Fibromyalgia has also been called Fibromyalgia Syndrome, Primary Fibromyalgia Syndrome, Fibrositis, Fibromyositis and Diffuse Myofascial Pain Syndrome. It is a systemic disease that mainly affects the muscles, their attachments (tendons, ligaments) and coverings (fascia).
Fibromyalgia may be considered as soft tissue rheumatism. Fibromyalgia may also affect many other parts of the body, including the stomach, bowels and female organs.
Fibromyalgia is more common in females; 85 to 90 percent of patients are women. The ages of fibromyalgia sufferers range from 40 to 60 years old, but the disease may even be seen as early as the late teens and early twenties.
Pain is widespread, involving at least one fourth or half of the body for at least three months or more. Patients describe the pain as a deep aching, tingling, numbness, stiffness, tenderness or flu-like pain. The skin itself may be tender and may cause pain when gently pinched between the fingers, especially over the shoulders.
Ninety percent of patients with Fibromyalgia complain of being tired, with a lack of energy and decreased tolerance to exercise, especially upon awakening. Sometimes the fatigue may be worse than the pain, making the disease similar to Chronic Fatigue Syndrome.
Most Fibromyalgia patients complain that they wake up tired after not being able to rest at night. Studies have shown that there is a reduction in the restorative phase of sleep in Fibromyalgia patients. The study of brain waves when the patient is asleep demonstrates that during the rest period of sleep (non-REM sleep), there is an intrusion of brain waves similar to those normally seen when the patient is awake.
Recurrent mood changes are seen in about 75 percent of patients with Fibromyalgia. About one-fourth of patients with mood changes have signs of depression. Sometimes depression occurs suddenly and without obvious reason. Chronic anxiety disorder is also commonly seen among Fibromyalgia patients. There is no evidence of psychiatric disease associated with Fibromyalgia.
Irritable bowel syndrome and spastic colon are frequently associated with Fibromyalgia. Patients complain of excessive gas and swelling, abdominal cramping and a bloated feeling. Some patients may have chronic constipation, interrupted with episodes of diarrhea. They may suffer pain during bowel movements. Certain Fibromyalgia patients experience bladder spasm, with pain over the pubic bone, and complain of pain when urinating.
Irregular and painful menstrual periods are associated with Fibromyalgia. Pelvic pain may be so severe at times that these patients often have repeated gynecological examinations or even laparoscopies. Gynecologic conditions such as endometriosis may co-exist with Fibromyalgia and should always be ruled out as the cause of pelvic pain by the gynecologist, before it is attributed to Fibromyalgia. Fibromyalgia patients may also experience pain during sexual intercourse (dyspareunia).
Fibromyalgia patients may show Raynaud's phenomena, a condition where hands or feet turn blue and hurt when exposed to cold. Some Fibromyalgia patients complain of dry skin, dry mouth and dry eyes. Patients may also experience tingling, numbness and electric-like pain in the arms and legs.
Fibrocystic breast disease is common among Fibromyalgia patients. With this condition, breasts are tender and contain cysts. Patients who are diagnosed with fibrocystic breast disease need regular breast examinations and mammograms because of the possibility of cancer. Sometimes pain originates from the chest wall muscles even though the patient may have fibrocystic breast disease as well.
Certain behaviors and conditions tend to aggravate Fibromyalgia, interfere with the treatment and prolong the disease. These are called perpetuating factors, and include the following:
Inactivity tends to cause weakening of already compromised muscles. Weak muscles hurt more initially when forced to do normal activity; therefore, it is essential that an Fibromyalgia patient carry out a regular exercise program as recommended by a physician.
Mental stress, just like physical stress, causes aggravation of Fibromyalgia symptoms, particularly muscular pain. Mental stress causes increased muscle tension, leading to tension headaches and aching muscles. Increased muscle tension tends to put pressure on the blood vessels and can compromise the blood flow to the muscle fibers. When the blood flow is compromised, muscle fibers cannot get adequate oxygen and nutrients and generate pain to show their distress.
Poor body mechanics, like faulty posture and unbalanced gait, cause muscles to contract unevenly and joints to wear out prematurely. Some people acquire poor body posture as a bad habit while trying to lessen pain by avoiding activity on one side. This poor posture then becomes part of the problem.
Smoking is detrimental for Fibromyalgia patients for several reasons. Smoking reduces blood-oxygen content and impairs the already compromised muscle oxygenation further. Nicotine is a potent muscle contractor and causes aggravation of muscle tension and spasm, leading to increased pain. Nicotine is also a stimulant and increases the mental tension, which in turn intensifies pre-existing muscular tension.
