With Fibromyalgia now effecting between 2 to 5% of women (0.5% in men and commonly diagnosed between the ages of 30 to 45 years it is understood that what was thought to be a psychologically based illness is now recognised as a medical condition in its own right and research into the condition has increased. Natural medicine has a huge part to play in the treatment of symptoms and getting to the cause…
- Fibromyalgia causes pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation.
- Fibromyalgia does not cause body damage or deformity.
- Fatigue occurs in 90% of patients with fibromyalgia.
- Irritable Bowel Syndrome can occur with fibromyalgia.
- Sleep disorder is common in patients with fibromyalgia.
- There is no test for the diagnosis of fibromyalgia.
- Fibromyalgia can be associated with other rheumatic conditions.
- Fibromyalgia treatment is most effective with combinations of education, stress reduction, exercise, and medications.
What is Fibromyalgia
Fibromyalgia is a chronic condition characterised by widespread muscle pain and fatigue. The term ‘fibromyalgia’ literally means pain in muscles and fibrous tissues (ie: tendons and ligaments).
The muscle pain, tenderness and stiffness characteristic of this disorder are regarded as non-inflammatory, and are frequently associated with anxiety and sleeplessness. Essentially, fibromyalgia is characterised by three symptoms:
1. Widespread musculoskeletal pain that persists for at least three months with no evidence of inflammation or muscle abnormalities
2. Disordered sleep patterns, especially stage 4 non–rapid eye movement (NREM) sleep
3. Multiple tender points over the body. A tender point is defined as pain when approximately 4 kg of pressure is applied.
Approximately 80% of fibromyalgia sufferers are women and the condition is most commonly diagnosed in the 30 to 45 year age group.
The cause of fibromyalgia is unknown. There are indications that an injury, infection or illness may trigger the condition. There are also indications that hereditary factors are involved in the development of fibromyalgia as sometimes it occurs in several members of one family.
It is thought that fibromyalgia may be due to a malfunction in the way the central nervous system processes pain signals. This leads to people with fibromyalgia experiencing as pain, sensations that other people might perceive as uncomfortable.
Two brain chemicals, Serotonin and Substance P, are thought to play a role in the condition.
Serotonin is a neurotransmitter (a chemical that enables the transmission of nerve impulses) that influences mood, appetite, pain perception, sexual function, anxiety, temperature control and sleep. Studies have indicated that levels of this chemical are lower than usual in people with fibromyalgia.
Substance P, another neurotransmitter, is involved in transmitting pain sensations to the brain and also regulates the way we perceive pain. Some studies have found substantially elevated levels of this substance in people with fibromyalgia.
Other Major causative factors that can contribute to the incidence of fibromyalgia include:
Psycho-social influences: excessive mental/emotional stress
Intake of stimulant drugs: coffee, alcohol, cigarettes, amphetamines, cocaine, etc.
Defective gut and liver detoxification resulting in non-specific immune activation.
Peripheral afferent nerve trauma/ damage due to musculoskeletal injuries.
Hypoadrenal function associated
Patients often attribute a precipitating event to the initial onset of symptoms. These events include: flu-like illness, human immunodeficiency virus, Lyme disease, parvovirus B19, persistent stress, chronic sleep disturbance, and physical trauma.
Studies have proposed that low levels of somatomedin C (or Insulin like growth factor, a mediator of growth hormone function) are implicated as these alter muscle homeostasis, predisposing the patient to muscle trauma and impaired healing
Signs and Symptoms
A person with fibromyalgia can experience a wide range of symptoms but the main ones are muscle and joint pain, stiffness and fatigue.
The one symptom experienced by everyone with fibromyalgia is pain. This pain can be described in various ways, such as an ache, a sharp pain, a throbbing or a burning feeling. The pain is felt throughout the body and on both sides of the body. The pain can move from one part of the body to another. The amount of pain experienced can vary throughout the day and can also worsen with a change in weather, increase in stress, noise, activity and lack of sleep.
Stiffness of muscles and joints is most noticeable in the morning and after a period of rest. This can interfere with work and daily activities such as driving. Keeping moving is the best way to prevent stiffness. If a person has to sit for long periods, he or she can reduce stiffness by regularly getting up to move around and stretch.
