Fibromyalgia

 

Fibromyalgia (aka - FMS) originally named fibrositis, is a mysteriously debilitating syndrome that attacks women more often than men. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain that often moves about the body. Fibromyalgia can be so severe that it is often incapacitating.

Fibromyalgia is a condition that causes pain in muscles, joints, ligaments and tendons. The dots in the picture at the right represent tender points found in Fibromyalgia patients. These points are often the foundation of the doctors diagnosis.

What is Fibromyalgia?

Fibromyalgia, is a mysteriously debilitating syndrome. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain so severe that it is often incapacitating. Other symptoms include, but are not limited to; chronic muscle pain, aching, stiffness, disturbed sleep, depression, and fatigue. It is estimated that three to six million people are afflicted in the United States alone.

The condition mainly affects women aged 25 to 50 years and bears a striking resemblance to Chronic Fatigue Syndrome. Unfortunately, no one laboratory test or X-ray can diagnose fibromyalgia, however, research has revealed that upon a physical examination: the presence of 18 specific points in muscles, tendons or bones are tender and painful to the touch. These tender points can be used to distinguish fibromyalgia from other painful joint and muscle conditions. The identifying criteria for diagnosing fibromyalgia is pain or tenderness experienced in at least 11 of the 18 points. These tender points can range from mildly irritating to completely debilitating. Roughly 75% of CFS-diagnosed patients will meet the FMS criteria. As a person who suffers from FMS, you may have some degree of constant pain but the severity may vary. You may have a deep ache or a burning pain, muscle tightening or spasms. Most people with fibromyalgia feel tired or out of energy. They are sensitive to odors, bright lights, loud noises and even medicines. Headaches and jaw pain are also common.

Fibromyalgia IS! Fibromyalgia is NOT!!

A neurosomatic disorder

A (non inflammatory) rheumatic disease

A dysfunctional spectrum syndrome

A Musculoskeletal disorder

A pain modulation disorder

A psychiatric disorder

A chronic (often) debilitating condition of unknown etiology

A psychosomatic disorder

Most probably caused by different factors

A form of depression

 

An accident neurosis

 

A malingering behavior

What Causes Fibromyalgia?

The exact cause of Fibromyalgia is unknown. Many different factors, alone or in combination may trigger this disorder. In recent years, studies have shown that in FMS, the muscle is especially vulnerable to decreased circulation and minor injury. Research has also looked at the role of certain hormones or body chemicals that may alter pain, sleep, and mood.

What Can be done?

One of the most effective treatments is low-impact aerobic exercises. (Swimming, water exercise, stationary bicycling) You will probably want to start out at a very low level of exercise (even five minutes a day every other day is helpful) continue until you can increase the time to 20 or 30 minutes at least four times a week. Avoid alcohol and caffeine as they can cause poor sleep quality.

Symptoms of Fibromyalgia

1. PAIN
Pain becomes a part of your daily existence for patients of Fibromyalgia. The Pain of Fibromyalgia (FMS) runs throughout the body. Patients describe the pain as deep muscular burning, throbbing, shooting and stabbing. In a majority of cases, the pain and stiffness are more severe in the mornings. To meet the diagnostic criteria, patients must have widespread pain in all four quadrants of their body for a minimum duration of three (3) months and at least 11 of the 18 specified tender points. These 18  cluster around the neck, shoulder, chest, hip, knee and elbow regions.

2. SLEEP DISORDERS
Most FMS patients have an associated sleep disorder called the alpha-EEG anomaly. Research has found that people with FMS could fall asleep without much trouble, but their deep level (or stage 4) Sleep was constantly interrupted by bursts of awake-like brain activity. Some FMS-diagnosed patients have been found to have other sleep disorders, such as sleep apnea,, restless leg syndrome and teeth grinding.

4. CHRONIC HEADACHES
Recurrent migraine or tension type headaches are seen in about 50% of FMS patients.

5. IRRITABLE BOWEL SYNDROME
Constipation, diarrhea, frequent abdominal pain, abdominal gas and nausea represent symptoms frequently found in roughly 40 to 70% of FMS patients.

6. TMJ
Tempromandibular Joint Dysfunction Syndrome causes tremendous face and head pain in one quarter of FMS patients. Most of the problems associated with this condition are thought to be related to the muscles and ligaments surrounding the joint and not necessarily the joint itself.

Treatment Options for people who suffer from Fibromyalgia

1. Medications

2. Exercise

3. Relaxation

4. Education

5. Diet Regulation

Generally, treatment is geared towards improving the quality of sleep, as well as reducing pain. Why sleep? Because stage 4 sleep (the deepest level of sleep) is so critical for many body functions such as tissue repair, antibody production, and the production of many hormones, neurotransmitters, and immune system chemicals, the sleep disorders that frequently occur in FMS patients are thought to be a major contributing factor to the symptoms of fibromyalgia. If you suffer from fibromyalgia, you probably can't remember the last time that you slept through the entire night, and woke up totally refreshed the next day.

