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Other names for fibromyalgia: Chronic Fatigue Syndrome, Fibromyositis, or Fibrositis. Often co-exists with Myofascial Pain Syndrome.
Fibromyalgia is most common in women, 25 to 50 years in age.
Fibromyalgia is a syndrome characterized by chronic muscle pain and stiffness, disturbed sleep, depression, and/or fatigue. Fibromyalgia symptoms are a lot like those associated with Chronic Fatigue Syndrome. Other symptoms may include sensitive to odors, bright lights, loud noises, headaches, and /or jaw pain.
Low-impact aerobic exercises such as stationary bicycling and swimming
What Is Fibromyalgia?
There are some days when it almost "hurts too bad to move," or when you wake up from a full night's sleep "too tired to think straight."
For those who suffer from Fibromyalgia Syndrome, days like these happen on a regular basis. This throbbing, "aching all over" feeling often seems worse in the morning. And that makes it even more difficult to bear when you've just spent a seemingly endless night tossing and turning because restful sleep hasn't been seen in your bedroom for a long time. Fibromyalgia is also usually cyclical, with different symptoms from day to day, and changes in energy levels and pain. Sometimes everything may get worse for a while, and then there will be days where the patient feels nearly normal and symptom free. As the syndrome progresses, cycles of pain and fatigue may become longer and more severe.
Fibromyalgia [FM] is a chronic musculoskeletal condition causing widespread pain, fatigue and muscle stiffness throughout the body. One of the most difficult things about the disorder is that the symptoms mimic at least 46 other conditions. It is characterized by physical over sensitivity and pain responses to a wide range of triggers, sometimes seemingly without cause. With its wide variety of symptoms and its undeserved reputation as a "catch-all" diagnosis, fibromyalgia is a frustrating condition to manage.
One of the reasons is because those with fibromyalgia don't appear sick, even though they know something is very wrong. There's no swelling, no spots, no fever, nothing obvious, but there is chronic pain. They don't sleep. They're tired. And quite often they are a little overweight because it simply hurts too much to move. When they do finally seek medical advice, the typical blood tests come back normal. Because there is no blood test to detect FM, doctors often can't diagnose the problem until all similar disorders that CAN be detected by blood tests are first ruled out.
It can take up over 4 years for a diagnosis of fibromyalgia to be made, often while the patient gets worse and worse. Friends, family members, and even doctors may tell them that it's "all in your head," or that they just don't want to feel good. They may be accused of making it up, even though this condition has been documented in largely ignored medical literature for well over a century. The years that often pass until a proper diagnosis are often spent bouncing from doctor to doctor, trying to find someone familiar with fibromyalgia symptoms who won't ignore them.
Fibromyalgia affects as much as 4 percent of the U.S. adult population, making it the second most common rheumatological illness after osteoarthritis. It affects women more often than men by as much as a 10 to 1 ratio. The average age of a fibromyalgia sufferer is between 30 and 55.
It is a syndrome, not a disease, because it does not cause degeneration of body organs or tissues, nor does it deform. But the stress of living with a chronic, painful condition can be devastating.
The most common signs and symptoms of fibromyalgia are: widespread muscle pain, morning stiffness, non restorative sleep and daytime fatigue. Cold, damp weather and and physical activity can severely aggravate conditions.
Other common symptoms often found in fibromyalgia patients include irritable bowel syndrome, myalgia (muscle pain), arthralgia (joint pain), generalized muscle weakness, stiffness, numbness, swelling, tingling, lightheadedness when standing, migraine and tension headaches.
Cognitive problems such as not being able to "think straight" or remember things are also frequently linked to FM. These 'forgetful' episodes of short term memory or concentration impairment are referred to as 'fibrofog.' It's a frustrating, often scary, situation when you find yourself unable to remember things you've known 'forever,' like your own phone number or even your children's names.
And it's certainly not hard to see why depression and anxiety are often common problems for those with fibromyalgia. Chronic pain and loss of sleep can cause even the most cheerful person to experience these feelings. And because it's often hard to diagnose, the frustration and feelings of isolation that follow remarks like 'this is all in your head' or 'would you like the name of a psychiatrist' often intensifies feelings of depression and anxiety. In fact, neurotransmitter deficiencies and imbalances are a common part of fibromyalgia. These may have something to do with the prevalence of mood disorders, but also sleep and digestive problems.
