What is Fibromyalgia?
Fibromyalgia (FM) is an increasingly recognized, chronic pain illness which is characterized by widespread musculo-skeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle and hands, but any body part can be involved. Fibromyalgia patients experience a range of symptoms of varying intensity that wax and wane over time.
Who is affected?
It is estimated that approximately 3-6% of the U.S. population has FM. Although a higher percentage of women are affected, it does strike men, women and children of all ages and races. Because of its debilitating nature, Fibromyalgia has a serious impact on patients' family, friends, and employers, as well as society at large.
- Pain - The pain of FM is profound, widespread and chronic. It knows no boundaries, migrating to all parts of the body and varying in intensity. FM pain has been described as deep muscular aching, throbbing, twitching, stabbing and shooting pain that defines the very existence of the Fibromyalgia patient. Neurological complaints such as numbness, tingling and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors which affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.
- Fatigue - In today's world many people complain of fatigue; however, the fatigue of FM is much more than being tired. It is an all-encompassing exhaustion that interferes with even the simplest daily activities. It feels like every drop of energy has been drained from the body, which at times can leave the patient with a limited ability to function both mentally and physically.
- Sleep Problems - Many Fibromyalgia patients have an associated sleep disorder which prevents them from getting deep, restful, restorative sleep. Medical researchers have documented specific and distinctive abnormalities in the stage 4 deep sleep of FM patients. During sleep, individuals with FM are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep.
- Other symptoms - Additional symptoms may include: irritable bowel and bladder, headaches and migraines, restless legs syndrome (periodic limb movement disorder), impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, Raynaud's syndrome, neurological symptoms and impaired coordination.
How is it diagnosed?
Currently there are no laboratory tests available for diagnosing Fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination, and an accurate manual tender point examination that determines the presence of multiple tender points at characteristic locations.
It is estimated that it takes an average of five years for a FM patient to get an accurate diagnosis. Many doctors are still not adequately informed or educated about FM. Laboratory tests often prove inconclusive, and many FM symptoms overlap with the symptoms of other conditions, thus leading to extensive investigative costs and frustration for both the doctor and patient. Another essential point that must be considered is that the presence of other diseases, such as rheumatoid arthritis or lupus, does not rule out a FM diagnosis. Fibromyalgia is not a diagnosis of exclusion and must be diagnosed by its own characteristic features.
To receive a diagnosis of FM, the patient must meet the following diagnostic criteria:
- Widespread pain in all four quadrants of the body for a minimum duration of three months
- Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see figure above)
What causes Fibromyalgia?
While the underlying cause or causes of FM still remain a mystery, new research findings continue to bring us closer to understanding the basic mechanisms of Fibromyalgia. Most researchers agree that FM is a disorder of central processing with neuroendocrine/neurotransmitter disregulation. The FM patient experiences pain amplification due to abnormal sensory processing in the central nervous system. An increasing number of scientific studies now show multiple physiological abnormalities in the FM patient, including: increased levels of substance P in the spinal cord, low levels of blood flow to the thalamus region of the brain, HPA axis hypofunction, low levels of serotonin and tryptophan, and abnormalities in cytokine function.
Recent studies show that genetic factors may predispose individuals to FM. For some, the onset of FM is slow; however, in a large percentage of patients the onset is triggered by an illness or injury that causes trauma to the body. These events may act to incite an undetected physiological problem already present.
Exciting new research has also begun in the areas of brain imaging and neurosurgery. Continued work will look at the hypothesis that FM is caused by an interpretative defect in the central nervous system that brings about abnormal pain perception. Medical researchers have just begun to untangle the truths about this life-altering disease.
How is FM treated?
One of the most important factors in improving the symptoms of FM is for the patient to recognize the need for lifestyle adaptation. Most people are resistant to change because it implies adjustment, discomfort and effort. However, in the case of FM, change can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement.
An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and who will listen to and work with the patient is an important component of treatment. Conventional medical intervention may be only part of a potential treatment program.
Alternative treatments, nutrition, relaxation techniques and exercise play an important role in FM treatment as well. Each patient should, along with their healthcare practitioner, establish a multifaceted and individualized approach that works for them.
