The development of myofibrils degeneration and scarring in muscles are the main causes of myofascial pain syndromes. As to contemporary presentations, fibromialgia (FM) features as functional syndrome which inherent chronic skeleton-muscle pains, impairments of the sleeping, feeling waked after sleeping, asthenia, different mental abnormalities during the lack of organ pathology explaining this symptomatic. By the important examination criterion of illness is considered the evidence of stereotype located painful places above discrete compartments of body detected during palpation . Distinctively exacerbation of expressions FM following stress situations, during changes of weather, in premenstrual term. This pathology is described in literature under titles FM pain, muscle rheumatism, psychogenic rheumatism, fibrositis and etc.

Despite diverse prevalence and clinical implication, problem of FM will remain one of least studied. There is no generally accepted point of view on aetiology, as well as on morphologic changes, lying in warp FM.

Some authors associate FM with palpable painful condensations in muscles. These changes are very persistent, they can stay for decades and be detected during dissection .

As to our cases, the same type of persistent painful condensations are discovered during FM not only in transversely-brindled muscles, but also in fascies, as to along abdominal line),subcutaneousfatty cellular tissue. The presence of palpable painful condensations in soft tissues is, to our opinion, the principal objective criterion of FM diagnostics, the morphological substrate of illness. Convincing evidences of this are the concurrence of the localization of pains during FM and dispositions of these condensations, as well as the persistent remission of clinical features of FM during local therapy directed on the removal of these condensations.

The new term proposed by us - myofibrillosis - characterises the degenerative-dystrophic process, with an immunological reaction taking place in the muscles, Constantly painful points in each muscle and fibrous cord, which we named the 'bow-string symptom' (traditionally known as 'trigger-point' and 'trigger-zone'), were revealed by palpation to be the main cause of the disease. The name of the symptom helps to explain why the patient senses pain and irritation while this fibrous cord is palpated. We have stated that, unlike other pathological changes, this painful syndrome (myofibrillosis) either diminishes or disappears completely when artificial relaxation takes place. Our studies show there are four types of pain associated with the scarring process in muscles, or other anatomical formations:

1. That of weak chaotic character, caused by local necrosis of separate myofibrils bundles.

2. Chronic stable myofascial pain, caused by the scarring process developing in muscular fibers.

3. Acute necrosis (infarct) of the extensive part of the skeletal muscles.

4. Compression of cutaneous nerve branches.

We, in difference from foreign authors carry out a blindfold study of the microscopic sections of muscular fibers from the corpses of 50 patients on the clinic from different illnesses at the age of 17 - 82 years while in the medical documentation of anamnesis on muscular pains was not.

On the testings of taken parts of musculus scalenus anterior and the posterior bunch of musculus temporalis with two flanks at a distance 1 cm from the attachment place. Material was fixed in 20% formalin, was by means of automatic machine AT- 4. From paraffin pulleys were done serial sections, agents were stained by hematoxylin eosin. Were used also histochemical of dyeing toluidine-blue, as to Van-Hizon. Was conducted light microscopic during increment e150, e300, e600 For monitoring compartments from mean portion denoted muscles.

During histologic examination in agents is detected the accrementation of connective tissue in the form of delicate cords between myocytes and in the form of fields and bundle perineural and perivascular, so that vessels and nerve fibers turned out to be in the center of the accrementation of connective tissue. In the vessels of capillary pattern is indicated the eccentric nodule of walls, the proliferation of endothelium with the narrowing of the lumen of vessel, but in distinct patterns by almost complete its closure. In the certain agents of among fibrous tissue disorderly are situated of 3-4 axial cylinder as to pattern ablative neuron. In distinct nerve fibers the segmental nodule of Shwann's coat. During histochemical colouring is suggested the presence of centers of fibrosis and gealinosis in perineural, perivascular and intermuscular spaces.

In muscular fibers as to the margin of centers of fibrosis was evidenced disappearance transverse shade, the vacuolization of cytoplasm, cariopicnosis, and sometimes blocking breakdown of kernels. In the rest of the muscular fibers the phenomenon of the hypertrophy of the different degree of expression.

So, during the expanded biopsy of skeleton muscles in trigger dots from the corpses of individuals, not having in the anamnesis of instructions on pain syndrome and deceased from discordant somatic pathology, are detected the changes of identical scarry tissue. Scarry tissue is formed in the places of the attachment of muscles to bones on the compartments of the most weighting, of at the place preceding necroses muscular fibers. Perivascularis the accrementation of fibrous tissue leads to abnormality trophics adherence myocytes.

The other researchers have got the same results. Pieces of tissues fixed in 10% neutral formalin and overflowed in paraffin. Histological agents were stained by hematoxylin and eosin, as to Van- Gizon, toluidine blue, impregnated silver as to Gomori.

