Fibromyalgia: Is It Real and What Can You Do About It?

Fibromyalgia is a term that is thrown around often in medical circles, usually for patients with chronic pain but no diagnostic reasoning as to why they have the pain. Fibromyalgia is usually characterized with chronic, and in some cases disabling pain in the muscles, ligaments and tendons. They frequently have trouble sleeping, have been diagnosed with irritable bowel syndrome, have bouts of anxiety and depression, and can also suffer from tension headaches, dizziness and TMJ as well. For some patients, these symptoms are not crippling, but greatly affect their lives. But, what is fibromyalgia and what can be done for it? How do you know if you have it? The truth is there are several theories as to why it happens to people, but the treatments are more lifestyle changes, and more independently constructed by a doctor who is intimately knowledgeable about fibromyalgia and the patterns associated with the disorder.

Patients with fibromyalgia usually after several months of suffering and negative diagnostic tests get labeled with this term. Criteria for diagnosing fibromyalgia patients have included tender trigger points, or “knots” in 11 out of 18 designated spots in the body, subjective aching or pain for more than 3 months, normal blood work, specifically sedimentation rate and muscle enzyme levels and normal x-ray findings. Subjectively, or what the patient feels usually includes chronic pain, but can include headaches due to tension in the neck postural muscles, TMJ, and sleep disturbances and fatigue. Recent studies at the Mayo Clinic report that fibromyalgia patients have what is called, Alpha Wave Interrupted Sleep Pattern. This essentially means that deep sleep is being interrupted by increased brain activity, as if the patient is awake. This non-restorative sleep pattern generally affects the mood of the patient and depression has been a secondary by product, because the patient wakens unrefreshed and complaining of pain and exhaustion. It creates a self perpetuating vicious cycle of sleep deprivation, pain and fatigue which further increases the muscular tension in pain that is already present. In addition to these symptoms, it has been reported that approximately 50% of patients with fibromyalgia also suffer from irritable bowel syndrome, according to Dr. Campbell, Clark and Tindall in their article, Clinical characteristics of Fibrositis, published in 1983.

On physical exam, the patient usually is quite normal. The nerves are doing their job, muscle strength is normal, X-rays and lab work are negative, but direct pressure on the trigger points do elicit pain. So what is causing this?? While there is no consensus theory, some known causes include simple triggers like mechanical stress (working at a computer for several hours), deconditioning, abnormal brain reception of pain signals, poor diet and emotional stress. One recent study by Dr. Barb Loevinger of the University of Wisconsin’s Center for Women’s Health and Research found influence with what is called metabolic syndrome. Patients that were overweight, had high cholesterol, increased blood pressure and diabetes couldn’t maintain their sugar levels. Consequently, the sugar was getting converted to fat. Fat interferes with the muscle’s ability to draw sugar in, which makes it harder to exercise. The result of the study revealed lower energy to muscles, and increased pain with exercise. Independent of the study, a general lack of conditioning and exercise exacerbates the condition. Caffeine and other stimulants have also been found to have a detrimental effect on fibromyalgia, and more importantly our emotions are a big factor in our health as well. The psychogenic factor, or stress management is imperative to pain relief. In fibromyalgia, it has been found that the brain receptors to pain signals overreact to different stimuli. During stressful times, our body generates hormones that lower our pain tolerance. Coupled with the already increased sensitivity, stress usually leads to increased discomfort.

The good news is that the management of fibromyalgia has been successful, but is more of an art than a science. Patients need to be encouraged to help themselves, and that their lifestyle changes are going to play a big part in their recovery. Without patient cooperation, treatment of fibromyalgia can become frustrating and prolonged. The important issue beyond patient cooperation is making sure that all facets of care are followed through with. First, it is important to stay away from sugars and stimulants such as caffeine. In addition, MSM, a popular supplement has been found to be effective with pain management. Second, exercise must be a priority. Contraction based exercises such as weightlifting are not beneficial and will actually make the person feel worse most of the time. Eccentric exercises are needed which elongate the muscle. Yoga, swimming, stretches and massage therapy are extremely beneficial along with a general cardiovascular program. Stress management is also crucial. Exercise is an optimum way to manage stress, as is cognitive therapy. A good attitude is vital. Chiropractic manipulation is to be performed when necessary. If evidence exists to adjust a patient, then it has been effective, but some patients have joint looseness and manipulation, therefore would not be the treatment of choice. In summary, if you have been diagnosed with fibromyalgia or have symptoms similar to those described, consult a physician who has experience with this condition, and rest assure, that there is hope for the management of this disorder.

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