Fibromyalgia

Introduction

Fibromyalgia affects an estimated 2% to 4% of the population, most of which are female.

The main sensation is one of hurting all over, feeling exhausted constantly. Even after numerous tests, your doctor can't find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia.

Fibromyalgia is a chronic condition characterized by widespread pain in your muscles, ligaments and tendons, as well as fatigue and multiple tender points — places on your body where slight pressure causes pain. Fibromyalgia is more common in women than in men. Previously, fibromyalgia was known by other names such as fibrositis, chronic muscle pain syndrome, psychogenic rheumatism and tension myalgias.

While it may be reassuring to know that fibromyalgia isn't progressive or life-threatening it can and probably will be very annoying to you and your lifestyle. Treatments and self-care steps can improve fibromyalgia symptoms and your general health.

Signs and symptoms

Signs and symptoms of fibromyalgia can vary, depending on the weather, stress, physical activity or even the time of day. Common signs and symptoms include:

1. Widespread pain. Fibromyalgia is characterized by pain in specific areas of your body when pressure is applied, including the back of your head, upper back and neck, upper chest, elbows, hips and knees. The pain generally persists for months at a time and is often accompanied by stiffness.

2. Fatigue and sleep disturbances. People with fibromyalgia often wake up tired and unrefreshed even though they seem to get plenty of sleep. Some studies suggest that this sleep problem is the result of a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. So people with fibromyalgia miss the deep restorative stage of sleep. Nighttime muscle spasms in your legs and restless legs syndrome also may be associated with fibromyalgia.

3. Irritable bowel syndrome (IBS). The constipation, diarrhea, abdominal pain and bloating associated with IBS are common in people with fibromyalgia.

4. Headaches and facial pain. Many people who have fibromyalgia also have headaches and facial pain that may be related to tenderness or stiffness in their neck and shoulders. Temporomandibular joint (TMJ) dysfunction, which affects the jaw joints and surrounding muscles, also is common in people with fibromyalgia.

5. Heightened sensitivity. It's common for people with fibromyalgia to report being sensitive to odors, noises, bright lights and touch.

Other common signs and symptoms include: Depression, numbness or tingling sensations in the hands and feet (paresthesia, mood changes, chest pain, dry eyes, skin and mouth, painful menstrual periods, dizziness and anxiety.

Causes

There are no causes identified yet. A theory for fibromyalgia is that people with it have a lower threshold for pain because of increased sensitivity in the brain to pain signals. But what initiates this process of central sensitization isn't known.
It's likely that a number of factors contribute to the development of fibromyalgia. Other theories as to the cause of fibromyalgia include:

1. Sleep disturbances. Some researchers theorize that disturbed sleep patterns may be a cause rather than just a symptom of fibromyalgia.

2. Injury. An injury or trauma, particularly in the upper spinal region, may trigger the development of fibromyalgia in some people.

3. Infection. Some researchers believe that a viral or bacterial infection may trigger fibromyalgia.

4. Abnormalities of the autonomic (sympathetic) nervous system. Part of your autonomic nervous system — the sympathetic, or involuntary, system — controls bodily functions that you don't consciously control, such as heart rate, blood vessel contraction, sweating, salivary flow and intestinal movements.

5. Changes in muscle metabolism. For example, deconditioning and decreased blood flow to muscles may contribute to decreased strength and fatigue. Differences in metabolism and abnormalities in the hormonal substance that influences the activity of nerves may play a role.

Psychological stress and hormonal changes also may be possible causes of fibromyalgia.

Risk factors

Risk factors for fibromyalgia include:

Sex: Fibromyalgia occurs more often in women than in men.

Age:Fibromyalgia tends to develop during early and middle adulthood. But it can also occur in children and older adults.

Disturbed sleep patterns:It's unclear whether sleeping difficulties are a cause or a result of fibromyalgia — but people with sleep disorders, such as nighttime muscle spasms in the legs, restless legs syndrome or sleep apnea, can also develop fibromyalgia.

Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.

Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis, lupus or ankylosing spondylitis, you may be more likely to have fibromyalgia.

When to seek medical advice

See your doctor if you experience general aching or widespread pain that lasts several months and is accompanied by fatigue. Many of the symptoms of fibromyalgia mimic those of other diseases, such as low thyroid hormone production (hypothyroidism), polymyalgia rheumatica, neuropathies, lupus, multiple sclerosis and rheumatoid arthritis. Your doctor can help determine if one of these other conditions may be causing your symptoms.

Diagnosis

Diagnosing fibromyalgia is difficult because there isn't a single, specific diagnostic laboratory test. In fact, before receiving a diagnosis of fibromyalgia, your doctor may order several medical tests, such as blood tests and X-rays, only to rule out other conditions, such as rheumatoid arthritis, lupus and multiple sclerosis, but they will not confirm fibromyalgia, which by definition is a diagnosis of exclusion.

