short periods of light activity with movements, specific myofascial therapy, myofascial trigger points usually at abdominis rectus, obliques, levator ani, obturator internus, piriformis, ilopsoas, hip adductors, trigger points are hard, palpable, hypersensitive nodules in the muscles, spot tenderness over the trigger point, taut band and a nodule at the site of pain, trigger point compression elicits local and referred pain which reproduces patient’s usual pain, snapping compression of trigger point elicits a muscle twitch, passive stretch of a muscle with a trigger point painful, muscle may also show painful weakness, satellite trigger points – these are trigger points which develop in the muscles of referral zones or synergistic muscles of the original primary trigger point muscle. Tx – Trigger point release with spray and stretch, voluntary contraction and release, trigger point pressure release, deep stroking massage, trigger point injection.
15) Infections – Fasiocoliasis, amebiasis, giardia, chronic candida yeast infection (particularly in those given multiple courses of antibiotics for UTI, sinusitis, otitis media, sore throat)