What is Fibromyalgia? Symptoms, Causes, and Treatments
Fibromyalgia (FM) is a chronic pain illness characterized by widespread musculoskeletal 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 affected. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.
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.
FM is characterized by the presence of multiple tender points and a constellation of symptoms.
The pain of FM is profound, widespread and chronic. FM pain has been described as an aching, throbbing, twitching, stabbing and shooting pain deep in the muscles. Neurological complaints such as numbness, tingling and burning are often present and add to the patient’s discomfort. The severity of the pain and stiffness is often worse in the morning. Cold or humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety, and stress all can aggravate pain.
In today’s world many people complain of fatigue. FM fatigue, however, 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. It can, at times, leave the patient with a limited ability to function both mentally and physically.
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 brain activity typical of being awake; limiting the amount of time they spend in deep sleep.
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.
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 dysregulation. 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 a genetic susceptibility 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 incite an undetected physiological problem already present.
Exciting new research has also begun in the areas of brain imaging and neurosurgery. Current and future research will investigate 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 Fibromyalgia 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. This exam is based on the standardized criteria developed by the American College of Rheumatology. Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.
Many FM symptoms overlap with the symptoms of other conditions, leading to extensive investigative costs and frustration for both doctor and patient. It is essential to know that the presence of other diseases, such as rheumatoid arthritis or lupus, does not rule out an 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 at least three months
- Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see figure above)
How is Fibromyalgia Treated?
One of the most important factors in improving the symptoms of FM is for the patient to recognize the need for lifestyle adaptation. For people with 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. It may be a family practitioner, an internist, or a specialist like a rheumatologist or neurologist. Conventional medical intervention may be only part of a potential treatment program. Alternative and complementary therapies, nutrition, relaxation techniques, and exercise play an important role in FM treatment as well. Patient should, along with the healthcare practitioner, establish a multifaceted and individualized approach that works for them.
Over-the-counter pain medications, such as acetaminophen or ibuprofen, may be helpful in relieving pain. The physician 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 antidepressants are “serotonin builders” and can be prescribed at low levels to help improve sleep and relieve pain. If the patient is experiencing depression, higher levels of these or other medications may need to be prescribed. Another beneficial pain therapy that works well on localized areas of pain is lidocaine injections into the patient’s tender points.
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.
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 (quiet, free from distractions, and neither hot nor cold; the bed must also be supportive), 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, new sleep medications can be prescribed. Some of them are especially helpful if the patient’s sleep is disturbed by restless legs or periodic limb movement disorder.
Learning to live with a chronic illness can be an emotional challenge. FM patients need 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, which can provide important information. Many 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 build healthier relationships within the patient’s family.
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.
What is the Prognosis for People with Fibromyalgia?
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!
This article was reprinted with the permission of the National Fibromyalgia Association.