As stated earlier, Fibromyalgia is frequently associated with mood changes, which may cause either an increase or decrease in the appetite leading to an unbalanced diet. A poor diet may also aggravate bowel irregularities commonly seen in Fibromyalgia; therefore, a good diet together with vitamin and mineral supplements is an important part of Fibromyalgia treatment.
Hormones that regulate certain body functions play an important role in the development of Fibromyalgia symptoms. Among these, sex hormones, such as progesterone and estrogen, and thyroid hormones are particularly important. Low thyroid function is common in Fibromyalgia patients. Unless hormonal problems are addressed, the muscular pain of Fibromyalgia may be difficult to manage. Infection Chronic and insidious infections may tend to aggravate the symptoms of Fibromyalgia because there may be some weakness in the immunological system of Fibromyalgia patients.
Diagnosis of Fibromyalgia is based on the patient's history and clinical examination. There is no conclusive laboratory test for Fibromyalgia; therefore, other causes of similar symptoms should be ruled out before they are attributed to Fibromyalgia. Sometimes a sleep study may help diagnosis by showing a decrease of restorative sleep.
Currently, there is no cure for Fibromyalgia; however, the disease is manageable with a great deal of patient and physician cooperation. Most of the treatment is done by the patient; therefore, it is important that the patient actively assumes responsibility under the guidance of a knowledgeable and experienced physician.
Regular exercise is the basis of Fibromyalgia treatment. In the beginning, heavy exercise should be avoided and activity gradually increased as tolerated. The recommended type of exercise for Fibromyalgia is low impact such as low impact aerobics, swimming, stationary bicycle and tai-chi. Massage and physical therapy, such as heat application, ultrasound, electrical stimulation and pool therapy may help control the pain.
Adopting good sleep habits will reduce or eliminate the use of sleep medications and their harmful effects. Stimulants such as nicotine and caffeine should be avoided. Patients improve dramatically after a good night's sleep.
Some Fibromyalgia patients tend to use narcotic pain medications to alleviate their symptoms, which can lead to multiple problems. Because Fibromyalgia is a chronic condition, continual or frequent drug use can become habit-forming and lead to addiction. The patient is compelled to use drugs to support addiction, rather than to combat the pain. Narcotics act by slowing the brain function, which means that they magnify the underlying mood disorder and cause depression. All depressant drugs such as narcotic pain killers and Valium-like medications should be avoided at all times.
Medications that treat mood disturbance and depression and directly or indirectly relax the muscles have a beneficial effect of Fibromyalgia. Anti-inflammatory pain killers may occasionally be used, but do not have a proven benefit. Narcotic pain killers, tranquilizers and steroids are detrimental and should be avoided.
Antidepressant medications, especially those which selectively increase the brain level of serotonin by blocking its re-uptake, have been proven beneficial. Although the patient may not be significantly depressed, low doses of these medications help control the pain and improve sleep. Such antidepressants include fluoxentine (Prozac), paroxetine (Paxil) and sertraline (Zoloft).
Another group of antidepressants called tricyclic antidepressants also are useful in the management of Fibromyalgia. Tricyclic antidepressants include amitriptyline (Elavil), nortriptyline (Pamelor), doxepin (Sinequan), desipramine (Norpramin) and many others. This group of medications help the patients rest and sleep better. Although all have certain side effects, one suitable to the patient's need without intolerable side effects can be found. Among the most effective muscle relaxants is the drug cyclobenzaprine (Flexeril). This drug is related to tricyclic antidepressants and has sedative effects. It relaxes the tense muscles and helps the patient sleep better at the same time.
Learning to pace activities and relaxation training can be taught through psychological counseling. Sometimes personal problems that cause mental stress and depression can be resolved with such therapy.
The importance of proper diet was emphasized earlier. There is a question of impaired absorption of vitamins in Fibromyalgia patients, and vitamin and mineral supplements seem to be a reasonable step. Vitamin C and vitamin B complex are often recommended.
Nerve blocks are not mainline treatment of Fibromyalgia, but sometimes may be of significant benefit. Trigger point injections (TPI) are done to suppress the pain emanating from tender spots. TPI helps about 15 percent of Fibromyalgia patients. Patients with Raynaud's phenomenon may need sympathetic nerve block to improve the circulation.