What is
fibromyalgia?
Fibromyalgia is a common
and disabling disorder affecting about 5 % of the population. the majority
of suffers are women. Despite the condition's frequency, the diagnosis is
often missed. Patients with fibromyalgia usually ache all over, sleep
poorly, are stiff on waking, and are tired all day. They are prone to
headaches, memory and concentration problems, dizziness, numbness and
tingling, itching, fluid retention, crampy abdominal or pelvic pain and
diarrhea, and several other symptoms.
 There
are no specific lab or x-ray abnormalities, but a doctor can make the
diagnosis by finding tender points in characteristic locations.
Fibromyalgia often runs in
families, suggesting an inherited predisposition. It may lie dormant until
triggered by an infection, injury, stress, or sleep disturbance. It is
closely related to the chronic fatigue and irritable bowel syndromes and to
migraines. Some have suggested that these are all just different facets of
the same underlying disorder.
What causes
it?
Fibromyalgia was once
thought to be an inflammatory condition and later a psychiatric one, but
neither of these causes now appears likely. There isn't any reliable
evidence to support fibromyalgia as having inflammation or arthritis at it's
core. When depression and anxiety occur they are more often the result than
the cause of fibromyalgia. Patients with fibromyalgia are no more likely to
be depressed than patients with other chronic painful disorders such as
rheumatoid arthritis. Spinal fluid levels four times normal of the main pain
neurotransmitter substance P suggest that the pain is not imaginary.
We still do not know exactly what causes fibromyalgia, but we know much more
than we did a few years ago. Several good theories have been proposed and
much scientific data gathered. One leading theory links fibromyalgia with an
abnormality of deep sleep. Fibromyalgia patients often note that
not getting enough sleep
or even just staying up an hour late makes their fibromyalgia symptoms worse
the next day. Abnormal brain waveforms have been found in deep sleep in many
patients with fibromyalgia. Fibromyalgia-like symptoms and
tender points
can be produced in normal volunteers by depriving them of deep sleep for a
few days. Low levels of growth hormone, important in maintaining good muscle
and other soft tissue health, have been found in patients with fibromyalgia.
This hormone is
produced almost exclusively in deep sleep, and its production is increased
by exercise. Daily exercise has been found to be an important part of
treatment of fibromyalgia along with steps taken to improve sleep.
Fibromyalgia is also associated with certain immune system changes. These do
not appear to be of the auto immune kind seen in some unrelated disorders
like multiple sclerosis or rheumatoid arthritis, but rather the immune
system appears as if fighting a virus. No virus has been convincingly
demonstrated, and the fact that fibromyalgia does not appear to be
contagious (for example, it is no more common in spouses of affected
patients than in the general population) argues against an infectious cause.
What can
you do about fibromyalgia?
- Medication to improve
deep sleep.
- Regular sleep hours and
an adequate amount of sleep.
- Daily gentle aerobic
exercise and stretching.
- Avoidance of over
exertion and stress.
- Treatment of any
coexisting sleep disorders.
- Patient education.
Medication by itself
is of little value in treating fibromyalgia.
Successful
treatment demands the patient's active involvement in treatment as well as
lifestyle changes. Each of the six parts of treatment above is important. If
any one is omitted, the chance of significant improvement is considerably
reduced.
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