Fibromyalgia
By Dr. Vic Weatherall
Fibromyalgia (FM) is a disorder characterized by achy pain and stiffness in the muscles, tendons, and ligaments of the body. Its cause is unknown but it can be triggered by physical or mental stress, inadequate sleep, injury, exposure to dampness or cold, certain infections, and occasionally rheumatoid arthritis or a related disorder.
Who gets it?
Fibromyalgia is a common disorder affecting 2.1 to 5.7% of the general population. Women are four times more likely to develop FM than men. The incidence of FM increases with age and is most common in women 50 years of age or older.
What are the signs and symptoms?
Individuals with FM can experience a variety of symptoms including
- fatigue
- stiffness (particularly in the morning)
- achy pain in the muscles, tendons, and ligaments
- numbness
- disturbed sleep
- joint or soft tissue swelling
- dry eyes
- intolerance to cold
- poor memory and concentration
- sensitivity to certain foods, medications, and allergens
- a feeling of weakness
A number of other conditions may be present in people with FM, including:
- depression
- tension and migraine headaches
- irritable bowel and bladder
- chronic fatigue syndrome (CFS)
- temporomandibular joint (TMJ) dysfunction
Because of the heightened experience of pain, it is common to become less active as a way of avoiding pain. Decreased activity then leads to muscle deconditioning and prolonged recovery.
Although the person may appear outwardly well, the effects of FM are very real. Fibromyalgia can seriously affect daily activities including work, leisure, and home life. It is often difficult for sufferers to gain understanding and support from their family, friends, and employers. Being in pain, feeling fatigued, and being depressed makes it difficult to remain active, especially when many of these activities worsen the pain.
How is it diagnosed?
Fibromyalgia is diagnosed based on the pattern and location of the pain and does not require specialized equipment or lab tests.
To be diagnosed with FM, a patient must have both
- widespread pain (pain above and below the waist, and on both sides) for a period of 3 or more months
- 11 of 18 active tender points
Tender points have been identified in specific parts of the body and are considered active when pressure to that area causes an increase in pain.
Because some of the symptoms of FM are also common in other types of arthritis, blood tests, x-rays, and other tests may be required to verify the diagnosis.
Individuals who have many of the signs and symptoms of FM, but do not fit the diagnostic criteria, may also benefit from similar treatment.
How is it treated?
Many different treatments are available for FM, with most falling into one of three categories: physical management, lifestyle management, and medication.
Physical management
Physical management includes conditioning exercise, stretching, and proper posture. The key points are listed below:
- Maximum benefit is obtained when that activity produces shortness of breath and perspiration for 30 minutes, three times a week—build up to this level gradually.
- Common conditioning activities are walking, low impact aerobic programs tailored for arthritis, water exercise programs, cycling, and stair climbing.
- Warm up and stretch before beginning exercise.
- Listen to the body to determine the right level of exercise—if there is pain for an extended period, reduce the exercise.
- Heat from a heating pad, shower, or bath may provide some temporary relief.
- Some experts suggest that physical management is dependent upon, or can benefit from, improving mechanical problems of the neck and low back.
- Gentle massage, ultrasound, and certain forms of low force joint mobilization may be helpful.
Lifestyle management
With fibromyalgia, often the patient cannot maintain their usual level of activity and their life may get "out of balance." They must listen to and respect what their body tells them. They should keep a diary over a period of several weeks or longer, and track pain and fatigue levels in relation to other things which are happening such as mood, level of activity, stress and quality of sleep. For example,
- After doing certain activities is the pain a lot worse?
- Staying awake at night from fears and worries?
- Depression making the fatigue worse?
Once aware of the factors which may be out of balance, there are many things which can be done to improve the situation and by doing so the patient will begin to feel more in control of their condition, rather than feeling that the FM is controlling them.
Some possible supplements include
- for pain—valerian root and bromelain
- for fatigue—magnesium, primrose oil, echinasia, borage oil
- for depression—ginko biloba, vitamin B12, St. John’s Wort
- zinc, vitamins B6, C, E, and A
Additional dietary changes could include
- increasing water intake
- increasing fruits and vegetables
- reducing animal protein and fats
- avoiding coffee, sugars, and refined and processed food
Medication
Low dose tricyclic and tetracyclic antidepressant medications are the most effective drugs for treating FM. They work by increasing the amount of time a person spends in deep sleep (Stage 4 sleep), increasing serotonin levels, and by helping to relieve pain. Medications such as pregabalin (Lyrica) are also used to treat fibromyalgia. They work by affecting brain chemicals that send pain signals. Non-steroidal anti-inflammatory drugs (NSAIDS) and corticosteroids are not useful in treating FM.
What is the outcome?
The outcome of FM is variable. Many people are able to remain at work and to lead satisfying, fulfilling lives. Some, however, become quite debilitated and have trouble sustaining their usual level of work and recreational activity. One of the main factors which has been shown to affect outcome, is how quickly treatment begins following the onset of the symptoms.