Medications
Medicines that boost your body's level of serotonin—a neurotransmitter that modulates sleep, pain, and immune system function—are often prescribed in low doses. Examples of drugs in this category would include Elavil, Prozac, Flexeril, Sinequan, Paxil, Xanax and Klonopin. in addition, Nonsteroidal, anti-inflammatory drugs (NSAIDS) like Ibuprofen may also be helpful.

Many patients also use other treatments such as trigger point injections with lidocaine, physical therapy, acupuncture, acupressure, relaxation and mind/body techniques, osteopathic or chiropractic manipulation, therapeutic massage or a gentle exercise program.

Exercise
Daily gentle aerobic exercise is very important. While patients who try to do too much exercise too soon or of the wrong type will make themselves temporarily worse, most patients who don't begin a daily aerobic exercise regimen will never notice much improvement in their fibromyalgia. Aerobic exercise is defined as exercise that increases your heart rate for the duration of the exercise period.

How To Tell If Exercise Intensity Is Too Hard
There are a number of guidelines to help you exercise safely and conservatively. Here are some good ones for you to follow:

Exercise should not make you huff and puff. You should be able to breathe comfortably AND carry on a conversation without gasping for breath. this is called "The Talk Test."

Normal, easy breathing is what should occur. There is a difference between "normal, exertional breathing" and "shortness of breath." It is normal to breath a little harder while you are exercising (walking, aerobic dance, etc.) than you do when you are sitting or lying—this is called "Normal, exertional breathing." Normal, exertional breathing is simply that—breathing a little harder than you do at rest because your body is doing something. However, it is NOT having to gasp for breath! Huffing and puffing, having to gasp for breath, having difficulty getting enough breath is called "Shortness of breath" and is a reason for you to slow down or stop your activity until you can once again breathe normally.

Monitor discomfort or pain throughout your body, and especially in your chest, neck, throat, arms, particularly the left arm or jaw—all of the signs that signal angina, or heart pain. At the slightest hint of angina, slow down—reduce the demand for oxygen to the heart muscle—and if the discomfort or pain goes away within 30 seconds or so, you may continue at this slower speed. If it does not go away, stop and allow yourself to recover. You may want to consider seeing your physician to have your heart evaluated for Coronary Artery Disease.

If you can take your pulse, or have a heart rate monitor, notice what your resting heart rate is prior to exercise. During exercise your goal is to increase your heart rate 20 or 30 beats above that resting rate.

For example:

Resting Heart Rate = 70 beats per minute.

Add 20 to 30 beats per minute to that for an exercise rate.

In this example, the Exercise Heart Rate would be 90 to 100 beats per minute.

Your Exercise Heart Rate will vary depending upon your Resting Heart Rate.

Monitoring heart rate is not essential if you will stay in touch with your body as suggested in the previous items. However, if you find yourself to be one of those people whom must push harder and harder every day, if you grew up with the "No Pain—No Gain" ethic, this heart rate method of monitoring exercise intensity is more mechanical and less subjective than other methods and may help slow you down to an appropriate activity level for someone who is interested in a gentle aerobic exercise program.

Remember—Do Less Than You Think You Can. Have something left at the end of your exercise so you will feel like coming back and doing it again tomorrow. This is not what your high school coach or gym teacher told you. But you are probably not 18 anymore either—AND you have fibromyalgia. Your body will not like you if you push to "Work through the pain," or "Go for the burn." If you are in pain or discomfort you are doing too much and need to slow down or quit until you have recovered. It is more important to do something regularly for a longer period of time almost every day than it is to do something harder. If you get to choose (You do!), do your activity longer instead of harder.

Here is something interesting for fibromyalgia patients. Exercise seems not to work through conditioning of muscles but rather through a direct, possibly hormonal effect on pain and sleep, which explains why you don't need to exercise painful muscles for the pain in them to decrease. Daily exercise is essential. Patients who have been exercising regularly and then miss a day usually find that their fibromyalgia symptoms are significantly worse for the next day or two.

The kind of exercise is unimportant. Just make sure to pick something that doesn't make you hurt worse. It may take trying several different kinds before finding one or more types that agree with you. Popular kinds include walking, a water exercise program, regular or exercise bicycles, other exercise equipment, and "gentle" aerobic dance. Jogging, vigorous aerobic dance, and weight lifting tend not to very good choices. If your pain is mainly in your legs or back, exercise just your arms or try exercising in the water.

While many patients insist that they get plenty of exercise at work, doing housework, or in their yard, it is rarely the right kind. Effective exercise must result in a sustained elevation of the heart rate, and these incidental kinds of exercise are usually stop and go and may instead increase your pain. You need to set aside a time specifically for daily exercise.

