Many people are of the mind that Fibromyalgia (FM) is a chronic pain disorder only experienced by women. While women do suffer this condition more than men, it is a condition experienced by women, men and also children, of all ethnicities and races. This debilitating condition actually affects ten million people in the United States alone.
Fibromyalgia is a condition that exhibits widespread musculo-skeletal aches, pain and stiffness, soft tissue tenderness, fatigue, and sleep disturbances. While this condition can produce pain in any area of the body, it most often manifests itself in the neck, back, shoulders, pelvic girdle, and hands. Intensities can vary widely from patient-to-patient, and this disorder is known to come-and-go on a schedule of its own. When pain comes, it generally sticks around for up to three months, before disappearing once again.
Recognizing the Symptoms of Fibromyalgia
When fibromyalgia displays itself, it typically exhibits multiple tender points and a multitude of additional symptoms. When FM pain manifests in the patient, that pain is typically profound, widespread and chronic, migrating to all areas of the body. Some patients even suggest it demonstrates stabbing and shooting pain, deep muscular aching, throbbing, and twitching. In addition to the pain symptoms, FM also displays numbness, tingling, and burning in most patients.
Often fibromyalgia symptoms are worse in the morning, during cold or humid weather, after excessive physical activity and even physical inactivity, or when the patient is experiencing anxiety or stressful situations.
Deep, restful, restorative sleep is most often achieved in a Stage 4 deep sleep. But FM patients often have their deep sleep interrupted by bouts of awake-like brain activity, which steals the restorative power of sleep from FM patients.
Fatigue, often brought on by a lack of good sleep, long work hours, or stress, is much more than just being tired. Fatigue is a high level of exhaustion that interferes with one's daily activities, often resulting in a temporary physical and mental loss of strength, energy and vitality. As previously demonstrated, fibromyalgia patients already suffer from a sleep condition, which prevents them from getting a good night's sleep. As a result, FM patients slide more quickly into fatigue and are often plagued by it for much longer periods of time.
Beyond the overall symptoms of pain, sleep disorders, and fatigue, symptoms of fibromyalgia may also include irritable bowel and bladder, headaches and migraines, restless legs syndrome (RLS is a periodic limb movement disorder), skin sensitivities and rashes, Raynaud's Syndrome (skin discoloration in the fingers and toes), dry eyes and mouth, ringing in the ears, dizziness and vision problems. Also manifest in fibromyalgia is the fatigue-related conditions of impaired memory, concentration and coordination, anxiety, depression, and other neurological symptoms.
Diagnosing Fibromyalgia
This condition is currently impossible to diagnose by way of a laboratory test, but that does not mean that doctors do not have tools available to help them reach this diagnosis.
Unfortunately, the average FM patient will have to wait five years for their physician to reach a proper diagnosis. Unlike most conditions, this diagnosis is made more as a diagnosis of exclusion than anything else, since most symptoms overlap other more common illnesses, leading to a multitude of costly tests and frustration for both the doctor and patient.
The two most common diseases that must be eliminated as a possibility, before fibromyalgia will even be considered, are rheumatoid arthritis and Dr. House's favorite diagnosis, lupus.
Once these two diseases are eliminated; a healthcare practitioner will need to consider patient histories and self-reported symptoms, before performing an accurate "manual tender point examination". This exam is based on the standardized American College of Rheumatology (ACR) criteria.
Proper implementation of the "manual tender point examination" seeks the presence of multiple tender points in at least 11 of the 18 characteristic locations in the body that are common to this illness. Additionally, the physician will need to document widespread pain in all four quadrants of the body, persisting over a minimum duration of three months.
Causes Of Fibromyalgia
Scientists do not yet understand the cause of fibromyalgia, but recent discoveries have brought them closer to understanding the basic mechanisms of fibromyalgia. Research into this condition has established that fibromyalgia is a disorder, which interferes with the central processing in the brain, creating neuroendocrine / neurotransmitter dysregulation. In short, this means that pain is amplified in the body, due to abnormal sensory processing in the patient's central nervous system.
Researchers are just now starting to see multiple physiological abnormalities, manifest in fibromyalgia patients. Going forward, these new discoveries may lead medical science to find a method by which to perform a laboratory test to quickly confirm this diagnosis. The research results that are showing the greatest promise for a testing mechanism for doctors includes the observations that fibromyalgia patients are showing: low levels of serotonin and tryptophan, HPA axis hypofunction (chronic fatigue syndrome), increased levels of substance P in the spinal cord, low levels of blood flow to the thalamus region of the brain, and abnormalities in cytokine function (critical to the development and functioning of both the innate and adaptive immune response at the cellular level, and the developmental processes of a human embryo).
As is always the case with mainstream medical science, scientists are looking to identify physiological abnormalities that can be reliably detected in a patient's lab work, before they feel safe enough to recommend a certain testing procedure to the medical community.