The American College of Rheumatology has established general classification guidelines for fibromyalgia, to help in the assessment and study of the condition. According to these guidelines, to be diagnosed with fibromyalgia you must have experienced widespread aching pain for at least three months and have a minimum of 11 locations on your body that are abnormally tender under relatively mild, firm pressure.

In addition to taking your medical history, a doctor checking for fibromyalgia will likely press firmly on specific points on your head, upper body and certain joints so that you can confirm which cause pain.

Treatment

In general, treatment for fibromyalgia includes both medication and self-care. The emphasis is on minimizing symptoms and improving general health.

Medications

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

1. Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies and is not usually good nor has proven in research to be useful to fibromyalgia patients.. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Other medications include nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Anaprox, Aleve).

2. Antidepressants. Your doctor may prescribe antidepressant medications such as amitriptyline, nortriptyline (Pamelor) or doxepin (Sinequan) to help promote sleep. Fluoxetine (Prozac) in combination with amitriptyline has also been found effective. Sertraline (Zoloft) and paroxetine (Paxil) may help if you're experiencing depression.
Studies have found that duloxetine (Cymbalta) may help control pain better than placebo in people with fibromyalgia.

3. Muscle relaxants. Taking the medication cyclobenzaprine (Flexeril) at bedtime may help treat muscle pain and spasms. Muscle relaxants are generally limited to short-term use and may cause drowsiness.

4. Pregabalin (Lyrica). Pregabalin may reduce pain and improve function in people with fibromyalgia. It is the first drug approved by the Food and Drug Administration to treat fibromyalgia. Studies show pregabalin reduced signs and symptoms of fibromyalgia in some people. In one study, about half of the participants taking the highest doses of the drug reported at least a 30 percent improvement. Lyrica is not without side effects that include dizziness, sleepiness, difficulty concentrating, blurred vision, weight gain, dry mouth, and swelling in the hands and feet.

Prescription sleeping pills, such as zolpidem (Ambien), may provide short-term benefits for some people with fibromyalgia, but doctors usually advise against long-term use of these drugs.

Benzodiazepines may help relax muscles and promote sleep in the short term, but do not expect your doctor to continue these medications for long as benzodiazepines can become habit-forming, and they haven't been shown to provide long-term benefits.

Doctors don't usually recommend narcotics for treating fibromyalgia because of the potential for dependence and addiction. Corticosteroids, such as prednisone, haven't been shown to be effective in treating fibromyalgia.

Cognitive behavioral therapy

Cognitive behavior therapy seeks to strengthen your belief in your abilities and teaches you methods for dealing with stressful situations. Therapy is provided through individual counseling, classes, and with tapes, CDs or DVDs, and may help you manage your fibromyalgia.

Treatment programs

Programs that combine a variety of treatments may be effective in improving your symptoms, including relieving pain. These interdisciplinary programs can combine relaxation techniques, biofeedback and receiving information about chronic pain. There isn't one combination that works best for everybody. Your doctor can create a program based on what works best for you.

Self-care

Self-care is critical in the management of fibromyalgia. The patient needs to become actively involved in their own care.

1. Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.

2. Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.

3. Exercise regularly. At first, exercise may increase your pain. But doing it regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.

4. Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days.

5. Get rid of ANGER and Traumas. Get yourself a friend and try to talk out your emotional issues. Let lose of them and try living a peaceful life.

Complementary and alternative medicine

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. Some of the more common complementary and alternative treatments promoted for pain management include:

1. Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. In a 2006 Mayo Clinic study, acupuncture significantly improved symptoms of fibromyalgia.

2. Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. The therapy aims to improve blood circulation in the muscle, increasing the flow of nutrients and eliminating waste products.

3. Osteopathy. Doctors of osteopathy go through rigorous and lengthy training in academic and clinical settings, equivalent to medical doctors. They're licensed to perform many of the same therapies and procedures as conventional doctors. One area where osteopathy differs from conventional medicine — but is similar to chiropractic medicine — is in the use of manipulation to address joint and spinal problems, doing it much more effectively and gently than chiropractors.

4. Herbal Medicine. Can certainly help to reduce inflammation. Use herbs such as magnesium, malic acid, 5-hydroxytryptophan, MSM at high doses, SAM-e, Vitamin B12, high dose fish oil, etc.

5. Chinese Assesment and Herbs: By balancing meridians you can certainly help to improve and optimize the body’s function.

6. Diet. Avoid canned and heavily processed food. The patient will need to eat raw and unprocessed foods, drink plenty of water, lean protein. Avoid caffeine, dairy products and wheat. Avoid sugar and artificial sweeteners.

This is a video from a patient's perspective of Fibromyalgia