What is Fibromyalgia

Fibromyalgia is a syndrome characterised by fatigue and diffuse muscular pain. Many patients with fibromyalgia describe the symptoms as 'feeling as though they were run over by a truck'. While sleep disturbances are common among sufferers, it is not always clear whether the sleep problems are a symptom of the syndrome or one of its causes.

Fibromyalgia is a relatively common condition, and estimated to affect around 2.5 million people in the United States alone.

Diagnosis

The condition is often diagnosed by a medical specialist known as a rheumatologist. As these doctors specialise in arthritic and autoimmune conditions, they can rule out other conditions that might have similar symptoms. There are no blood tests or x-rays that can tell if a person has fibromyalgia, but a doctor might use these as part of the diagnostic process.

The main diagnostic test involves 'pressure points'. These are certain points along the body that tend to be extremely sensitive to gentle pressure among people with fibromyalgia. If a number of these pressure points are sensitive, and other conditions have been ruled out, a doctor might diagnose fibromyalgia.

Possible Causes

Doctors, researchers, and patients all have many theories as to what causes the condition. A common theme, however, is that of sleep. Most patients with fibromyalgia have disrupted sleep. Among the chronic illnesses that are commonly associated with fibromyalgia, most also have a negative impact on the quality of sleep? An interesting study found that when healthy college students had their sleep disrupted on a regular basis for several weeks, many of them developed the symptoms of fibromyalgia. When they were allowed to return to their previous sleeping habits, the symptoms disappeared.

Many people have undiagnosed sleep disorders, such as sleep apnoea. It is possible that such 'hidden' disorders may be associated with the development of fibromyalgia in some people - hopefully future research will have the answer.

The neurotransmitters1 that determine how our bodies perceive pain may also play a role in fibromyalgia, as might hormone levels. It is possible that the impact of sleep disruption on the development of fibromyalgia is mediated by altered neurotransmitter and/or hormone levels.

Several other causes have also been postulated, including both chronic and acute infections2, injuries, emotional trauma, and muscle abnormalities. It's unlikely that there is only one, simple pathway involved - the development of fibromyalgia may involve the interaction of several of these factors, and these may well vary from person to person.

Treatment

There are several important parts to treatment. Pain management is likely to be one of the first things the patient will be interested in, however.

Medications

Several different medications have been used for pain control in patients with fibromyalgia. Some of the most effective have been antidepressants, including tricyclics such as nortriptyline and SSRIs - selective serotonin reuptake inhibitors, such as fluoxetine3. Some patients or family members see the prescription of antidepressants as 'proof' that the doctors don't really believe in the patient's condition, or that it is an emotional problem. Considerable research has shown that these medications help block the perception of pain, and are used in the treatment of many other types of chronic pain. These medications can also help people with fibromyalgia enjoy a better quality of sleep, which can in turn alleviate symptoms.

While these medications can be useful, in many cases some of the other treatment modalities can help reduce the need for them.

'Sleep Hygiene'

As disrupted sleep has been observed as both a cause and a symptom of fibromyalgia, it is not unsurprising that many treatments focus upon restoring sleep quality. An important component here is keeping to a regular schedule - the grogginess that the average person feels after staying out late or sleeping in is greatly exacerbated by fibromyalgia. Good 'sleep hygiene' is key, which means trying to go to bed and wake at the same times each day. Some of the medications used for pain control in fibromyalgia can also help with sleep; daily exercise suggested below can also help establish more regular and restorative sleeping patterns.

Exercise While many people with fibromyalgia feel that their pain is simply too severe to allow exercising, repeated studies have shown that regular exercise is the most effective treatment for fibromyalgia. It is possible that it has an impact on abnormal neurotransmitter or hormone levels, or helps to alleviate muscular abnormalities. Exercising at roughly the same time each day is also helpful in achieving restorative sleep. If people with fibromyalgia have a difficult time finding ways to exercise without severe pain, a physical therapist can be extremely helpful.

Biofeedback, and Other Sources of Help

Relaxation training and biofeedback can both help patients find better ways of coping with pain. Others report benefits from massage therapy or acupuncture. Some have found that counselling and support groups have helped them cope with the impact that the condition has had upon their lives and relationships.

The Ugly Spiral

Without treatment, fibromyalgia can take a downward spiral. The chronic pain further disrupts sleep and prevents people from exercising. These changes in sleep and exercise patterns make the symptoms of fibromyalgia worse. Between the chronic pain and the isolation resulting from fewer activities, depression can often occur. The depression can then, in turn, worsen the fibromyalgia.

Myths and Misconceptions

It's all in your head. You're just depressed.

Depression can cause fibromyalgia, and the chronic pain of fibromyalgia can lead to depression. This does not, however, mean that they are the same thing. They have different diagnostic criteria, and many people with fibromyalgia do not meet the criteria for any psychiatric or emotional disorders. Because fibromyalgia occurs predominantly in women, it has often been disregarded as a type of PMS or 'female hysteria'. While diseases that can't be easily 'seen' can be harder to understand, people with fibromyalgia are experiencing real pain and real fatigue.

Or maybe you're just faking it. While there are undoubtedly some people who might be faking symptoms of fibromyalgia, they are likely a small minority. One study even found that rheumatologists could dependendably tell the difference between people who truly had fibromyalgia and those who were given an incentive to fake the symptoms. Furthermore, the benefits of faking the symptoms of fibromyalgia would be incredibly small - sadly, the condition tends to elicit more discrimination than sympathy.

Fibromyalgia is an early warning sign of life-threatening illness.

People who are chronically ill with conditions such as lupus, rheumatoid arthritis, or migraines are more likely than healthy people to develop fibromyalgia. However, there's absolutely no evidence that fibromyalgia in of itself has any long-term effects on a person's life expectancy.

Information taken from: http://www.bbc.co.uk/dna/h2g2

Fibromyalgia Causes:

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 body wide 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. (A different mechanism is at work in food intolerance, as opposed to allergy.) 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 non-restorative 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 build-up 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, and 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.

Information taken from: http://psyweb.com/FMS/fibromyalgia.jsp