Electronically-microscopic studying detected the rough dystrophic changes of collagen fibril, the abrupt elimination of the quantity of fibroblasts and their severe dystrophic changes. It is important to emphasize the lack of the signs of inflammation in explored agents

CONTRAIDICATIONS:

Serious condition of the patient

Local anaesthetic intolerance

Acute somatic or infectious diseases

Any chronic disease with serious decompensation or exacerbation of illness.

CONCLUSION

The main factor with a pain syndrome is the degenerative-dystrophic process in the surrounding muscles - myofibrillosis. We are convinced that the start of the treatment should focus on the dystrophic process in the muscle tissue This is the method of Dr Ulzibat's surgerv - gradual fibrotomy. All our investigations show that it is the only possible method of treating patients suffering from a pain syndrome, as well as children suffering from the after-effects of infantile cerebral paralysis.

Oboronnaya 21, Tula, RUSSIA Phone/fax +7 (0872) 31-11-12.

The problem of occult pain is one of the general problems of pain which is studied very little. We are able to reveal this symptom with every child and adult suffering from the ICP aftereffects. The well known literature on ICP problems does not describe the occult painful syndrome and only some doctors, while describing the clinical picture, state that the occult painful syndrome is accompanied by local pain. Our experience of treatment of about 8,000 patients of various age makes it possible to state that the principle clinical picture symptoms with such patients are the chronic occult or obvious symptoms (correspondingly 70% and 30%) and complicated muscular contractures resulting in these or those locomotive disorders. The more expressed pathologic process in muscles is the more expressed all painful points revealed by the doctor or are indicated by the patients.

Moreover the painful points have strictly definite localization (standard painful points). Having analyzed the results of about 500,000 operations of patients with the pathology discussed (during the period of 1991 - 1997) we state that atter operative treatment the stable improvement of muscular function takes place (without our influence on Central Nervous System (CNS). The spontaneous and occult muscular pain disappears. All this allows us to state the following: stating the painful syndrome is not enough; a doctor must find out the reason of the local focus of pain and think over the means of its eliminating even if there is no obvious sign of pathologic process (edema, hyperemia and hypertheremia). Moreover our experience makes it possible to ascertain that ICP is the manifestation of the inborn systemic decease of protein structures of muscular system and ligamentous apparatus as well as of protein structures CNS. We call it systemic proteinosis.

Systems proteinosis is the base of many chronic diseases, which were named after the main symptoms, without considering the state of the body's protein systems.(For example-the patient with Rheumatoid polyarthritis has pain in elbow but he dies of uremia).Although these diseases have different clinical symptoms, they have the same mechanisms, Without considering this you cannot develop an adequate treatment.

The transgression of the organism's protein structures functions, beginning after the influence of some pathologic factors of the outer environment exceeding the organisms adaptive possibilities, is the sign dystrophic process in these structures. The unrestorable loss of the functions testifies the beginning of' the development of the systemic proteinosis. The level of the allergic and autoimmune reactions depends on the "critical mass" of the dead protein. On the consequence this influences the transformation of the acute decease to chronic form, also the increase of the level of functional transgressions and their spreadness. We think that the systemic proteinosis is the cause of most the chronic system diseases, the names of which formed without taking into consideration the state of protein systems of the organism. This concept is shown in the following scheme

There are 5 protein functioning systems:

1. Proteins of locomotor system.

2. Proteins of Central and Peripherals Nervous System.

3. Proteins of epithelium and glandular tissues.

4. Proteins of cardiovascular and hematopoietic systems.

5. Proteins of metabolic system canals.

If there are local influence of proteins - A, lesion of genetic system - B, violation of proteins supply - C, then the influence of lesion factors leads to increasing of autoimmune reactions - D, antigenic characteristics - E, dystrophy - F. Which depends on the level of critical mass of this factor. Systemic proteinosis can be congenital and acquired. The violation of the functions depends on the "critical mass" of the dead protein. And there begins a decease:

I. Myofibrosis, myopathy, multiple sclerosis, Infantile Cerebral Palsy, rheumatoid polyarthritis etc

II. Encephalopathy of organs, neuroses, schizophrenia, narcomania etc.

III. Diabetes, goiter, pathology of adrenal glands etc.

IV. Hemophilia, leukosis, anemia, endarteritis, atherosclerosis, myocardiopathy etc.

V. Lung proteinosises hepatoses, cirrhoses, nephroses, nephrites, ulcer etc.

Which have the following degrees of seriousness: light, medium, serious, terminal. Due to our experience of treatment about of 8,000 patients we figured out that every one of them have MFP syndrome in every muscle. The patients themselves mostly say that they have headache or the low-back pain and the use the medicines was needed . We treat this MFP syndrome using microorthopedic operations (by now we made about 500,000 of them). The 7 years of this work and the catamnesis of the results prove our hypothesys that the MFP syndrome is a consequence of local muscle dystrophic process. Z

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