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The aches and pains in his muscles wouldn’t stop. After the car accident, it seemed like everything was going downhill. First she lost her job, then her boyfriend. Sleep almost never comes and if it does, the pain and tightness in her shoulders and neck wakes her up. After countless visits to a myriad of specialists, she finally got a diagnosis. She thought she was going crazy, but the rheumatologist said she had fibromyalgia. Learn about this mystery disease, the signs and symptoms, the latest theory on the cause, and some treatment options in this article. For an in-depth review of diet and supplements that may benefit fibromyalgia, see the article “Nutritional Strategies for Fibromyalgia.”
Fibromyalgia (FM) literally means pain in the fibrous connective tissue that surrounds joints, usually muscle and tendon that attaches muscle to bone. It is not a disease, but rather a syndrome, which is a collection of signs and symptoms that occur together. It is a form of soft tissue rheumatism. The American College of Rheumatology defines FM as generalized pain present for at least three months in combination with tenderness at 11 or more of 18 specific tender point sites. FM used to be called fibrositis, but this incorrect definition meant that an inflammatory condition was present, and it is not. Due to the difficulty in diagnosing fibromyalgia and the similarities between fibromyalgia and other illnesses, many people are misdiagnosed or it takes a lot of time and effort to diagnose. Given that fibromyalgia affects 2% of the US population, with a distribution of 3.4% in women and 0.5% in men, it is not a rare syndrome.
Signs and symptoms
Fibromyalgia patients commonly report that they “ache all over” and describe their pain as stabbing, aching, or throbbing. They also describe feelings of stiffness, especially on waking. Pain on palpation is found in 11 of the 18 specific points that have been identified around the body. Patients with fibromyalgia may experience fatigue, trouble sleeping, headaches, abdominal pain, bloating, constipation, diarrhea, bladder urgency and frequency, and skin tenderness. FM seems to occur in a vicious circle. Lack of sleep leads to muscle soreness and fatigue, which leads to less participation in physical activity, which leads to depression, and more deconditioned muscles, which leads to more pain, which leads to less sleep.
central nervous system theory
Many researchers now believe that the central nervous system (CNS) plays an important role in the development of this syndrome. The central nervous system is made up of the spinal cord and the brain. What investigators believe is that an event, whether emotionally or physically traumatic, leads to CNS hyperactivity. This hyperactivity leads to sleep disturbances, like the increased number of awakenings in patients with fibromyalgia. Hyperactivity also affects the ratio between excitatory and inhibitory neurotransmitters. Neurotransmitters are chemical messengers that communicate between nerves. In FM, there appear to be higher concentrations of excitatory neurotransmitters (like substance P) and lower concentrations of inhibitory neurotransmitters (like serotonin). This irregular ratio causes the amplification of pain in patients with FM. FM patients’ pain perception is normal, but their pain sensitivity is increased and their pain tolerance is decreased. CNS hyperactivity can then lead to problems involving all body systems, which explains the seemingly unrelated symptoms of FM. There are even reasons to believe that FM may have a genetic component.
A combination of medications, cognitive behavioral therapy, relaxation techniques, exercise, and education is recommended as treatment for FM. Medications that help promote sleep and relaxation have been used, but studies have shown mixed results. Nonsteroidal anti-inflammatory drugs (NSAIDs) are no more effective than placebos, and corticosteroid injections worsen FM symptoms. Trigger point injections using a local anesthetic can be helpful, but have only temporary effects, and the authors of a study that showed improvement in symptoms still recommended other forms of treatment. Only one high-quality study suggests that real acupuncture is more effective than sham acupuncture. Cognitive-behavioral therapy, which involves learning emotional coping strategies, and stress reduction programs have been shown to be effective in the long-term treatment of FM.
Exercise programs that focus on cardiovascular fitness seem to be the tool to break the circle of pain. Fibromyalgia patients are deconditioned by avoiding exercise. This can lead to additional pain due to shortened and tight muscles. Many doctors recommend a balanced program of flexibility, gentle strengthening, and aerobic conditioning. Exercise should be seen as health training, not sports training. Intensity and duration should start slowly, but become part of the FM patient’s lifestyle. Pool exercises are a good starting point with a gradual progression to land exercises. Physiotherapists can help design exercise and stretching programs. The Arthritis Foundation also recommends learning progressive muscle relaxation techniques in addition to exercise and stretching.
The good news
Fibromyalgia is not a fatal disease and is not physically deforming. Symptoms usually do not worsen and can be alleviated with appropriate interventions. Although researchers are still working on a full explanation for the syndrome, progress is progressing rapidly. Without a definitive treatment for every FM patient, an individualized approach and experimentation with different methods must be used. In a study of patients with fibromyalgia who still had symptoms after ten years of onset, 66% of patients said their symptoms improved a little or a lot, 55% said they felt fine or very well and only 7% thought they were doing well. poorly. Of course, education about the syndrome is the first step to understanding and starting a treatment program. For more information, visit the American College of Rheumatology website at http://www.rheumatology.org or the Arthritis Foundation website at http://www.arthritis .org. You can call the Fibromyalgia Alliance of America, Inc., (614) 457-4222 and the Fibromyalgia Network information line: (520) 290-5508. A newsgroup devoted to fibromyalgia can be found at alt.med.fibromyalgia.
References on request.
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