Fibromyalgia

Fibromyalgia (FM), previously known as fibrositis, chronic muscle pain syndrome, psychogenic rheumatism, and tension myalgias,is an illness of widespread chronic pain that has been described as twitching, aching, throbbing, stabbing or shooting in nature.  It is typified by widespread musculoskeletal, ligament, and tendon pain.  People with FM experience aches, pain, and stiffness of varying intensity from day to day.   FM is not progressive, life threatening, or crippling.  It affects approximately 2% of the population which are primarily women at a rate of 4:1.  Most people are diagnosed during their middle age period of life.

Signs and Symptoms

• Widespread chronic pain
• Soft tissue tenderness
• Muscle weakness
• Joint pain
• Sleep disturbances
• Morning stiffness
• Headaches
• Painful menstrual periods
• Restless leg syndrome
• Irritable bowel syndrome
• Irritable bladder
• Difficulty concentrating
• Difficulty remembering
• Depression
• Anxiety
• Palpitations
• Chest pain
• General feeling of fatigue
• Numbness
• Tingling
• Burning
• Rashes
• Skin sensitivities
• Dry eyes
• Dry mouth
• Ringing in the ears
• Dizziness
• Vision problems
• Raynaud’s syndrome
• Coordination difficulties
• Facial pain
• Temporomandibular joint (TMJ) dysfunction
• Sensitivity to odors, bright lights, noise, and touch

Diagnosis

There are currently no standard tests such as MRI, laboratory, blood, or x-ray that will detect FM. Therefore, diagnosis is often made over a period of time, usually five years, and is based on the patient’s reporting of symptoms, patient histories, and physical examination.  However, new research is suggestive of the presence of physiological abnormalities such as increased levels of substance P (a chemical found in the brain that is associated with pain, stress, anxiety, and depression), 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.

In 1990, The American College of Rheumatology designated specific sites that must be involved in order to warrant a diagnosis of FM.  Affected areas must be present in all four quadrants of the body with emphasis along the neck and back and may include the shoulders, pelvis, hips, arms, and legs.  The client will feel an increase in pain when pressure is applied to specific spots in these locations and eleven of the eighteen sites must be tender.  Additionally, patients must experience symptoms for a period greater than three months.

It is possible to have diagnosis for other diseases such as lupus and rheumatoid arthritis.  FM is not a diagnosis of exclusion, but rather, is diagnosed based on the presenting and reported symptoms that are characteristic to it. 

Causes of FM

The causes of FM are still largely unknown.  Current research would seem to suggest that FM is disorder of central processing with the regulation of neuroendocrine and/or neurotransmitters being affected.  It is believed that pain is being amplified in the central nervous system due to this abnormal chemical and/or hormonal regulation.  However, ongoing research is still required to confirm this theory.

Possible Risk Factors

• Family history or other relative diagnosed with FM
• Illness or injury causing bodily trauma
• Repetitive injuries
• Certain diseases (rheumatoid arthritis, lupus, ankylosing spondylitis)
• Female
• Middle aged
• Sleep disturbances (may be a cause and not a symptom)
• Can occur on its own

Factors That Aggravate The Pain

• Mornings
• Cold/Humid weather
• Non-restorative sleep
• Physical and mental fatigue
• Excessive physical activity
• Lack of physical activity
• Anxiety
• Stress

Treatment

• Pain management
• Regular gentle stretching and exercise
• Allowing time for adequate sleep
• Establishing regular sleep hours
• Avoiding caffeine, alcohol, and sugars
• Good nutrition
• Avoiding eating before sleep
• Relaxation exercises as you fall to sleep
• Psychological support (personal coaching, counselling, support group, etc.)
• Reduce stress
• Cognitive Behavior Therapy for dealing with stress and stressful situations
• Biofeedback
• Deep breathing exercises
• Meditation
• Pacing one’s self

The above treatment and coping strategies will help in the reduction of pain and will enhance the lifestyle of those who are experiencing fibromyalgia.