Another condition related to fibromyalgia is "subjective swelling," a feeling that an area is swollen even though there is no physical change in the site. And the list of symptoms goes on ... TMJ (temporomandibular joint dysfunction) - a painful disorder of the jaw joints, dry eyes and mouth, eye twitching, temperature sensitivity such as intolerance to cold or dizzy 'fainting spells' in hot conditions, exercise intolerance, Raynaud's Disease (sporadic attacks of blood vessel spasms resulting in interruption of the blood flow to the fingers, toes, ears and nose), hearing problems, mitral valve prolapse, fever, osteoarthritis, polymyalgia rheumatica, Seasonal Affective Disorder (SAD), multiple food and/or chemical sensitivities, Rheumatoid arthritis, Sjogren's syndrome (systemic autoimmune disease that affects the musculoskeletal system and organs), sore throat, swollen lymph nodes, chronic rhinitis (runny nose), skin problems, vertigo, urinary problems, vulvar pain syndrome (vaginal pain and spasms), painful intercourse, PMS, menstrual cramping, eating disorders, digestive problems, weight gain, candidiasis (yeast infections), immune system weaknesses, ADD/ADHD (Attention Deficit Hyperactivity Disorders), Gulf War Syndrome, Post Polio Syndrome, etc.
Nearly half of the females who have fibromyalgia also have hypoglycemia (low blood sugar, or reactive hypoglycemia (low amounts of usable sugar). Studies indicate that 40 percent of females have fibroglycemia (a combination of both) and 20 percent of men with FM also have it. Symptoms of hypoglycemia include an intense craving of sweets, tremors, sweating, panic attacks, heart palpitations, faintness, confusion, and frontal headaches.
The American College of Rheumatology bases the diagnosis of FM upon two major criteria:
- Widespread, diffuse pain lasting at least three months;
- A minimum of 11 (out of 18 possible specified tender points throughout the body.
This is the strict definition for being included in a clinical study of fibromyalgia, but tender points may change from time to time, and may worsen or get better in the cyclical way that this syndrome seems to work.
These tender points will hurt when pressed, but the pressure will not cause pain in any other part of the body. The physician applies a standardized amount of pressure, about 4 kg (enough to turn the thumbnail white). Remember, a tender point has to be painful at palpation, not just "tender." When pressed, these areas tend to feel like bruises in various stages of healing.
Also, a tender point is different from what you may know as a trigger point. Tender points hurt, trigger points hurt and refer pain to other body parts. Trigger points cause myofascial pain syndrome, which often coexists with fibromyalgia, but can be treated with massage, physical therapy, or gentle stretching. When muscles feel hard and pressing on them causes a response elsewhere in the body, or even nausea, trigger points are responsible. Tender points are caused by an unknown mechanism, and their severity is often cyclic. Tender points do not generally respond to physical therapy, often becoming more painful with pressure.
Widespread pain is defined as having pain in both sides of the body and pain above and below the waist. In addition, pain must also be present in the cervical spine, anterior chest, thoracic spine or lower back.
During guaifenisin therapy, it is recommended that these tender points be mapped and monitored as treatment progresses.
Although an exact cause of fibromyalgia is unknown, there are several underlying conditions that contribute to the disorder. Treatment is usually focused on reducing the severity of the symptoms related to the most prominent conditions.
Not getting enough "restful" sleep is thought to be one of the chief underlying causes of fibromyalgia. The body sleeps in stages. Stage four is when the body should be in a deep sleep. This deep sleep is the time that the body has set aside for healing. Tests show that stage 4 of the sleep cycle in fibromyalgia sufferers is interrupted. More conclusive results came about when researchers continuously interrupted the stage 4 sleep of people who had previously never had signs or symptoms of fibromyalgia. As a result of loss of sleep during this critical time, those who had never suffered with fibromyalgia before began to show signs of the disorder. These sleep studies also suggested a direct link between fibromyalgia and a deficiency in the Growth Hormone. This hormone is important in muscle maintenance and repair and is secreted during sleep stage 4.
Neurotransmitter (chemicals that communicate between nerve cells) levels in fibromyalgia patients are often disrupted, causing bodywide imbalances. Any of the following neurotransmitters may be disrupted in fibromyalgia, resulting in a wide range of possible symptoms, and requiring different treatments. All of these substances work together, starting and stopping different reactions to allow us to respond to our environment. If they are out of balance, certain reactions that are helpful in moderation may run out of control. The causes of this disruption are unknown.
- Acetylcholine - This neurotransmitter controls heart contraction, mucus production in the upper respiratory tract, digestive enzyme secretion, sweating, and the contractions of the stomach, intestines, and eliminatory organs. Involuntary motion and thoughts are also associated with improper levels of acetylcholine.