Particularly if you are out of shape, start out with just 3-5 minutes of exercise and gradually increase as tolerated, shooting for twenty to thirty minutes. Take a few minutes to stretch your muscles, then start out slowly, increasing to full speed after a minute or two. Slow down again for the last minute or two and repeat the stretches. There are five recommended stretches, each done for 20 seconds a side. They should be gentle and painless. Hold onto a tree or post for support for #s 3-5:

1. Shrug your shoulders in a circular motion.
2. Reach your arm over your head and bend to the opposite side.
3. Bend forward with your legs straight.
4. Pull your foot towards your buttock while standing on the other leg.
5. With your feet flat on the ground and one foot ahead of the other, lean forward, bending just the front knee

Exercise is most effective if done in the late afternoon or early evening. If you absolutely can't do it then, exercising earlier in the day is better than not exercising at all, but you will probably need to exercise longer for the same effect. Don't exercise just before bed as this may interfere with sleep. Some patients find that exercise provides an immediate benefit, making them feel more alert and comfortable for several hours. If you experience this effect, you may want to try exercising on awakening and at noon as well. Some patients for whom this works may not need medication AEROBICS CAN CONQUER FATIGUE Aerobic exercise can help patients suffering from chronic fatigue syndrome regain their energy, researchers have claimed.

Dr Peter White and colleagues at St. Bartholomew's Hospital in London said experiments on 66 volunteers showed aerobics helped sufferers reduce fatigue and feel better overall.

Exercise Summary
Regular, almost every day.

Comfortable intensity, not hard.

Follow the "Talk Test." You should be able to walk and talk without huffing and puffing.

Warm Up AND Cool Down-you'll feel better and you'll be safer.

Longer is better than harder.

Relaxation Techniques—Mind/Body Applications
(This information is presented for your information only. It is not intended to replace advice from a qualified healthcare professional.)

Relaxation and stress management techniques are effective for many people with fibromyalgia. These include:

1. Eliciting the Relaxation Response
2. Yoga (gentle stretches and breathing)
3. Meditation
4. Guided Imagery and Progressive Muscular Relaxation
5. Cognitive Restructuring

Acute Pain is limited in duration, and the cause is usually known. Chronic pain lasts longer than three months, and the cause is ill defined or unknown. Think of Chronic Pain as a form of Chronic Stress. These techniques help reduce the amount of stress the individual experiences, and therefore help in the management of the chronic pain associated with fibromyalgia.

Chronic Fatigue Syndrome
The term chronic fatigue syndrome (CFS) is used to classify a variety of symptoms whose causes are not entirely clear. Once derided as 'yuppie flu', it is now becoming accepted and recognized by many doctors as a physical disorder.

Diet And Fibromyalgia
From FIBROMYALGIA—NUTRITION RESOURCE CENTER 1-800-229-3376
Fibromyalgia patients should eat a balanced, whole foods diet to provide the body with the nutrients it needs to function well and to replace the nutrients that are depleted on a daily basis. Many of those with Fibromyalgia are high sugar eaters, and therefore every effort should be taken to minimize sugar intake as it an adversely affects energy levels when taken excessively. Avoid acid-forming foods such as red meats, caffeine and carbonated drinks. Saturated fats found in refined foods should be reduced.

Try eliminating common food allergens such as milk, corn, wheat, eggs, and nightshade vegetables such as tomatoes, potatoes, pepper and eggplant.

Adequate protein is also important because it is used for tissue repair, in particular ligaments and tendons which are largely protein. Protein deficiency occurs in the diet when it is deficient in food containing the essential amino acids, or from an inability to digest food properly.

Sufficient Essential Fatty Acid in the diet also appears to be important, especially if it contains Gamma Linolenic Acid or GLA. In a study of 63 patients with post-viral fatigue, and myalgia, Essential Fatty Acid supplementation resulted in improvement in 74% of patients after 1 month and 85% after 3 months. ADRENAL SUPPORT FOR FATIGUE, PAIN, AND STRESS In a recent two year study of 12 Fibromyalgia patients, there was "remarkable improvement" after DHEA (Dehydroepiandosterone) was added to their program. Prior to this study plasma levels of DHEA were tested on the patients revealing low levels of DHEA.

DHEA is a steroid hormone that is produced naturally by the adrenal glands. Some researchers call it "the mother hormone," because it is a metabolic precursor of all other steroid hormones, including estrogen, testosterone, and cortisone. When DHEA levels are low, the body is susceptible to disease and other age-related effects. When DHEA levels are high, the body is at its youthful peak; vibrant, healthy, and able to combat diseases effectively. Stress, anxiety, chronic pain and aging can cause the levels of DHEA to drop dramatically.

Patients in the 2 year study were given between 25 and 50 mg of DHEA. All 12 patients reported a decrease in pain and stiffness, and an increase in energy.

Educational Resources
Education and self-care are your best bet in the treatment of fibromyalgia. There are a number of fibromyalgia support groups around the country. They can be contacted through your local branch of The Arthritis Foundation.

A number of resources are also available on the Internet. Here is a place to get you started:

Fibromyalgia Resources

Fibromyalgia and CFS Basics

Fibromyalgia Network Article

Fibromyalgia CBS Health Watch Article

Ordinary Touches Multiply into Severe Pain for Fibromyalgia Patients