New Research
Some researchers have suggested that fibromyalgia may be the result of genetic factors that predispose an individual to a genetic susceptibility to this disorder. While the symptoms slowly creep into the picture for many patients, the majority of people see a sudden onset of fibromyalgia after a trauma to the body or an illness. Science is asking at this time whether the sudden onset of FM is the result of the trauma or illness simply exposing a pre-existing condition in the patient, or whether the trauma or illness causes the onset of fibromyalgia.
Other researchers are studying non-invasive brain imaging, working with neurosurgeons, to identify an interpretative defect in the central nervous system, which would cause the abnormal pain perception.
Fibromyalgia Treatment
People tend to resist any treatments that do not include medication, because the inverse implies adjustment, discomfort and effort that the patient may be unwilling to undertake. To date, the best fibromyalgia treatment is one that the patient will have the greatest control over the outcome.
Many practitioners believe that the patient will be able to make great strides in the quality of life, if only the patient is willing to make some changes in their lifestyle. For the average patient, the best medicine will include: complementary therapies, nutrition, relaxation techniques, stretching and exercise - yes, exercise. Stretching helps maintain muscle tone and reduces pain and stiffness.
Fibromyalgia Pain Management
Conventional medical intervention may be only part of a potential treatment program. Over-the-counter pain medications, such as acetaminophen or ibuprofen, may be helpful in relieving pain.
Every healthcare practitioner will need to approach treatment in a way that is individualized for the patient. The practitioner may need to prescribe non-narcotic pain relievers (such as tramadol), benzodiazepines (a class of psychoactive drugs), or even low doses of antidepressants (e.g. tricyclic antidepressants, serotonin reuptake inhibitors). Lyrica is the first medication to now have a FDA indication for the treatment of fibromyalgia.
Antidepressants can be prescribed at low levels to help improve sleep and to relieve pain. They work by sustaining levels of serotonin. If the patient is experiencing depression, the practitioner may need to prescribe higher levels of these or other medications.
Some practitioners may recommend Lidocaine injections into the patient's tender points to address localized areas of pain.
Sleep Management
Whether a fibromyalgia patient or not, the following tips will guide the average person to a better night's sleep:
Go to bed at the same time every night, and awaken at the same time every morning.
Sleeping environment is conducive to sleep (quiet, comfortable temperature, and a comfortable bed).
Avoid caffeine, sugar, alcohol, and food for at least two hours before bedtime.
Light exercise during the day.
Practicing relaxation techniques as you lay down for sleep.
If you suffer from restless legs or periodic limb movement disorder, then your practitioner may prescribe medication to help you sleep at night.
Complementary Therapies
Alternative or complementary therapies can be very beneficial to the average fibromyalgia patient.
Healthcare practitioners more frequently recommend physical therapy and light aerobics, than some of the other treatments described here.
Osteopathic or chiropractic manipulation, yoga, relaxation exercises, breathing techniques, as well as the application of heat or cold, are recommended by some as excellent alternative treatments.
Therapeutic massage and myofascial release therapy (manual massage techniques for stretching the fascia and releasing bonds between fascia, integument, muscles, and bones) are also considered to be worthwhile treatments by many.
Water therapy, acupressure, acupuncture, aromatherapy, cognitive therapy, and biofeedback have attracted the attention of some FM patients. For others, herbs and nutritional supplements offer the greater promise for more immediate relief.
Fibromyalgia Supplements
If taking prescription medication always checks with your prescribing practitioner before starting a new supplement regimen.
Magnesium there is over 300 biochemical reactions in the body that require magnesium. Magnesium combined with malic acid may be helpful in increasing energy and decreasing pain in fibromyalgia.
S-adenosylmethionine or SAMe has been reported to decrease fatigue, stiffness, and pain, and plays a role in the formation of cartilage. The recommended dose is 400mgs to 800 mgs daily.
Essential fatty acids, such as omega 3 fatty acids found in fish oil have been shown to have anti-inflammatory effects and also increase energy.
5HTP is a natural serotonin supplement which acts increases natural brain serotonin levels. Studies have shown that those suffering with fibromyalgia symptoms had low levels of serotonin in the brain which contributes to low mood and altered pain perception. Suggested dose is 100-300 mg per day.
Melatonin 0.5-3mg helps improve sleep and oxidative stress.
Willow bark reduces pain and inflammation with little to no stomach upset.
Hops, Passion flower,
and valerian have muscle- relaxant properties and can help with sleep at night.
Fibromyalgia Diet
Eat a diet high in complex carbohydrates
such as fruits and vegetables. The more unsaturated fats, plant-based
foods such as vegetables, whole grains, fruits, plus essential fatty acids
(cold-water fish, nuts, and seeds) you eat the less acidic your body
becomes. An acid pH leads to inflammation and pain. Animal products, dairy,
junk food, and refined sugar causes and acidic environment.
Avoid foods with additives, (MSG),
preservatives, and artificial sweeteners such as NutraSweet.
Eat organic whenever
possible.
Avoid alcohol and caffeine.
If your fibromyalgia symptoms become worse after
eating certain foods, try an elimination diet: stop eating the suspected food
for 2 weeks and see if symptoms improve.
