Fibromyalgia

Fibromyalgia (FM or FMS) is a chronic syndrome (constellation of signs and symptoms) characterized by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. It is not contagious, and recent studies suggest that people with fibromyalgia may be genetically predisposed. It affects more females than males, with a ratio of 9:1 by ACR (American College of Rheumatology) criteria. Fibromyalgia is seen in about 2% of the general population. Recently there has been an increase in the number of diagnoses, which is assumed to be associated with better identification of the disorder. It is most commonly diagnosed in individuals between the ages of 20 and 50, though onset can occur in childhood.

The disease is not directly life-threatening. The degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission; however, the syndrome is generally perceived as non-progressive.

The defining symptoms of fibromyalgia are chronic, widespread pain and tenderness to light touch, and usually moderate to severe fatigue. Those affected may also experience heightened sensitivity of the skin (also called allodynia), tingling of the skin (often needle-like), achiness in the muscle tissues, prolonged muscle spasms, weakness in the limbs, and nerve pain. Chronic sleep disturbances are also characteristic of fibromyalgia -- and not just from discomfort: some studies suggest that these sleep disturbances are the result of a sleep disorder called alpha-delta sleep, a condition in which deep sleep (associated with delta EEG waves) is frequently interrupted by bursts of brain activity similar to wakefulness (i.e. alpha waves). Deeper stages of sleep (stages 3 & 4) are often dramatically reduced.
In addition, many patients experience cognitive dysfunction (known as "brain fog" or "fibrofog"), which may be characterized by impaired concentration and short-term memory consolidation, impaired speed of performance, inability to multi-task, and cognitive overload. Many experts suspect that "brain fog" is directly related to the sleep disturbances experienced by sufferers of fibromyalgia. However, the relationship has not been strictly established.

Other symptoms often attributed to fibromyalgia (possibly due to another comorbid disorder) may include myofascial pain syndrome, chronic paresthesia, physical fatigue, irritable bowel syndrome, genitourinary symptoms (such as those associated with the chronic bladder condition interstitial cystitis), dermatological disorders, headaches, myoclonic twitches, and symptomatic hypoglycemia. Although it is common in people with fibromyalgia for pain to be widespread, it may also be localized in areas such as the shoulders, neck, back, hips, or other areas. Many sufferers also experience varying degrees of temporomandibular joint disorder. Not all patients have all symptoms.

Symptoms can have a slow onset, and many patients have mild symptoms beginning in childhood, that are often misdiagnosed as growing pains. Symptoms are often aggravated by unrelated illness or changes in the weather. They can become more tolerable or less tolerable throughout daily or yearly cycles; however, many people with fibromyalgia find that, at least some of the time, the condition prevents them from performing normal activities such as driving a car or walking up stairs. The syndrome does not cause the inflammation as is present in rheumatoid arthritis, although some NSAIDs may temporarily reduce pain symptoms in some patients. Their use however is limited, and often of little to no value in pain management.

The cause of fibromyalgia is still unknown. Fibromyalgia can, but does not always, start as a result of some trauma such as a traffic accident, major surgery, or disease. Some evidence shows that Lyme Disease may be a trigger of fibromyalgia symptoms. Another study suggests that more than one clinical entity may be involved, ranging from a mild, idiopathic inflammatory process to clinical depression.
Studies have shown that stress is a significant precipitating factor in the development of fibromyalgia, and that PTSD is linked with fibromyalgia. The Amital study found that 49% of PTSD patients fulfilled the criteria for FMS, compared with none of the controls.
Related to this is the idea that fibromyalgia may be a psychosomatic illness. One controversial theory of this nature has been popularized in the books of Dr. John E. Sarno, as a theoretical condition to which Dr. Sarno has given the name of "tension myositis syndrome". Dr. Sarno's theory claims that in many cases chronic pain is the result of physical changes in the body caused by a person's subconscious as a strategy for distracting from painful or dangerous unconscious emotions, such as repressed anger. Dr. Sarno believes that this can be treated through a program of education and attitude change (and in some cases, psychotherapy) which stops the brain from using that chronic pain strategy.

