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Autogenic Training

Autogenic Training

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Published by Hussain Ali Talbani

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Published by: Hussain Ali Talbani on May 10, 2013
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Although there are a number of similarities between fibromyalgia
pain syndrome and another musculoskeletal condition known as
myofascial pain syndrome, significant differences exist between
these two syndromes. Such differences need to be fully recognized
conditions. For this reason, these clinical entities will be briefly jux-
taposed in this section.
Travell and Simons (1983) provided a set of criteria in order to
make a clear distinction between fibromyalgia and myofascial pain
syndrome (MPS). For example, myofascial pain syndrome is almost
only a small percentage (15 to 20 percent) attributed to physical
trauma. Patients suffering from fibromyalgia have definable indica-
sleep disorder is only reported in a small percentage of this latter

In terms of the sensation of pain, myofascial syndrome is recog-
nized by localized pain with few specific trigger points in specific



ways diffuse and a large number of tender points are present. Here it
is important to make a distinction between tender and trigger points.
According to Danish (1997) a trigger point is a taut irritable band of
tissue typically located in a muscle. When aggravated by pressure,
overstretching, or activity, the trigger point refers pain to a distant
area in a characteristic pattern. Trigger points develop in response to
trauma and overuse and occur in individual muscles or regional areas
and are not a systematic phenomenon. On the other hand, a tender
point characteristic of fibromyalgia is just that: a tender or sensitive
point. A point is established as “tender” if pressure equal or less than
4 kilograms is sufficient to cause a pain response in the patient. It is
important to keep in mind that tender points do not refer pain and are
found throughout the body of a person with FM.
Finally, in terms of prognosis and treatment, there are more posi-
tive signs that myofascial pain syndrome need not become a chronic
condition. This self-limiting condition may be treated successfully
via the use of ischemic compression techniques, trigger point injec-
tion, myofascial release therapies, and spray and stretch techniques
(Travell, 1952). With regard to fibromyalgia, the data so far suggest
that the condition usually becomes chronic and its treatment requires
far more complex interventions, usually requiring medication (anal-
gesics, antidepressants, muscle relaxants, etc.) as well as specific
forms of exercise, and stress management techniques for pain man-


The American College of Rheumatology has suggested specific
physical criteria which must be met before the diagnosis of fibro-
myalgia pain syndrome is made. These criteria include a history of
widespread pain, including bilateral pain above and below the waist.
In addition, pain in the cervical spine, the anterior chest, the thoracic
spine, or the lower back must be present (Wolfe, Smythe, and Yunus,



tender points on digital palpation, with palpation of less than 4 kilo-
the point as “painful” and not “tender or sensitive” (Wolfe, Smythe,
and Yunus, 1990) (See Table 1.1). The presence of these specific ten-
der points constitutes one of the central criteria for the diagnosis of

TABLE 1.1. Criteria for the diagnosis of fibromyalgia, established by the Ameri-
can College of Rheumatology

1.History of widespread pain

Definition: Pain is considered widespread when all of the following are present:
pain in the left side of the body;pain in the right side of the body;pain above the
waist;pain below the waist.In addition, axial skeletal pain (cervical spine, anterior
and buttock pain is considered as pain for each involved side. Low-back pain is
considered lower segment pain.

2.Pain in 11 of 18 tender points on digital palpation

Definition:Pain on digital palpation must be present in at least 11 of the following
18 tender point sites:

Occiput:bilateral, at the suboccipital muscle insertion.

Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at

Trapezius:bilateral, at the midpoint of the upper border.

Supraspinatus: bilateral, at origins, above the scapula spine near the media bor-

tions on the upper surfaces.

Lateral epicondyle:bilateral, 2-cm distal to epicondyle.

Gluteal:bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.

Greater trochanter:bilateral, posterior to the trochanteric prominence.

Knee:bilateral, at the medial fat pad proximal to the joint line.

Source: Wolfe, Smythe, and Yunus (1990). Reprinted by permission.



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