Fibromyalgia (FM) is an increasingly recognized chronic pain illness characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, fatigue and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle and hands, but any body part can be involved. Fibromyalgia patients experience a range of symptoms of varying intensities over time. FM affects approximately 3-6% of the U.S. population of all races and ages. Women are the primary demographic, but FM also affects a large percentage of men.
FM is characterized by the presence of multiple tender points, severe pain, fatigue, sleep disorder, and a constellation of other symptoms. FM encompasses profound, widespread and chronic pain represented as muscular aching, nerve pain and incapacitating fatigue. The severity of the pain and stiffness is often worse in the morning. Environmental factors such as cold/heat, physical and mental activity, anxiety and stress also play a significant role. Many Fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep.
Other symptoms may include: irritable bowel syndrome, headaches and migraines, restless legs syndrome, impaired memory/concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, and vision problems. Neurological symptoms are also present with impaired coordination including numbness, tingling and burning sensations.
There is currently no diagnostic test for Fibromyalgia and most patients take in excess of a year to get a diagnosis. Physicians use patient histories, patient relayed symptoms, tender point examination and a process of elimination to diagnose patients. Complicating this process, FM symptoms overlap with other medical conditions. To receive a diagnosis of FM, the patient must meet the following diagnostic criteria:
While pathology of FM is still unknown, research findings agree that FM is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation. The FM patient experiences pain amplification due to abnormal sensory processing in the central nervous system. An increasing number of scientific studies now show multiple physiological abnormalities in the FM patient, including: increased levels of substance P in the spinal cord, low levels of blood flow to the thalamus region of the brain, HPA axis hypofunction, low levels of serotonin and tryptophan and abnormalities in cytokine function. Recent studies show that patients may be genetically predisposed. FM can develop gradually but studies show that a larger percentage of occurrences are as a result of immediate/acute onset triggered by an illness or injury.
One of the most important factors in improving the symptoms of FM is for the patient to recognize the need for lifestyle adaptation. Most people are resistant to change because it implies adjustment, discomfort and effort. However, in the case of FM, change can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement. Therapy is based upon the individual's presenting symptoms and treatment is mainly based on minimizing symptoms on an individual basis. This usually incorporates a trail and error regimen of prescription medicines in an effort to help relieve pain; sleep disturbances; if present, depression and anxiety. Medications have mixed results and can be supplemented by Alternative therapies. Alternative treatments include therapies such as acupuncture, tai chi and alternative food and herbal supplements. Three medications have been approved by the FDA for treatment of FM. They are Cymbalta, Lyrica and Sevella.
Patients quickly recognize that lifestyles need to be altered. Symptoms and sensitivities may lead to changes in diet; exercise limitations; alterations in activities of daily living according to one's energy level; and sleep/rest management. All may require the assistance of professional clinicians, such as a dietitian, physical and/or occupational therapist, mental health professional and sleep therapist. Other treatments include physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation.