fibromyalgia

The aches and pains in his muscles just wouldn’t stop. After the car accident, it seemed like everything was going downhill. She first lost her job, then her boyfriend. Her sleep almost never comes, and if she does, the pain and tightness in her shoulders and neck wake her up. After countless visits to a host of specialists, she finally got a diagnosis. She thought she was going crazy, but the rheumatologist said she had fibromyalgia. Learn about this mysterious ailment, the signs and symptoms, the latest theory about its cause, and some treatment options in this article. For an in-depth look at diet and supplements that may benefit fibromyalgia, see the article “Nutritional Strategies for Fibromyalgia.”

Complicated syndrome

Fibromyalgia (FM) literally means pain in the fibrous connective tissue that surrounds the joints, usually the muscle and tendon that attach muscle to bone. It is not a disease, but a syndrome, which is a set of signs and symptoms that occur together. It is a form of soft tissue rheumatism. The American College of Rheumatology defines FM as widespread pain present for at least three months in combination with tenderness in 11 or more of 18 specific tender points. FM used to be called fibrositis, but that wrong definition meant that an inflammatory condition was present, and that is not the case. Due to the difficulty of diagnosing FM and the similarities it has with other diseases, many people do not receive a proper diagnosis or the diagnosis requires a lot of time and effort. Since FM 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

FM patients typically report “their whole body aches” and describe their pain as stabbing, aching, or aching. They also describe feelings of stiffness, especially on waking. Tenderness is found in 11 of the 18 specific points that have been identified around the body. FM patients may experience fatigue, sleep disturbances, headaches, abdominal pain, bloating, constipation, diarrhea, bladder urgency and frequency, and skin tenderness. FM seems to occur in a vicious circle. Lack of sleep causes muscle pain and fatigue, which leads to less participation in physical activity, which results in depression and more weakened muscles, which leads to more pain, which leads to less sleep.

The 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 the researchers think is that an event, whether emotionally or physically traumatic, leads to overactivity in the CNS. This hyperactivity leads to sleep disturbances, such as the increased number of awakenings found in FM patients. Hyperactivity also affects the ratio of excitatory and inhibitory neurotransmitters. Neurotransmitters are chemical messengers that communicate between nerves. In FM, there appear to be higher concentrations of excitatory neurotransmitters (such as Substance P) and lower concentrations of inhibitory neurotransmitters (such as serotonin). This irregular relationship causes pain amplification in FM patients. The perception of pain in FM patients is normal, but their sensitivity to pain is increased and their tolerance to pain is decreased. CNS overactivity can 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.

FM Management

A combination of medication, cognitive behavioral therapy, relaxation techniques, exercise, and education is recommended as a treatment for FM. Medications that help promote sleep and relaxation have been used, but studies have had mixed results. Nonsteroidal anti-inflammatory drugs (NSAIDs) are no more effective than placebos, and corticosteroid injections make FM symptoms worse. Trigger point injections under local anesthesia can be helpful, but they only have temporary effects, and the authors of a study that showed symptom improvement 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 affective coping strategies, and stress reduction programs have been shown to be successful in the long-term treatment of FM.

Exercise programs that emphasize cardiovascular fitness seem to be the tool to break the cycle of pain. FM patients are unconditioned to avoid exercise. This can lead to more pain due to shortened and tight muscles. Many doctors recommend a balanced program of flexibility, gentle strengthening, and aerobic conditioning. Exercise should be viewed as health training, not sports training. The intensity and duration should start slowly, but become part of the FM patient’s lifestyle. Pool exercises are a good place to start with a gradual progression to land exercises. Physical therapists can help design stretching and exercise programs. The Arthritis Foundation also recommends learning progressive muscle relaxation techniques in addition to exercise and stretching.

The good news

FM is not a life-threatening disease, nor is it physically disabling. Symptoms do not usually worsen and can be lessened with appropriate interventions. Although researchers are still working on a full explanation for the syndrome, progress is moving rapidly. Without a definitive treatment for each FM patient, an individualized approach and experimentation with different methods must be used. In a study of FM patients who still had symptoms ten years after onset, 66% of patients reported that their symptoms had improved somewhat or a great deal, 55% said they felt well or very well, and only 7 % felt they were improving. evil. Of course, education about the syndrome is the first step in understanding and beginning 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. You can find a newsgroup dedicated to fibromyalgia at alt.med.fibromyalgia.

References to request.