Fibromyalgia

Introduction

Fibromyalgia is a chronic condition primarily characterized by aching pain in muscles and fibrous tissues (tendons and ligaments), chronic tiredness and tenderness at particular points across the body. It can come on quickly with flu like symptoms or can have a more gradual onset. The disorder is often associated with chronic fatigue and myalgic encephalomyelitis and exhibits similar psychological and physical ailments. Complications include sleeping problems, digestive problems, problems with memory and concentration, anxiety and a range of problems that differ between individuals.

Fibromyalgia is often found in people between the ages of 20 and 65 and is most common in women of 35 years of age. It is estimated that six million Americans suffer with fibromyalgia. There is no definitive test for fibromyalgia due to the many different signs and symptoms patients may demonstrate. Diagnosis is generally determined by the presence of widespread pain in all four quadrants of the body, for a minimum of 3 months, a number of specific tender points and any number of other related symptoms such as fatigue. It is possible that there is a common genetic predisposition to fibromyalgia and that the condition is likely a result of chemical imbalances in the brain in response to stress.

Sign and Symptoms

The signs and symptoms of fibromyalgia differ between people. Onset of the illness can be sudden or slow and each individual will suffer from different complications. All people with fibromyalgia experience ongoing widespread muscle pain all over the body and have a number of particularly tender points around the neck, shoulder, chest, hip, knee and elbow.

Other common problems with fibromyalgia patients include:

Fatigue– patients may suffer from ongoing physical and mental tiredness, which limits their capabilities.

Sleep problems- Sleep disturbances range from sleep apnea to restless leg syndrome and may further increase fatigue.

Mood Disturbances – Patients may suffer from mood swings and may feel depressed and anxious.

Irritable bowel and bladder- Sufferers are often diagnosed with Irritable Bowel Syndrome, causing their bowel movements to fluctuate between constipation and diarrhea and causing them to experience flatulence, bloating and abdominal pain. Irritable bladder may increase the need to urinate suddenly and more frequently or give a sensation of need to urinate more frequently.

Cognitive impairment (memory and concentration) – Patients may experience poor concentration, an inability to absorb information and loss of memory.

Headaches – Prolonged aching of the head that varies in extremity.

Decreased physical endurance– physical activities are more difficult to undertake and result in extreme exhaustion.

Reduced co-ordination- patients find it difficult to undertake normal activities that require hand eye co-ordination and can be clumsier.

Balance Disturbance –losing balance or feeling dizzy

Morning stiffness – upon waking joints feel stiff and creaky making movement slow and difficult.

Numbness and tingling in the hands and feet­ – A lack of feeling or a pins and needles sensation in hands and feet.

Intolerance to pain – Extra sensitive to even slight pain.

Lightheadedness – patients may experience faintness and spinning, which can lead to nausea.

Nervousness and depression– Patients can feel tense or edgy and extreme sadness causing patients to withdraw and feel hopeless.

Anxiety – An intense sensation of worry or nervousness.

Sensitivity to light, sound, touch and odors– normal levels of light, smells and sound can be overwhelming for patients. In some individual, skin may become very sensitive to touch.

Nausea – general feeling of illness, similar to the feeling before vomiting.

PMS type symptoms – Painful menstruation and pain experienced during sexual intercourse

Pain from exertion – Feeling ill  with flu like body aches from physical activity.

Jaw Pain – Jaw and facial muscle pain.

Causes

The cause of fibromyalgia is unknown. The disorder affects a wide range of individuals between 20 and 65, male and female and in countries all over the world. There is some indication that fibromyalgia may be caused by the body responding to stress, such as a stressful emotional event or a physical injury or viral infection. In some individuals there may be a genetic predisposition.

Some of the possible causes include:

Stressful work, relationships or events may be one of the triggers of fibromyalgia, particularly if the stress is prolonged.

Physical Injury or Trauma
There is some evidence supporting an association between trauma and fibromyalgia.

Viral infection, immune and nervous system dysfunction
Viruses such as the Epstein-Barr virus, immune dysfunction and a disruption in the normal functioning of the nervous system have been associated with fibromyalgia and may be causal.

Gut Dysbiosis
This is an overgrowth of the normal intestinal yeast such as Candida albicans which can proliferate due to antibiotic usage and other factors. This may cause some of the problems associated with fibromyalgia.