- Adrenaline and Noradrenaline - These complementary neurotransmitters are most known for their connection with stress, and the 'fight or flight' response system. They both regulate energy consumption in the body. Adrenaline is associated with sugar metabolism and insulin production, and is thought to be released into the body too quickly in response to carbohydrates in reactive hypoglycemics. Noradrenaline inhibits digestion, and lowers the body temperature and pain threshold. High levels of these chemicals can create a restless, oversensitive, high anxiety state that may quickly burn out the body's energy reserves. Low levels can cause an apathetic, low energy state, common in fibromyalgia.
- Dopamine - This neurotransmitter controls motor activity and concentration. Too much can cause muscle cramps and anxiety, while too little may lead to fatigue and lethargy. ADD and ADHD, more common in fibromyalgia patients, are sometimes associated with low levels of dopamine in certain areas of the brain.
- GABA (gamma-amino-n-butyric acid) - GABA affects both mood and muscle tone. Low levels can be responsible for muscle spasm and tightness, as well as mood and memory dysfunction.
- Histamine - This chemical is released in our bodies when we are exposed to either a trauma or a toxin. Sometimes histamine production is too high, raising the body's alarm system when there is no danger. This is how common allergies occur, and why antihistamines are so effective. Excess histamine production may result in red, watery eyes, headache, stomach upset, or low blood pressure.
- Serotonin - A disruption (usually a deficiency) of serotonin is common in fibromyalgia. This chemical regulates mood, digestion, weight, sleep, blood pressure, pain sensitivity, and motivation. Individuals who are prone to migraine or nonrestorative sleep are especially likely to have deficiencies in serotonin. SSRIs (selective serotonin reuptake inhibitors) work by increasing levels of this chemical, and this may be why they are effective for some patients.
- Substance P - This chemical regulates pain sensations, stomach contractions, blood pressure and mucus production.
- Peptides - These chemicals are related to how individuals feel pain. Many people have heard of endorphins, which are the 'feel good' peptides released naturally during moderate exercise. A lack or surplus of any peptides may increase our likelihood of experiencing pain, or reduce our resistance to pain sensations.
Additional underlying factors include deficiencies of nutrients such as magnesium. This can cause muscle cramps upon exertion and upon awakening. It has also been suggested that a buildup of phosphorus in the body may be responsible for the condition. (Guaifenisin treatment is thought to work by eliminating extra phosporus.) If that is the case, it suggests an explanation for the normal blood test results often received by fibromyalgia patients. Other possible causes of fibromyalgia symptoms are hypoxia (lack of oxygen in body tissues), muscular injury, muscular atrophy, emotional stress, digestion, and mood disorders.
Still another possibility is the onset of infections or viral exposures. More than half of fibromyalgia patients said this occurred prior to the onset of their symptoms. Included among these are Lyme Disease (infection that manifests itself as a multi-system inflammatory disease), Human Immunodeficiency virus, Coxsackie Virus (common source of infection in children that often causes flu-like symptoms), Epstein-Barr (member of the herpes virus family, often associated with chronic fatigue), or Streptococcus and Parvovirus (virus that can cause joint pain and swelling).
Lack of regular physical exercise seems to be a factor although it is not known whether lack of conditioning promotes pain or vice versa. While exercise is often invigorating for healthy individuals, it can exhaust a fibromyalgia sufferer, sometimes for days.
Sometimes the symptoms began much earlier than the fibromyalgia patient realizes. Thirty percent of patients remember having 'growing pains' in childhood that seemed to disappear before puberty. These pains seem to reappear more severely later on in adulthood.
There is also some indication that fibromyalgia can be hereditary, as it tends to run in families. Incidence of sleep disorders, blood sugar difficulties, headaches or migraine, ADD or ADHD, Asperger's syndrome, irritable bowel, joint problems, and food allergy or intolerance may all be common in the families of fibromyalgia patients. It is unclear how these conditions interact, or what causes what, but in fibromyalgia it often seems like several conditions pile on top of each other.
Standard Fibromyalgia Treatments:
Prescription medications that manage the symptoms of this syndrome are the most common method of treatment at present. None of these treatments is a cure for fibromyalgia, but all have seen some success in certain individuals in reducing pain, sleeplessness, ar other discomfort. The treatment goal is usually pain or fatigue management and allowing the individual to lead a less restricted life than they otherwise would.
