Fibromyalgia

Definition:

Fibro - refers to fibrous tissues such as tendons and ligaments.

my - muscle

algia - pain

Fibromyalgia or Fibromyalgia Pain Syndrome (FMS) is a chronic pain condition, that can lead to exhaustion. There are many symptoms and also a connection with other health problems such as arthritis, CFS, thyroid, etc. 

Fibromyalgia affects men, women, and children. However, women between the age of 25 and 50 seem most affected (the ratio of women to men is 10 to 1). Children are often misdiagnosed as having growing pains or behavioral problems.

Diagnosis:

Fibromyalgia is diagnosed in two steps.

1. Other illnesses and conditions are ruled out using
1. a medical history and
2. laboratory tests.
2. Apply the criteria explain below. (In 1986, a committee of 24 doctors from medical centres across North America began a study to determine criteria for the classification of Fibromyalgia.)

• History of widespread pain (present for at least three months). Pain is considered widespread when it is felt in ALL of the following regions:

1. left side of the body
2. right side of the body
3. above the waist
4. below the waist
5. axil skeleton (cervical spine or anterior chest or thoracic spine or lower back). Shoulder and buttock pain is considered pain on the side or sides reported; 'lower back' is considered pain below the waist.

• Pain on digital palpitation in 11 of the 18 tender point sites (9 on each side) (see Figure).

For a tender point to be considered positive, the person MUST state that the palpitation was 'painful'. Digital palpitation should be performed with an approximate force of four kg. 

Musculoskeletal pain and fatigue experienced by Fibromyalgia patients is a chronic problem which tends to have a waxing and waning intensity. There is often a concern on the part of patients and sometimes physicians, that FMS is the early phase of some more severe disease, such as multiple sclerosis, systemic lupus esthematosus, etc. Long term follow up of Fibromyalgia patients has shown that it is very unusual for them to develop another rheumatic disease or neurological condition. However, it is quite common for patients with "well established" rheumatic diseases, such as rheumatoid arthritis, systemic lupus and Sjogren's Syndrome to also have Fibromyalgia. Patients with Fibromyalgia do not become crippled with the condition, nor is there any evidence it effects the duration of their expected life span. Nevertheless, due to varying levels of pain and fatigue, there is inevitable contraction of social, vocational and avocational activities which leads to a reduced quality of life.

Symptoms:

Fibromyalgia patients have widespread body pain which arises from their muscles. Some FMS patients feel their pain originates in their joints. Pain that emanates from the joints is called arthritis, extensive studies have shown FMS patients do not have arthritis. Although many Fibromyalgia patients are aware of the pain when they are resting, it is most noticeable when they use their muscles, particularly with repetitive activities. Their discomfort can be so severe it may significantly limit their ability to lead a full life. As a consequence of muscle pain, many FMS patients severely limit their activities including exercise routines. This results in their becoming physically unfit, which eventually makes their Fibromyalgia symptoms worse.

Generally people with Fibromyalgia state that they hurt all over, especially in the parts that are used the most. Stiffness, especially on waking, sleep disorders, irritable bowel syndrome (see separate sheet), irritable bladder syndrome, premenstrual syndrome, restless leg syndrome, headaches (especially migraines and tension headaches) (see separate sheet), muscle spasms, cold intolerance, TMJ, cognitive difficulties, numbness and tingling in the extremities are some of the symptoms. Other common symptoms include a decreased sense of energy, disturbances of sleep, and varying degrees of anxiety and depression related to patients' changed physical status.

There are significant similarities between Fibromyalgia and Myofascial Pain Syndrome. MPS is discussed in this booklet as well.

We do not know what causes Fibromyalgia. Many people pinpoint a time when the symptoms started, for example, after a trauma, such as a car accident. Others say that their symptoms came on gradually.

Treatment:

Treatment centers on the symptoms, not the illness.

In general, drugs used to treat musculoskeletal pain, such as aspirin, non-steroidals and cortisone are not particularly helpful in this situation. Also, routine use of sleeping pills such as Halcion, Restoril, Valium, etc. should be avoided as they impair the quality of deep sleep.

Low dosages of antidepressants are often used to treat pain and sleep disorders. Zostrix (capaiscin cream) is a prescription/over-the-counter cream which can be helpful to alleviate pain. It is made from natural ingredients from hot peppers and penetrates through the skin and into muscles.

