Fibromyalgia Syndrome

FMS (fibromyalgia syndrome) is a widespread musculoskeletal pain and fatigue disorder for which the cause is still unknown. Fibromyalgia means pain in the muscles, ligaments and tendons–the fibrous tissues in the body. FMS used to be called fibrositis, implying that there was inflammation in the muscles, but research later proved that inflammation did not exist.

Most patients with fibromyalgia say that they ache all over. Their muscles may feel like they have been pulled or overworked. Sometimes the muscles twitch and at other times they burn. More women than men are afflicted with fibromyalgia, but it shows up in people of all ages.

To help your family and friends relate to your condition, have them think back to the last time they had a bad flu. Every muscle in their body shouted out in pain. In addition, they felt devoid of energy as though someone had unplugged their power supply. While the severity of symptoms fluctuate from person to person, FMS may resemble a post-viral state and this is why several experts in the field of FMS and CFS believe that these two syndromes are one and the same.

SYMPTOMS AND ASSOCIATED SYNDROMES

(1) Pain

The pain of fibromyalgia has no boundaries. People describe the pain as deep muscular aching, burning, throbbing, shooting and stabbing. Quite often, the pain and stiffness are worse in the morning and you may hurt more in muscle groups that are used repetitively.

(2) Fatigue

This symptom can be mild in some patients and yet incapacitating in others. The fatigue has been described as “brain fatigue” in which patients feel totally drained of energy. Many patients depict this situation by saying that they feel as though their arms and legs are tied to concrete blocks, and they have difficulty concentrating.

(3) Sleep disorder

Most fibromyalgia patients have an associated sleep disorder called the alpha-EEG anomaly. This condition was uncovered in a sleep lab with the aid of a machine which recorded the brain waves of patients during sleep. Researchers found that fibromyalgia syndrome patients could fall asleep without much trouble, but their deep level (or stage 4) sleep was constantly interrupted by bursts of awake-like brain activity. Patients appeared to spend the night with one foot in sleep and the other one out of it. In most cases, a physician doesn’t have to order expensive sleep lab tests to determine if you have disturbed sleep. If you wake up feeling as though you have just been run over by a truck–what doctors refer to as unrefreshed sleep–it is reasonable for your physician to assume that you have a sleep disorder.

It should be noted that most patients diagnosed with chronic fatigue syndrome have the same alpha-EEG sleep pattern and some fibromyalgia-diagnosed patients have been found to have other sleep disorders, such as sleep myoclonus or PLMS (nighttime jerking of the arms and legs), restless leg syndrome and bruxism (teeth grinding). The sleep pattern for clinically depressed patients is distinctly different from that found in FMS or CFS.

(4) Irritable Bowel Syndrome

Constipation, diarrhea, frequent abdominal pain, abdominal gas and nausea represent symptoms frequently found in roughly 40% to 70% of fibromyalgia patients.

(5) Chronic headaches

Recurrent migraine or tension-type headaches are seen in about 50% of fibromyalgia patients and are a major problem in coping for this patient group.

(6) Temporomandibular Joint Dysfunction Syndrome

This syndrome, sometimes referred to as TMJD, causes tremendous face and head pain in one quarter of FMS patients. Most of the problems associated with this condition are thought to be related to the muscles and ligaments surrounding the joint and not necessarily the joint itself.

(7) Multiple Chemical Sensitivity Syndrome

Sensitivities to odors, noise, bright lights, medications and various foods is common in roughly 50% of FMS or CFS patients.

(8) Other common symptoms

Painful menstrual periods (dysmenorrhea), chest pain, morning stiffness, cognitive or memory impairment, numbness and tingling sensations, muscle twitching, irritable bladder, the feeling of swollen extremities, skin sensitivities, dry eyes and mouth, frequent changes in eye prescription, dizziness, and impaired coordination can occur.

(9) Aggravating factors

Changes in weather, cold or drafty environments, hormonal fluctuations (premenstrual and menopausal states), stress, depression, anxiety and over-exertion can all contribute to symptom flare-ups.

POSSIBLE CAUSES

The cause of fibromyalgia and chronic fatigue syndrome remains elusive, but there may be many triggers thought to bring it on. A few examples would be an infection (viral or bacterial), an automobile accident or the development of another disorder, such as rheumatoid arthritis, lupus, or hypothyroidism. These triggering events probably don’t cause FMS, but rather, they may awaken an underlying physiological abnormality that’s already present in the form of genetic predisposition.

What could this abnormality be? Theories of alterations in neurotransmitter regulation (particularly serotonin and norepinephrine, and substance P), immune system function, sleep physiology, and hormonal control are under investigation. Substance P is a pain neurotransmitter that has been found to be elevated threefold in the spinal fluid of fibromyalgia patients. Two hormones which have been shown to be abnormal are cortisol and growth hormone. In addition, brain imaging techniques are being used to explore various aspects of brain function–while the structure may be intact, there is likely a dysregulation in the way the brain operates.

COMMON TREATMENTS

Traditional treatments are geared toward improving the quality of sleep, as well as reducing pain. Because deep level (stage 4) sleep is so crucial for many body functions, such as tissue repair, antibody production, and perhaps even the regulation of various neurotransmitters, hormones and immune system chemicals, the sleep disorders that frequently occur in fibromyalgia and chronic fatigue patients are thought to be a major contributing factor to the symptoms of this condition.

Medicines that boost your body’s level of serotonin and norepinephrine–neurotransmitters that modulate sleep, pain and immune system function–are commonly prescribed. Most patients will probably need to use treatment methods such as trigger point injections with lidocaine, physical therapy, acupuncture, acupressure, relaxation techniques, osteopathic manipulation, chiropractic care, therapeutic massage, or a gentle exercise program.

WHAT IS THE PROGNOSIS?

Long term follow-up studies on fibromyalgia syndrome have shown that it is chronic, but the symptoms may wax and wane. The impact that FMS can have on daily-living activities, including the ability to work a full-time job, differs among patients. Overall, studies have shown that fibromyalgia can be equally as disabling as rheumatoid arthritis.

According to a research study, people who meet the criteria for both FMS and CFS tend to be at the more severe end of the spectrum of symptoms and are more likely to become work-disabled.

SELF-HELP STRATEGIES

Lifestyle modifications may help you conserve your energy and minimize your pain. Learn what factors aggravate your symptoms and avoid them if possible. Join your local Lupus support group and discuss this with your GP.