Due to the upset in neurotransmitter levels seen in fibromyalgia, certain symptoms often respond to antidepressants. Note that this does not imply that the condition is merely psychological, nor is fibromyalgia the only physical condition that benefits from medications that adjust the levels of different neurotransmitters. Antidepressants often improve the regularity of the sleep-wake cycle and benefit digestion. They are taken in much lower doses for fibromyalgia than they would be if used to treat depression. Many fibromyalgics are also quite sensitive to drugs that affect the nervous system, and are likely to react strongly to high doses of antidepressants and central nervous system depressants.
Something that should also be noted is that there is a difference between physical withdrawal symptoms after long-term medication use and psychological dependence. Physical withdrawal is a fairly common consequence of long-term medication use, even if that medication is necessary to manage physical discomfort. Psychological addiction implies a desire to take a medication even when feeling healthy, and when the symptoms it is designed to treat are not present. Actual drug addiction rates are generally very low among patients using medication for chronic pain.
Because of the chronic nature of fibromyalgia symptoms, individuals with this condition may end up needing to manage ongoing pain, sleeplessness, and severe muscle tension for long periods of time. Many medications that affect the central nervous system are generally indicated for acute symptoms that resolve over a period of weeks, maybe months at most. Taking them for long periods of time increases the risk that the body will react to removing the medication. Speak to your doctor about drug holidays, rotation schedules, gradually decreasing dosage to end treatment and avoid uncomfortable symptoms that may result from the long-term use of a medication. Some medications may also become less effective the longer they are used, and the greater the dosage. It's very important to the continued effectiveness of many treatments that the minimum dose needed to successfully manage your symptoms should be used at all times.
Remember that pain control is a legitimate and important goal of medical treatment for fibromyalgia, or any condition. Severe, chronic pain and discomfort can be extremely disruptive to anyone's life. While a physician should pay attention to the possibility of unwanted side effects and dependence, the needs of the patient must be considered on an individual basis. If a treatment is ineffective, it is the duty of the physician to try alternate methods, and the duty of the patient to communicate their needs clearly. Appropriate treatment may vary widely among individuals, and it may be the case that several treatments will need to be tried before an effective medication with minimal unwanted side effects is found.
- Benzodiazepines (a class of antidepressants, anti-panic agents, and muscle relaxants) - These include Ativan (lorazepam), Valium (diazepam), Halcion (triazolam), Restoril (temazepam), Librium (chlordiazepoxide), Xanax (alprazolam), Tranxene-SD (clorazepate), Paxipam (halazepam), ProSom (estazolam), Klonopin (clonazepam), and others. Benzodiazepines are commonly prescribed for fibromyalgia, especially when a combination of anxiety and sleeplessness is present along with muscle tension.
- Guaifenisin - This common expectorant (thins mucus, making it easier to expel) is found in many adult and pediatric cold medications. Some individuals finds that it reverses the symptoms of fibromyalgia (after first increasing them), sometimes dramatically.
- Muscle Relaxants - Flexeril, Robaxin, and Soma are all commonly prescribed as fibromyalgia treatments and may prove effective at relieving tender points and reducing achiness.
- Narcotic pain medication - These include Codeine, Demerol (meperidine), Buprenex (buprenorphine), Darvon (propoxyphene), Dilaudid (hydromorphone), MS Contin or Kadian (morphine), nalbuphine, OxyContin (oxycodone), Percocet (oxycodone, acetaminophen), Stadol (butorphanol), Talwin compound (pentazocine), Vicodin Tuss (hydrocodone, guaifenisin), Vicodin (hydrocodone, acetaminophen), and Vicoprofen (hydrocodone, ibuprofen). The mild opioid Ultram (Tramadol), has been found to be fairly effective for fibromyalgia, and generally poses less risk of dependence and side effects than other opiates.
- Non-Steroidal Anti-Inflammatories (NSAIDs) - Such as Motrin or Advil (Ibuprofen), or Naprosyn (naproxen). These medications can relieve pain without the strong central nervous system effects of narcotics and barbiturates. Ibuprofen, a common over the counter pain reliever, can be found as a generic ingredient in combination with some narcotic pain medications.
- Selective serotonin reuptake inhibitors (SSRIs) like Celexa (citalopram), Paxil (parxetine), Prozac (fluoxeine), Luvox (fluvoxamine), or Zoloft (sertraline) may sometimes be prescribed in low doses to normalize serotonin levels. They are usually taken in the morning, as these drugs can cause insomnia. They may sometimes be prescribed along with low doses of a tricyclic antidepressant, which will then be taken at night to promote sleep.
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