My Symptoms: Myofascial Pain, Fibromyalgia, or Autonomic Dysfunction?

What condition do I actually have?

Recently, due to work-related stress, I often feel physically and mentally exhausted.
Last month, I experienced shoulder pain that was tender to the touch, and sometimes I felt a warm sensation running down my right leg.
I consulted an online doctor, who referred me to a rehabilitation specialist, Dr.
Lai Yen-Ting, who suggested that based on my description, I might have myofascial pain syndrome.
However, when I visited a general pain clinic, the doctor diagnosed me with fibromyalgia and prescribed a week’s worth of medication, which did not help at all.
A colleague then recommended that I see a specialist for autonomic nervous system issues.
This clinic was out-of-pocket, and after explaining my situation to the doctor, he asked me several questions that aligned with my symptoms.
He concluded that I was experiencing autonomic nervous system dysregulation, which included shoulder stiffness and pain, occasional palpitations, and sometimes breathing difficulties similar to what people describe as taking deep breaths.
I mentioned to the doctor that I felt quite stressed lately, both at work and at home.
He suggested that I visit the Dong's Foundation website to assess for potential depression.
After answering some questions, my score was 31.
Additionally, I have developed a habit of watching TV or browsing the internet every night before bed (like now, it’s already 1 AM) until my eyes feel tired enough to sleep; otherwise, I can’t fall asleep even when lying down.
However, by then, it’s already past 1 AM.
I also have been having illogical dreams, such as seeing the same characters in one moment on the ground and the next moment on a boat.
In summary, I have been experiencing strange dreams every night, which makes me feel very tired in the morning when I wake up for work.
I have asked so many questions mainly to understand what condition I might have: is it myofascial pain syndrome, fibromyalgia, autonomic nervous system dysregulation, or depression combined with neuroasthenia? My mind is racing with thoughts.
Doctor, what should I do?

Man Lao Zi Zai Luan Xiang De Ren, 30~39 year old female. Ask Date: 2011/05/19

Dr. Wang Chongren reply Psychiatry

Dear Dr.
Wang Chong-Ren, Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare:
Hello,
The main issue you mentioned in your letter is your uncertainty about what illness you have.
You seem confused about being diagnosed with four different conditions and feel overwhelmed by the chaos in your mind.
I would like to provide you with some insights from a psychosomatic medicine perspective, hoping to clarify your doubts.
Myofascial pain syndrome and fibromyalgia are actually the same condition, and they, along with autonomic dysregulation and neurasthenia, are considered modern civilization diseases.
The etiology may be related to stress-induced autonomic dysregulation.
Stress can lead to excessive sympathetic nervous system activation, resulting in symptoms affecting the brain and various bodily organs.
For instance, many patients with depression experience headaches, chest tightness, palpitations, insomnia, tinnitus, and gastrointestinal discomfort.
Many individuals become confused by these diverse physical symptoms and may not realize that their excessive anxiety has led to pessimistic thoughts, decreased work capacity, and depressive moods.
Therefore, your concerns should not only focus on physical symptoms but also on stress and psychological issues, as the latter often represent more fundamental problems.
If you continue to feel troubled and unable to cope, you may seek evaluation and treatment from a psychosomatic or psychiatric specialist.
Generally, if the condition is not severe, you can proactively reduce stress by addressing its sources and maintaining a regular lifestyle, supplemented by treatments for physical symptoms (such as rehabilitation and massage) and relaxation exercises, which can often lead to self-relief.
Wishing you good health, peace, and well-being!
Sincerely,
Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare

Reply Date: 2011/05/19

More Info

Based on your description, it seems you are experiencing a complex interplay of symptoms that could be associated with myofascial pain syndrome, fibromyalgia, autonomic dysfunction, and possibly underlying anxiety or depression. Let's break down these conditions and how they might relate to your experiences.

Myofascial Pain Syndrome (MPS) is characterized by localized muscle pain and tenderness, often triggered by stress or overuse. The pain can be persistent and may radiate to other areas, which aligns with your experience of shoulder pain and sensations in your leg. MPS is often associated with "trigger points," which are hyperirritable spots in the muscle that can cause referred pain. Treatment typically involves physical therapy, massage, and sometimes medications to relieve pain and muscle tension.

Fibromyalgia, on the other hand, is a more systemic condition that involves widespread pain, fatigue, and other symptoms such as sleep disturbances and cognitive difficulties. It is often accompanied by tender points throughout the body, but not everyone with fibromyalgia will have the classic tender points. Your description of persistent fatigue, sleep issues, and the sensation of heat in your leg could suggest fibromyalgia, especially if the pain is widespread and not confined to specific areas.

Autonomic Dysfunction refers to a condition where the autonomic nervous system (ANS) does not function properly, leading to symptoms such as heart palpitations, sweating, and gastrointestinal issues. Your experiences of shoulder stiffness, pain, and feelings of anxiety could be linked to autonomic dysfunction, particularly if you notice that your symptoms worsen with stress. Stress can exacerbate autonomic symptoms, leading to a cycle of discomfort.

Your mention of anxiety and the need to engage in activities like watching TV before bed to fall asleep indicates that psychological factors may also be at play. Anxiety can amplify physical symptoms and lead to sleep disturbances, which in turn can worsen fatigue and pain. The fact that you are experiencing strange dreams and waking up feeling exhausted suggests that your sleep quality is poor, which is a common issue in both fibromyalgia and anxiety disorders.

Given the complexity of your symptoms, it is crucial to approach your situation holistically. Here are some steps you can take:
1. Consult a Specialist: Since you have already seen various specialists, consider visiting a pain management clinic or a rheumatologist who specializes in fibromyalgia and chronic pain conditions. They can provide a comprehensive evaluation and tailored treatment plan.

2. Psychological Support: Since anxiety and stress seem to be significant factors in your symptoms, seeking support from a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) is particularly effective for managing anxiety and can help you develop coping strategies.

3. Lifestyle Modifications: Implementing stress-reduction techniques such as mindfulness, yoga, or gentle exercise can help alleviate symptoms. Regular physical activity is essential, but it should be balanced with rest to avoid exacerbating pain.

4. Sleep Hygiene: Focus on improving your sleep environment and routine. Limiting screen time before bed, establishing a regular sleep schedule, and creating a calming bedtime routine can enhance sleep quality.

5. Medication Review: Discuss with your healthcare provider the medications you are currently taking. Sometimes, medications for pain management can have side effects that contribute to fatigue or other symptoms. A review may lead to adjustments that improve your overall well-being.

In conclusion, your symptoms are likely a combination of myofascial pain syndrome, fibromyalgia, and autonomic dysfunction, exacerbated by anxiety and stress. A multidisciplinary approach that includes medical treatment, psychological support, and lifestyle changes will be essential in managing your condition effectively. Don't hesitate to advocate for yourself and seek the care you need to improve your quality of life.

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