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 fibrous tissues in the body. FMS
used to be called fibrositis, implying that
there was inflammation in the muscles, but
research later proved that inflammation did
not exist. Most patients with fibromyalgia say
that they ache all over. Their muscles may
feel like they have been pulled or overworked.
Sometimes the muscles twitch and at other
times they burn. A characteristic of FMS is
the presence of multiple “trigger
points.” More women than men are
afflicted with fibromyalgia, but it shows up
in people of all ages. Fibromyalgia syndrome
affects up to 5% of the population, including
children. This disorder might be hereditary
(run in families), so you may have family
members with similar symptoms.
FMS
sufferers feel like they have a bad flu. Every
muscle in their body aches and is in pain. In
addition, they have virtually no energy. While
the severity of symptoms vary from person to
person, FMS in many ways resembles a
post-viral state, which is why a number
experts in FMS and CFIDS believe that these
two syndromes are one and the same and may be
caused by an as yet unidentified viral agent.
The
Symptoms and Signs of fibromyalgia are
varied:
Pain
- The pain of fibromyalgia has no boundaries.
People describe it as deep muscular
aching, burning, throbbing, shooting
and stabbing. Quite often, the pain and
stiffness are worse in the morning and may be
more intense 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 fog" 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.
Sleep
disorders - 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 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. In most cases, a
physician doesn't have to order
expensive sleep lab tests to determine if you
have disturbed sleep. If you wake up feeling
as though you have just been run over by a
truck - what doctors refer to as unrefreshed
sleep - it is reasonable for your physician to
assume that you have a sleep disorder. It
should be noted that most patients diagnosed
with chronic fatigue syndrome have the same
alpha-EEG sleep pattern and some fibromyalgia-diagnosed
patients have been found to have other sleep
disorders, such as sleep myoclonus or PLMS
(nighttime jerking of the arms and legs),
restless leg syndrome and bruxism (teeth
grinding). The sleep pattern for clinically
depressed patients is distinctly different
from that found in FMS or CFS.
Irritable
Bowel Syndrome - Constipation, diarrhea,
frequent abdominal pain, abdominal gas and
nausea represent symptoms frequently found in
roughly 40% to 70% of fibromyalgia patients.
Chronic
Headaches - Recurrent migraine or
tension-type headaches are seen in about 50%
of fibromyalgia patients and can pose as a
major problem in coping for this patient
group.
Temporomandibular
Joint Dysfunction Syndrome - This
syndrome, sometimes referred to as TMJD,
causes tremendous face and head pain in one
quarter of FMS patients. However, a 1997
report indicates that as many as 90% of
fibromyalgia patients may have jaw and facial
tenderness that could produce, at least
intermittently, symptoms of TMJD. 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.
Multiple
Chemical Sensitivity Syndrome -
Sensitivities to odors, noise, bright lights,
medications and various foods is common in
roughly 50% of FMS or CFS patients.
Other
Common Symptoms - Painful menstrual
periods (dysmenorrhea), 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, frequent changes in eye
prescription, dizziness, and impaired
coordination can occur.
Aggravating
Factors - Changes in weather, cold or
drafty environments, hormonal fluctuations
(premenstrual and menopausal states), stress,
depression, anxiety and over-exertion can all
contribute to symptom flare-ups.
Possible
Causes
The
cause(s) of fibromyalgia remain 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's already
present in the form of genetic predisposition.
What
could this abnormality be? Theories pertaining
to alterations in neurotransmitter regulation
(particularly serotonin and norepinephrine,
and substance P), immune system function,
sleep physiology, and hormonal control are
under investigation. Substance P is a pain
neurotransmitter that has been found by repeat
studies to be elevated threefold in the spinal
fluid of fibromyalgia patients. Two hormones
that have been shown to be abnormal are
cortisol and growth hormone. In addition,
modern brain imaging techniques are being used
to explore various aspects of brain
function--while the structure may be intact,
there is likely a dysregulation in the way the
brain operates. The body's response to
exercise,
stress and simple alterations in position
(vertical versus horizontal) are also being
evaluated to determine if the autonomic
nervous system is not working properly. Your
body uses many neurotransmitters, such as
norepinephrine and epinephrine, to regulate
your heart, lungs and other vital organs that
you don't have to consciously think about.
Ironically, many of the drugs prescribed for
FMS/CFS may have a favorable impact on these
neurotransmitters as well.
COMMON
TREATMENTS
Traditional
treatments are geared toward improving the
quality of sleep, as well as reducing pain.
Because deep level (stage 4) sleep is so
crucial for many body functions, such as
tissue repair, antibody production, and perhaps
even the regulation of various neurotransmitters,
hormones and immune system chemicals; the
sleep disorders that frequently occur in
fibromyalgia and chronic fatigue patients are
thought to be a major contributing factor to
the symptoms of this condition. Medicines that
boost your body's level of serotonin and
norepinephrine--neurotransmitters that
modulate sleep, pain and immune system
function--are commonly prescribed. Examples of
drugs in this category would include Elavil,
Flexeril, Sinequan, Paxil, Serzone, Xanax and
Klonopin. A low dose of one of these
medications may be of help. In addition,
nonsteroidal,
anti-inflammatory drugs (NSAIDs) like
ibuprofen may also be beneficial. Most
patients will probably need to use other
treatment methods as well, such as trigger
point injections with lidocaine, physical
therapy, acupuncture, acupressure, relaxation
techniques, osteopathic
manipulation, chiropractic care, therapeutic
massage, or a gentle exercise program.
WHAT
IS THE PROGNOSIS?
Long
term follow-up studies on fibromyalgia
syndrome have shown that it is chronic, but
the symptoms may wax and wane. The impact that
FMS can have on daily-living activities,
including the ability to work a full-time job,
differs among patients. Overall, studies have
shown that fibromyalgia can be equally as
disabling as rheumatoid arthritis.
On the other hand, follow-up of people meeting
the chronic fatigue sydnrome criteria
indicates that as many as 40% may
significantly improve but few are thought to
completely recover from this syndrome. Longer
term follow-up studies are not available to
indicate whether these "improved"
CFS patients later relapse with an increase in
symptoms. A preliminary follow-up study by the
CDC (Centers for Disease Control) reveals that
for those individuals with chronic fatigue
syndrome who do not recover or significantly
improve after five years duration, their most
prominent symptom changes from fatigue to
muscle pain with concentration problems
(sounds a lot like the permanent syndrome of
fibromyalgia but the CDC is not checking
patients for tender points).
According
to a research study by Dedra Buchwald, M.D.,
people who meet the criteria for both FMS and
CFS tend to be at the more severe end of the
spectrum of symptoms and are more likely to
become work-disabled. Buchwald says her
findings underscore the importance of
recognizing concurrent fibromyalgia and
chronic fatigue syndrome (Rheumatic
Disease Clinics of North America
22(2):219-243, 1996).
SELF-HELP
STRATEGIES
Lifestyle
modifications may help you conserve your
energy and minimize your pain. Learn what
factors aggravate your symptoms and avoid them
if possible. Eating proper, whole grain,
natural foods. Exercise on a regular basis.
Join your local support group and become
informed about your condition.
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useful websites:
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