If you have Fibromyalgia, decrease the amount of stress placed on the liver. If your liver isn't able to function properly, the body becomes more prone to pain, fatigue and allergic reactions. The juice of one half lemon, unsweetened in water, 20 minutes before breakfast daily, can help improve its function (if you have any pain that appears to originate from the gall bladder you may be reacting to the lemon).

Many people with Fibromyalgia may have problems with decreased oxygen flow to the muscles, resulting in lactic acid build-up which leads to pain. To help alleviate this the following can be used daily: B vitamin complex (50 mg once/twice daily), elemental calcium (citrate or aspartate, 1000-1200 mg/daily), magnesium (citrate or aspartate, 400-500 mg/daily), vitamin D (400-600 i.u.) and manganese (150 mg/daily). Apple cider vinegar (must say "pure" on label) can be helpful for reducing muscle pain, as it contains malic acid. Chronic muscle pain has been linked to heavy muscle toxicity with some people and malic acid has the ability to bind with these and carry them out of the body. Two teaspoons of vinegar daily is enough.

Feverfew is a natural pain reliever. It is especially helpful for migraine headaches. The pill form is usually taken (1-2, 125-150 mg up to four times daily) when needed. Although you may need to take it regularly if it does not help your pain. Caffeine may intensify pain. Decaffeinated tea or coffee also have other chemicals (other than caffeine) that can be harmful as well, so do not drink decaffeinated tea or coffee either.

Eat as close to a vegetarian diet as possible. There is arachidonic acid in meat that stimulates the production of inflammation and pain. Those with Fibromyalgia tend to be deficient in the essential fatty acids. Essential fatty acids act as natural anti-inflammatories. You can have your essential fatty acids tested at the Efamol Research Centre in the Coldbrook Industrial Park. If you have a requisition form from your physician the test is paid for through MSI. You may have to ask for the test to be read by a professional on site because many doctors are not able to interpret the results.

Flaxseed oil, borage oil, evening primrose oil are a few of the oils containing essential fatty acids. If you take evening primrose oil take either the marine blend or take cod liver oil with it because fish oil is required to help evening primrose oil work effectively.

If you suffer from digestive problems with Fibromyalgia you can take digestive enzymes containing amylase, protease and lipase (1-2 at each meal) or as needed.

Panax ginseng is good for increasing energy (25-50 mg/daily), but you should not take Panax ginseng if you are diabetic or suffer from hypertension.

Exercise according to the body's needs and ability. Overall, FMS patients must avoid impact loading exertion such as jogging, basketball, high-impact aerobics, etc. Low-impact aerobics such as regular walking, the use of a stationary exercycle and pool therapy utilizing an Aqua jogger (a floatation device which allows the user to walk or run in the swimming pool while remaining upright) seem to be the most suitable activities for FMS patients to pursue. Supervision by a physical therapist or exercise physiologist is of benefit wherever possible. In general, 20 minutes of physical activity, three times a week at 70% of maximum heart rate (220 minus your age) is sufficient to maintain a reasonable level of aerobic fitness.

Massage, hydrotherapy, physiotherapy, heat, and rest are of benefit. None cure Fibromyalgia but give much needed relief from pain.

Massage assists the removal of waste from muscles, while increasing blood and nutrient flow. This results in a greater availability of oxygen to cells.

Massage is useful for those with Fibromyalgia. Fibromyalgia affects all of the major systems (circulatory, respiratory, lymphatic, digestive, immune and endocrine) of the body and all of these systems respond favorably to massage. That means massage helps move a person towards wellness.

Hydrotherapy, a part of some physiotherapy clinics, has been used since the 1930's to address a wide variety of conditions. You may be able to join an aquatic (aerobic in the water) program at your community center. Hydrotherapy gives people benefits such as gravity-free exercise, local heat and massage, relaxation and pain management.

Particularly painful areas often may be helped for a short time (2-3 months) by tender point injections. This involves injecting a tender point with a local anesthetic (usually 1% Procaine) and then stretching the involved muscle with a technique called spray and stretch. It should be noted the injection of a tender point is quite painful (indeed, if it is not painful the injection is seldom successful). After the injection, there is typically a 2-4 day lag before any beneficial effects are noted.

Well that explains a few things.

Lord have mercy on me, a sinner.