Electroencephalography studies have shown that people with fibromyalgia lack of slow-wave sleep and circumstances that interfere with stage four sleep (pain, depression, serotonin deficiency, certain medications or anxiety) may cause or worsen the condition. According to the sleep disturbance theory, an event such as a trauma or illness causes sleep disturbance and possibly initial chronic pain that may initiate the disorder. The theory supposes that stage 4 sleep is critical to the function of the nervous system, as it is during that stage that certain neurochemical processes in the body 'reset'. In particular, pain causes the release of the neuropeptide substance P in the spinal cord which has the effect of amplifying pain and causing nerves near the initiating ones to become more sensitive to pain. Under normal circumstances, areas around a wound to become more sensitive to pain but if pain becomes chronic and body-wide this process can run out of control. The sleep disturbance theory holds that deep sleep is critical to reset the substance P mechanism and prevent this out-of-control effect.

The sleep disturbance/substance P theory could explain "tender points" that are characteristic of fibromyalgia but which are otherwise enigmatic, since their positions don't correspond to any particular set of nerve junctions or other obvious body structures. The theory posits that these locations are more sensitive because the sensory nerves that serve them are positioned in the spinal cord to be most strongly affected by substance P. The theory could also explain some of more general neurological features of fibromyalgia, since substance P is active in many other areas of the nervous system. The sleep disturbance theory could also provide a possible connection between fibromyalgia, chronic fatigue syndrome (CFS) and post-polio syndrome through damage to the ascending reticular activating system of the reticular formation. This area of the brain, in addition to apparently controlling the sensation of fatigue, is known to control sleep behaviors and is also believed to produce some neuropeptides, and thus injury or imbalance in this area could cause both CFS and sleep-related fibromyalgia.

Critics of the theory argue that it does not explain slow-onset fibromyalgia, fibromyalgia present without tender points, or patients without heightened pain symptoms, and a number of the non-pain symptoms present in the disorder.

Other theories relate to various toxins from the patient's environment, viral causes such as the Epstein-Barr Virus, growth hormone deficiencies possibly related to an underlying (maybe autoimmune) disease affecting the hypothalamus gland, an aberrant immune response to intestinal bacteria, neurotransmitter disruptions in the central nervous system, and erosion of the protective chemical coating around sensory nerves. A 2001 study suggested an increase in fibromyalgia among women with extracapsular silicone gel leakage, compared to women whose implants were not broken or leaking outside the capsule. This association has not repeated in a number of related studies, and the US-FDA concluded "the weight of the epidemiological evidence published in the literature does not support an association between fibromyalgia and breast implants." Due to the multi-systemic nature of illnesses such as fibromyalgia and chronic fatigue syndrome (CFS/ME), an emerging branch of medical science called psychoneuroimmunology (PNI) is looking into how the various theories fit together.

Another hypothesis on the cause of symptoms in Fibromyalgia states that patients suffer from vasomotor dysregulation causing improper vascularflow and hypoperfusion (decreased blood flow to a given tissue or organ).

Vitamin D has also been shown to have great effects on the treatment of fibromyalgia. People with persistent, non-specific musculoskeletal pain should be screened regularly for vitamin D deficiency, the leading study in the December 9, 2003 Mayo Clinic Proceedings reports. Research conducted at the University of Minnesota found that 93 percent of all subjects with non-specific musculoskeletal pain were vitamin D deficient.

A study of 150 children and adults at the University of Minnesota found that 100 percent of African-American, East African, Hispanic, and Native American subjects were vitamin D deficient. In addition, all study patients under age 30 were vitamin D deficient. Of these, 55 percent were severely deficient. Five patients unexpectedly had no vitamin D at all.

Treatment

  • Trial of Vitamin D of 2000 IU per day for at least 30 days
    • Check symptoms after 30 days to see if there is a difference
    • We carry some great products for just this
    1. Metagenics ISO D3 which has 2000 IU of vitamin D
    2. OrthoMolecular Vitamin D from 1000 IU to 5000 IU
  • Start exercising
    • Studies have found exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia.
  • Chiropractic Care
  • Acupuncture
  • Massage Therapy
  • Physical Therapy
Manage diet, sleep, stress and activity.