Fibromyalgia (FM) has been described as being both a “myth” and “real” (and probably everything in between the two). This is a VERY controversial disorder that some doctors push under the rug by saying, “….there is no such thing,” while others stake their reputation on it. So with this wide variance in attitude and beliefs about FM, what ARE the facts?
Fibromyalgia has been defined as “…a complex chronic pain disorder that affects an estimated 10 million Americans” by the National Fibromyalgia Association. FM mainly affects women but both men and children can develop the condition as well. Fibromyalgia can be subtle, hardly interfering with life and all of its activities to being totally disabling, disallowing participation in work and the most desired aspects of daily living.
DIAGNOSIS: In 1990, the American College of Rheumatology (ACR) introduced the diagnostic criteria for FM. This includes a patient's history of “wide spread pain” for at least three months, AND pain in 11 or more of the 18 specific tender points using 4 kg of pressure. Due to the significant controversy about the reality of the disease (as stated in the opening paragraph), ONLY a physician knowledgeable about FM should make the diagnosis. Along with this diagnostic responsibility, ALL other conditions having similar presenting symptoms as FM must be ruled out BEFORE making the diagnosis of FM.
SYMPTOMS: Though the hallmark of FM is widespread, generalized pain (in all four body quadrants), a number of other symptoms are common among FM sufferers. Some of these include fatigue (moderate to severe), sleep disorders, brain fog, irritable bowel syndrome (IBS), headaches (including migraine), anxiety, depression, and environmental sensitivities. Studies suggest that there is a “neuroendocrine” (nerves and hormones) abnormality that may contribute to FM symptoms.
CAUSES: Research has found a genetic link, as FM is OFTEN seen in several family members (among siblings and/or mothers and their children). “Secondary fibromyalgia” arises AFTER other health-related issues occur such as physical trauma (like an acute injury or illness), which can act as a “trigger” for initiating FM. Recently, more attention has been directed to the central nervous system as the “underlying mechanism” for developing FM. Here, the threshold or level of a stimulus that triggers a painful response is found to be much lower in FM patients compared to a healthy group of people (this is called “central sensitization”). Thus, a pain response is amplified in the FM patient due to this lowered threshold of pain tolerance.
TREATMENT: As there is NO KNOWN cure for FM, symptomatic support and functional improvement are two important primary goals when treating patients with the condition. In the medical world, there are MANY drugs that have been utilized for FM (such as sleep aids, muscle relaxers, anti-inflammatory, analgesics, and anti-depressants/-anxiety meds). ALTERNATIVE therapies include massage therapy, chiropractic, myofascial release, acupuncture, herbal supplements, yoga, and other exercise approaches such as swimming and/or simply walking are popular care options for many FM patients. Increasing rest, pacing daily activities (to avoid “over-use”), stress management, exercise, and nutritional support can ALL HELP reduce FM symptoms and improve quality of life!