In most cases of fibromyalgia, no specific cause can be identified. In a few minor cases however, the cause is known. In these cases the condition is termed secondary fibromyalgia. The causes of secondary fibromyalgia include:

·           Ruptured silicone breast implants

·           Endometriosis

·           HepatitisC

·           Lyme disease

·           Surgery

·           Traumatic injury

·           Repetitive stress injury

Fibromyalgia is a prolonged chronic disorder which often impacts severely on the quality of life of sufferers. Whilst the condition is not fatal, many complications arise for sufferers which can further exacerbate the condition.

The initial onset of fibromyalgia can be traumatic in itself as there is no standard diagnosis for the condition and no physical damage to explain the widespread ongoing pain and fatigue. Sufferers physical capacity and ability to lead a normal live is severely limited placing more pressure on family, friends and work colleagues. Many doctors are unfamiliar with the condition and tell patients the pain is all “in their head”. Such misunderstandings create a stressful environment for the patient, which can make their condition worse. People suffering from fibromyalgia are often unable to work, they may feel useless and that they are a burden on friends and family and may become depressed.

Individuals with fibromyalgia may show abnormal changes in hormone levels and levels of chemicals in the brain. These changes are likely to be a response to stress and pain. Patients may have lower levels of serotonin, and stress hormones which are responsible for controlling pain, emotions and the body’s reaction to physical and psychological stressors. Patients may also have a low level of growth hormones which are essential for bone and muscle growth. Low levels can cause intolerance to cold, muscle weakness, poor concentration and fatigue.

To manage the pain and fatigue patients are often prescribed a range of pain killers, antidepressants and a variety of drugs to treat the various symptoms of fibromyalgia. Often these drugs are used for prolonged periods of time which can have negative side effects and cause other medical problems. As pain is widespread and can become more or less severe without any physical trauma, many patients are unaware of new medical problems that arise. New pain is often put down to being part of the condition and some problems can go untreated putting the patient at greater risk of further illness.

Possible treatment methods

Currently there is no treatment to cure or even reduce the pain and fatigue associated with fibromyalgia. However many various treatment have been introduced to relieve the discomfort of the various ailments affecting sufferers.

Treatments include pain killers, antidepressants and anti-inflammatory medications which are all used to reduce muscle and joint pain and widespread body aches. Pfizer has recently released a drug called Lyrica which has been found to decrease pain and improve function for people with the condition.

Treatment options will differ between patients and some will work for certain individuals and not for others. As such it is important that the patient works closely with their doctor to identify the most effective multi-faceted treatment program.

Some possible programs include:

Physical Therapy and Exercise- Physical activity may increase a sense of well being, and in some cases reduces fatigue and pain. However due to the nature of fibromyalgia, even light exercise can magnify muscle pain extensively causing more distress.

Diet- Eating a healthy, well balanced diet with lots of fresh fruits, vegetables, and whole grains, whilst eliminating food allergens and excessive fat intake is important for fibromyalgia patients.

Stress Reduction- minimizing stressful situations and environments places less strain on patients.

Lyrica (pregabalin)-  reduces pain and improves function. Side effects are dizziness and sleepiness

Antidepressants (Tricyclics): reduces and relieves sleeplessness and muscle pain. These include; Amitryptyline, Desipramine, Doxepin, Amoxapine and Nortriptyline. Side effects are dry mouth, blurred vision, drowsiness and dizziness.

Selective Serotonin-Reuptake Inhibitors (SSRI): increase levels of serotonin in the brain, enhancing sleep and creating a sense of well-being whilst decreasing fatigue. SSRI’s include; Fluoxetine (Prozac), Sertraline, Fluvoxamine and Paroxetine. Side effects are nausea and agitation and loss of libido.

Dual Inhibitors: helps with the fibromyalgia by blocking the transmission of pain signals and helping promote sleep. Some dual inhibitors are Venlafaxine, Duloxetine and Milnacipran

Analgesics– pain relief drugs including; Acetominophen, Aspirin, Ibuprofen, Naproxen, Narcoticsas and Tramadol.

Zolpidem and Zaleplon– used short term to promote sleep.

Group Therapy– sessions managed by a professional therapist with others suffering from fibromyalgia may help individuals discover new coping techniques and feel less alone and helpless.

Multiple alternative therapies are available from many different sources, ranging from herbal remedies to acupuncture. Little evidence supports the effectiveness of many such therapies however some have worked for different individuals.