Open Access Highly Accessed Open Badges Research article

Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients

Hong-You Ge1*, Ying Wang1, César Fernández-de-las-Peñas13, Thomas Graven-Nielsen1, Bente Danneskiold-Samsøe2 and Lars Arendt-Nielsen1

Author Affiliations

1 Department of Health Science and Technology, Aalborg University, Fredrik Bajersvej 7, Aalborg, DK-9220, Denmark

2 The Parker Institute, Frederiksberg Hospital, Ndr. Fasanvej 57, Frederiksberg, DK-2000, Denmark

3 Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avda. de Atenas, s/n. Alcorcón, Madrid, 28922, Spain

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Arthritis Research & Therapy 2011, 13:R48  doi:10.1186/ar3289

Published: 22 March 2011



It has previously been reported that local and referred pain from active myofascial trigger points (MTPs) in the neck and shoulder region contribute to fibromyalgia (FM) pain and that the pain pattern induced from active MTPs can reproduce parts of the spontaneous clinical FM pain pattern. The current study investigated whether the overall spontaneous FM pain pattern can be reproduced by local and referred pain from active MTPs located in different muscles.


A spontaneous pain pattern in FM was recorded in 30 FM patients and 30 healthy subjects served as controls. Local and referred pain patterns induced from active (patients) and latent (controls) MTPs were recorded following manual stimulation. The existence of MTPs was confirmed by intramuscular electromyographical registration of spontaneous electrical activity.


Local and referred pain areas induced from key active MTPs in FM were larger than pain areas from latent MTPs in healthy controls (P < 0.001), but were similar to the overall spontaneous FM pain area in FM (P > 0.05). The induced pain area was positively associated with current spontaneous pain intensity in FM (P < 0.01). The locations of key active MTPs in FM patients were found to have latent MTPs in healthy subjects. The muscles containing key active MTPs in FM are often observed in the muscles of extensor digitorum, trapezius, infraspinatus in the upper part of the body and of quadratus lumborum, gluteus medius in the lower part of the body.


The overall spontaneous FM pain pattern can be reproduced by mechanical stimulation of active MTPs located in different muscles, suggesting that fibromyalgia pain is largely composed of pain arising from muscle pain and spasm. Targeting active MTPs and related perpetuating factors may be an important strategy in FM pain control.

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