Pain Management - Over-the-counter pain medications, such as acetaminophen or ibuprofen, may be helpful in relieving pain. Be careful of NSAIDs, which can have dangerous side effects if used long-term. Most conventional physicians may decide to prescribe one of the newer non-narcotic pain relievers (e.g. Tramadol) or low doses of antidepressants (e.g. tricyclic antidepressants, serotonin reuptake inhibitors) or benzodiazepines. Patients must remember that there are many alternatives to this. An important aspect of pain management is a regular program of gentle exercise and stretching, which helps maintain muscle tone and reduces pain and stiffness.
Sleep Management - Improved sleep can be obtained by implementing a healthy sleep regimen, which includes going to bed and getting up at the same time every day, making sure that the sleeping environment is conducive to sleep (i.e. quiet, free from distractions, a comfortable room temperature, a supportive bed), avoiding caffeine, sugar and alcohol before bed, doing some type of light exercise during the day, avoiding eating immediately before bedtime, and practicing relaxation exercises as you fall to sleep. When necessary, there are new sleep medications that can be prescribed, some of which can be especially helpful if the patient's sleep is disturbed by restless legs or periodic limb movement disorder.
Psychological Support - Learning to live with a chronic illness often challenges an individual emotionally. The FM patient needs to develop a program that provides emotional support and increases communication with family and friends. Many communities throughout the United States and abroad have organized Fibromyalgia support groups. These groups often provide important information and have guest speakers who discuss subjects of particular interest to the FM patient. Counseling sessions with a trained professional may help improve communication and understanding about the illness and help to build healthier relationships within the patient's family.
Other Treatments - Complementary therapies can be very beneficial. These include: physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation.
- Guided exercise program. Fibromyalgia patients who undergo regular exercise are more functional and have less pain. Regular exercise also gives you an increased feeling of control over the disorder.
- Coping skills education. Coping skills and stress management are an important but overlooked treatment. For example, chronic stress leads to increased stress hormones that disturb the HPA axis. In addition to stress management, a valuable coping skill is finding a support group. Fibromyalgia patients who are in support groups tend to do better than those who are isolated.
- FM appears to be partly a defect in oxidative phosphorylation, which is a biochemical pathway that is required for proper function of cells. Some FM patients also have a disordered hypothalamic-pituitary-adrenal (HPA) axis. This group of glands plays a central role in balancing and controlling biochemical processes in your body. Good dietary choices can favorably influence both oxidative phosphorylation and the HPA axis.
- Identify and eliminate food allergies, which can cause a number of symptoms.
- Avoid all sugar and refined carbohydrates (white flour products and starches) improves energy overall.
- Increase magnesium rich foods such as legumes, tofu, seeds, nuts, whole foods, and green leafy vegetables.
- Focus on a whole foods diet comprised mainly of good quality protein (lean animal protein, fresh, organic fruits and vegetables, nuts, seeds, and whole grains.)
- Some patients with FM are very sensitive to the food additives MSG and aspartate, and experience complete or nearly complete resolution of their symptoms after eliminating them from their diet.
- Selective vitamin therapy. In some cases, such as smokers, specific nutrient therapy may be indicated in order to provide the precursors necessary for improved muscle cell metabolism.
- Myer’s Cocktail. This intravenous nutrient formula can be beneficial for treating fibromyalgia.
Botanical (Herbal) Medicine
- Adaptogenic herbs such as ginseng, licorice, rhodiola and cordyceps all help support adrenal gland function and promote overall well-being, energy, and balance.
- Anti-inflammatory herbs and supplements such as Boswellia, Curcumin, Quercetin, and bromelain may be used effectively to decrease pain and inflammation.
- Other herbs may also be used depending on the complete symptom picture. Herbs may be used to detoxify the liver and blood and to support mood.
- Physical therapy. Some women with fibromyalgia syndrome respond to physical therapy, such as trigger point therapy or osteopathic manipulation.
- Acupuncture. Studies show that acupuncture is an extremely useful adjunctive treatment for many patients with fibromyalgia.
What is the prognosis?
Better than ever before! The efforts of individuals, support groups, organizations and medical professionals to help improve the quality of life for people with FM are starting to pay off. Better ways to diagnose and treat FM are on the horizon. The symptoms of FM can vary in severity and often wax and wane, but most patients do tend to improve over time. By actively seeking new information, talking to others who have FM, re-evaluating daily priorities, making lifestyle changes, and working hard to keep a hopeful attitude, the FM sufferer can become the FM survivor!