WHAT IS FIBROMYALGIA SYNDROME?
FMS (fibromyalgia
syndrome) is a widespread musculoskeletal pain and fatigue
disorder for which the cause is still unknown. Fibromyalgia
means pain in the muscles, ligaments, and tendons – the soft
fibrous tissues in the body.
Most
patients with fibromyalgia say that they ache all over. Their
muscles may feel like they have been pulled or overworked.
Sometimes fibromyalgia symptoms may include muscle twitches and
burning sensations. More women than men are afflicted with
fibromyalgia, and it shows up in people of all ages.
To help
your family and friends relate to your fibromyalgia symptoms,
have them think back to the last time they had a bad flu. Every
muscle in their body shouted out in pain. In addition, they felt
devoid of energy as though someone had unplugged their power
supply. While the severity of symptoms fluctuate from person to
person, FMS may resemble a post-viral state. This similarity is
the reason experts in the field of FMS and chronic fatigue
syndrome (CFS) believe that these two syndromes may be one and
the same. Gulf War syndrome also overlaps with FMS/CFS.
FIBROMYALGIA
SYMPTOMS AND ASSOCIATED SYNDROMES
Pain
- The pain of FMS has no boundaries. People describe the pain as
deep muscular aching, throbbing, shooting, and stabbing. Intense
burning may also be present. Quite often, the pain and stiffness
are worse in the morning and you may hurt more in muscle groups
that are used repetitively.
Fatigue - This symptom can be mild in some patients and
yet incapacitating in others. The fatigue has been described as
"brain fatigue" in which patients feel totally drained of
energy. Many patients depict this situation by saying that they
feel as though their arms and legs are tied to concrete blocks,
and they have difficulty concentrating, e.g., brain fog.
Sleep disorder
- Most FMS patients have an associated sleep disorder called the
alpha-EEG anomaly. This condition was uncovered in a sleep lab
with the aid of a machine which recorded the brain waves of
patients during sleep. Researchers found that most FMS patients
could fall asleep without much trouble, but their deep level (or
stage 4) sleep was constantly interrupted by bursts of
awake-like brain activity. Patients appeared to spend the night
with one foot in sleep and the other one out of it.
Sleep lab tests may not be necessary to determine if you have
disturbed sleep. If you wake up feeling as though you've just
been run over by a Mack truck – what doctors refer to as
unrefreshing sleep – it is reasonable for your physician to
assume that you have a sleep disorder. Many FMS patients have
been found to have other sleep disorders in addition to the
alpha-EEG, such as sleep apnea (as well as the newly discovered
form of interrupted breathing called upper airway resistance
syndrome, or UARS), bruxism (teeth grinding), periodic limb
movement during sleep (jerking of arms and legs), and restless
legs syndrome (difficulty sitting still in the evenings).
Irritable Bowel Syndrome - Constipation, diarrhea,
frequent abdominal pain, abdominal gas, and nausea represent
symptoms frequently found in roughly 40 to 70% of FMS patients.
Acid reflux or gastroesophogeal reflux disease (GRED) also
occurs with the same high frequency.
Chronic
headaches - Recurrent migraine or tension-type headaches are
seen in about 70% of FMS patients and can pose a major problem
in coping for this patient group.
Temporomandibular Joint Dysfunction Syndrome - This
syndrome, sometimes referred to as TMJ or TMD, causes tremendous
jaw-related face and head pain in one quarter of FMS patients.
However, a 1997 published report indicated that close to 75% of
FMS patients have a varying degree of jaw discomfort. Typically,
the problems are related to the muscles and ligaments
surrounding the jaw joint and not necessarily the joint itself.
Other common symptoms - Premenstrual syndrome and painful
periods, chest pain, morning stiffness, cognitive or memory
impairment, numbness and tingling sensations, muscle twitching,
irritable bladder, the feeling of swollen extremities, skin
sensitivities, dry eyes and mouth, dizziness, and impaired
coordination can occur. Patients are often sensitive to odors,
loud noises, bright lights, and sometimes even the medications
that they are prescribed.
Aggravating factors - Changes in weather, cold or drafty
environments, infections, allergies, hormonal fluctuations
(premenstrual and menopausal states), stress, depression,
anxiety and over-exertion may all contribute to symptom
flare-ups.
POSSIBLE CAUSES
The cause
of FMS remains elusive, but there are many triggering events
thought to precipitate its onset. A few examples would be an
infection (viral or bacterial), an automobile accident or the
development of another disorder, such as rheumatoid arthritis,
lupus, or hypothyroidism. These triggering events probably don't
cause FMS, but rather, they may awaken an underlying
physiological abnormality that is already present.
What could this abnormality be? Theories pertaining to
alterations in pain-related chemical transmitters (particularly
substance P, nerve growth factor, serotonin, and norepinephrine),
immune system function (e.g. abnormally elevated levels of
cytokines that form the communications link between your
immunologic and neurologic systems), sleep physiology, and
hormonal irregularities are under investigation. In addition,
modern brain imaging techniques are being used to explore
various aspects of brain function. The body's response to
exercise, stress, and alterations in the operation of your
autonomic nervous system (the one that operates in your
peripheral tissues) are also being evaluated. Substance P and
nerve growth factor are increased threefold and fourfold
(respectively) in the spinal fluid of people with FMS, but
researchers are working to figure out why these elevations
exist. With regards to genetics, its role in FMS is also the
focus of many investigations.
TREATMENT OF
FIBROMYALGIA
Traditional
treatments are geared toward improving the quality of sleep and
reducing pain, which means that a sleep study may aid with
individualizing your therapy. Deep level (stage 4) sleep is
crucial for many body functions (such as tissue repair, antibody
production, and the regulation of various neurotransmitters,
hormones and immune system chemicals). Therefore, the sleep
disorders that frequently occur in FMS patients are treated
first because they may be a strong contributing factor to the
symptoms of this condition. Medications that boost your body's
level of serotonin and norepinephrine (neurotransmitters that
modulate sleep, pain, and immune system function) are commonly
prescribed in low doses, such as amitriptyline, cyclobenzaprine
and Cymbalta. Ambien, Lunesta, clonazepam, and trazodone are
just a few of the medications that may be used to aid sleep.
Ultram may help with the pain, although stronger opioids may be
needed for treating moderate to severe pain. Muscle relaxants,
anti-epileptics (such as Neurontin and Lyrica) and other drug
categories may be prescribed as well. In addition to
medications, most fibromyalgia patients will need to use other
treatment methods as well, such as trigger point injections with
lidocaine, physical therapy, occupational therapy, acupuncture,
acupressure, relaxation/biofeedback techniques, osteopathic
manipulation, chiropractic care, therapeutic massage, or a
gentle exercise program.
WHAT IS THE
PROGNOSIS?
Long term
follow-up studies on FMS have shown that it is chronic, but the
symptoms may wax and wane. The impact that FMS has on daily
living activities, including the ability to work a full-time
job, differs among patients. Overall, studies show that FMS may
be equally as disabling as rheumatoid arthritis.
SELF-HELP
STRATEGIES
Lifestyle modifications may help you
conserve energy and minimize pain. Learn what factors aggravate
your symptoms and avoid them, if possible.
