All About Fibromyalgia
The Ache That Just Won’t Go Away
If you’re over thirty (or under thirty and just not treating yourself that well), you’ve experienced those days when everything hurts. Any movement is a painful experience. Luckily, for most of us, a few Advil or simply the passage of time is enough to resolve things. For some, however, the diffuse achiness is a chronic issue. Scientists are just starting to understand what causes this condition, called fibromyalgia, and only in the last decade or so have there been effective treatments. There is no cure. Fortunately, though, there are proven strategies to help reduce the symptoms and help fibromyalgia sufferers lead a more normal and enjoyable life.
This condition was first described in 1976, and it took more than 10 years for scientists to accept it. A landmark paper published in 1990 helped promote better understanding in the general medical community. “Myo” is the medical term for muscles, and “algia” means pain. So, “fibromyalgia” means painful muscle fibers. It was previously called Fibromaylgia Rheumatica. The added word referred to the now disproven theory that the illness was caused by an autoimmune disorder, a problem caused by the patient’s own immune system inappropriately aimed against itself. The accepted proper name now is Fibromyalgia Syndrome (FMS).
Approximately 5 percent of the population will suffer with FMS at some point in their life. Women are stricken almost eight times more often than men. Of the thousands of cases per year initially diagnosed in the United States, a significant percentage are ultimately found to actually have other disorders, like Lyme disease, rheumatoid arthritis, lupus, or celiac disease. For those for whom the diagnosis of FMS sticks, most will suffer with it for years, if not the rest of their lives.
Doctors consider the diagnosis of fibromyalgia when a patient presents with diffuse muscle aches not explained by overuse or strain. Fatigue and reduced endurance are frequent accompanying symptoms. Mildly reduced cognitive function (called FibroFog) may be present as well. The patient cannot tolerated even light exercise. Routine daily activities that most of us do without a second thought become an exercise in pain tolerance and perseverance. A classic finding is the presence of trigger points, areas of the body that, when touched lightly, provoke marked pain. The scenario is one of exaggerated discomfort and exhaustion to minimal stressors. During a physician evaluation, testing is done to check for the diseases mentioned above. Heavy metal poisoning and vitamin deficiencies are frequently ruled out as well.
The underlying problem of fibromyalgia syndrome is now pretty well understood. It is actually a neurological condition in which there is unregulated transmission of intense pain signals. Normally, an electrical impulse from a body part is modified and dampened before it reaches the part of our brain that allows awareness of it. In this way, the myriad of stimuli we are exposed to every day are manageable. In FMS, a neurochemical imbalance is present, which renders the mechanism that mutes those powerful pain signals ineffective. The neurological basis of this disorder is confirmed by comparison of brain scans of patients with fibromyalgia syndrome to those who are healthy. Distinct differences in the brainstem are noted.
What provokes this nervous system dysfunction at the root of fibromyalgia? Viral infections have been effectively ruled out. Stress remains a possible cause, as there is a correlation between chronic stress and the associated chronically elevated adrenaline level and FMS. Additionally, there is a strong relationship between depression and FMS. It is felt that the same neurochemical imbalance that disrupts mood may also result in nerve hypersensitivity. Sleep deprivation is felt to be a potential cause, too. Studies show that volunteers repeatedly blocked from entering stage IV sleep develop the same inability to inhibit pain messages that FMS sufferers have. One other theory is that sensitivity to gluten (a common component of modern grains) is the trigger.
Treatment for fibromyalgia is in its infancy, and many sufferers have to try several different strategies before finding one that helps them. Total avoidance of gluten as a trial for at least 6 weeks is advised. If helpful, this dietary restriction should be continued indefinitely. Prescriptions are also available to help FMS patients. Medications previously used to calm the nervous system in folks with seizures (Neurontin and Lyrica) can help by suppressing the overly intense pain messages sent to the brain. Serotonin boosters (typically called antidepressants) like Zoloft and Prozac work to restore pain inhibition function and can provide significant relief. Exercise, that cure for so many human ills, also has a place in the treatment of fibromyalgia. Its benefits have been felt to be mainly due to the restoration of normal (including stage IV) sleep. Finally, a specific type of psychological therapy, called Cognitive Behavioral Therapy, can allow an FMS patient to manage their symptoms more effectively and lead to a normal life. It can also alleviate the commonly associated depression. Researchers believe cognitive behavioral therapy should be a part of any FMS treatment plan.
So if you or a loved one are feeling achy and tired all the time, it may be more than just stress and exhaustion. Get checked out by your doctor! There are many scientific options that could help you enjoy a healthier and better quality of life, even if you are found to have that dreaded “mystery” condition, fibromyalgia.
Patrice Thornton, MD, is an internal medicine physician at SVMC Northshire Campus in Manchester Center, VT. The practice is part of Southwestern Vermont Medical Center in Bennington.