Fatigue is experienced by up to 90% of people with the condition. The level of fatigue can vary from person to person, from being barely noticeable to severe. As with the amount of pain experienced, the degree of fatigue can vary throughout the day, from day to day, and may even be absent on occasion.
Many people with fibromyalgia experience sleep problems. There are a number of stages of normal sleep ranging from light to deep sleep. It seems that people with fibromyalgia often lack the deep restorative stages of sleep and often wake feeling un-refreshed.
Over half of people with fibromyalgia experience symptoms such as irritability, forgetfulness, lack of concentration, mood changes, anxiety and depression.
Other symptoms that can be experienced by people with fibromyalgia include:
- Migraine and tension headaches
- Recurrent abdominal pain
- Difficulty swallowing
- Irritable bladder leading to frequent or painful urination
- Numbness and tingling of the extremities
- Dry eyes and mouth.
- Psychological disturbances
- Postexertional muscle pain
- Restless leg syndrome
- Irritable bowel syndrome
- Memory lapses
Not everyone feels all symptoms and the severity of symptoms varies greatly between individuals. There may also be days when more symptoms are present than others. A period when there is an increase in the number and severity of symptoms is known as a “flare”.
Fibromyalgia can be a difficult condition to diagnose as the symptoms of fibromyalgia are often similar to those of other conditions, such as rheumatoid arthritis or chronic fatigue syndrome. Blood tests and x-rays usually return normal results in someone with fibromyalgia but they are often performed in order to rule out other conditions.
In order to make a diagnosis of fibromyalgia the following indicators of the condition will be looked at:
- A history of widespread pain
- At least 11 of 18 specific tender point sites (as shown below)
- Normal blood tests
- Chronic fatigue
- Sleep disturbances
- Skeletal pain (mainly in the neck and back).
Exercise is highly recommended even though people with fibromyalgia may be reluctant to exercise because of their pain. Exercise is important to prevent the muscles from losing strength due to lack of use. Other benefits of regular exercise include sleep promotion, aiding digestion, increasing blood flow and improving muscle tone. It is best to start with small amounts of low impact exercise (such as walking) on a daily basis, and gradually increase this as tolerated.
Rest is also important in managing fibromyalgia. People with fibromyalgia often feel exhausted after only small amounts of activity. It is often helpful therefore, to rest regularly during the day and even during activity if it is needed. Even brief periods of rest (such as 5 to 10 minutes) can be helpful.
Stress reduction is important as increased stress can magnify fibromyalgia symptoms. Finding methods of relaxation (such as reading or listening to music) that suit the individual with fibromyalgia can be helpful in stress reduction. Talking about the condition with friends and family can also be helpful. Some people may find it helpful to work with a professional counsellor or psychologist to develop relaxation techniques and strategies to cope with the pain
Eliminate all food allergens from the diet.
Decrease overall intake of carbohydrates. Eat protein as part of each meal and include moderate amounts of fat.
Eliminate inflammatory foods such as refined foods, sugar, saturated fats (meat and dairy products), alcohol, and caffeine.
Eat whole foods such as vegetables, whole grains, fruits, protein, and essential fatty acids (cold-water fish, nuts, and seeds).
Sleep is often inadequate in quality for people with fibromyalgia. It is not advisable to use sleeping tablets unless they are absolutely necessary, and then only for brief periods of time. Some methods that may help to gain more restful sleep include avoiding alcohol and coffee in the evening, using the bedroom only for sleep (ie: not for working or eating), ensuring the room is dark when trying to sleep and having a regular time for going to bed.
Therapies such as acupuncture/acupressure, hot and cold packs, massage therapy (light), nutritional supplements and dietary modifications, herbal preparations, osteopathy or chiropractic treatment, have proved effective for many people in managing the symptoms of fibromyalgia.
Mind-body techniques may be particularly helpful in reducing symptoms of fibromyalgia and minimising exacerbations. NLP, Cognitive-behavioural therapy, support groups, meditation, visualisations, progressive muscle relaxation, tai chi, yoga, and gentle exercise may alleviate concurrent depression and/or anxiety, as well as improve coping skills, sleep, and sense of well-being
Medication: see medicinenet.com
Contact Sheena Hendon Health for assistance with diagnosis treatment of symptoms and cause of Fibromyalgia and associated Polymyalgia