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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How Can Fibromyalgia And Chronic Myofascial Pain Be Treated?

Hi.After receiving a clinical trial chemo (Bexxar - a monoclonal antibody with a radioisotope attached) in 2005 for small cleaved cell follicular NHL, I began to have excruciating pain within a month of receiving it. I also had 6 doses of CHOP prior to the Bexxar. I was eventually diagnosed with fibrmyalgia and chronic myofascial pain (Fibro was very much a waste basket diagnosis at that time). I did find a wonderful DO and he understood my pain and began pain management with a fentanyl patch, which over the years has been changed to Morphine ER 15mg Bid 15mg and Morphine 15mg imm release 1-2 times per day for breakthrough pain. I also have protruding Thoracic disks and get epidurals and I have very painful trigger points. I get trigger point injections for that. Over a year ago, I was in a car accident. I was at a complete stop and a driver hit me while going at least 40 to 50 miles per hour. Traffic was stopped on I-40. I was thrown forward with my seat belt on, then I was hit again by the same driver and thrown forward again. I was taken to ER and was given a prescription for prednizone and was told to f/u with family doctor. My pain doctor said he doesn t treat injuries from MVA s. The pain in the shoulder muscles got increasingly worse over time. My Doctor did not think I had an injury in my rotator cuff. Over more time, she ordered PT eval and treatment twice.. Now I m on my third order for PT. I finally had an MRI and it did show some some small tears in my rotator cuff. I have gotten one injection of cortisone in that area since the MRI but it didn t help much. As of now, I continue to have pain in that area at a level as high as 8-9. This is with me still on morphine for the chronic pain. I am at my wits end. Can you please give me your opinion and a possible suggestion on what to do next? Thank you so very much. Sincerely, Kathy Fernandez (not hispanic, ex s grandfather was spanish. Didn t know if ethnic back ground has a role in any disorders)kathy
Wed, 25 Jul 2018
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General Surgeon 's  Response
Hello and Welcome to ‘Ask A Doctor’ service.
I have reviewed your query and here is my advice.

Myofascial pain and fibromyalgia has most of the times the stress and anxiety as the instigating or enhancing factors and unless you get a good control over it, it becomes chronic or recurrent.
The chronocity indicates that now there is organic lesions like fibrosis that has set in which needs good anti-inflammatory and oral steroids as the primary treatment.
Secondary treatment is symptomatic like local steroid injection in trigger spots, physiotherapy and so on.
You need to take a course towards Naturopathy to get control over the psychological factors like stress and anxiety so that the basic cause is also treated. This is by far the most important.

Hope I have answered your query.
Let me know if I can assist you further.
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How Can Fibromyalgia And Chronic Myofascial Pain Be Treated?

Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Myofascial pain and fibromyalgia has most of the times the stress and anxiety as the instigating or enhancing factors and unless you get a good control over it, it becomes chronic or recurrent. The chronocity indicates that now there is organic lesions like fibrosis that has set in which needs good anti-inflammatory and oral steroids as the primary treatment. Secondary treatment is symptomatic like local steroid injection in trigger spots, physiotherapy and so on. You need to take a course towards Naturopathy to get control over the psychological factors like stress and anxiety so that the basic cause is also treated. This is by far the most important. Hope I have answered your query. Let me know if I can assist you further.