Fibromyalgia is a chronic medical condition that was once thought to be purely psychological in nature. Today physicians know that has a basis in the physical that is exacerbated by psychological stress. It is characterized by wide spread pain in the ligaments and tendons. Fibromyalgia also causes fatigue and multiple tender points. These are places on the body where even a slight amount of pressure will cause pain. (1)
There are 18 different trigger points or tender sites used in the diagnosis of fibromyalgia. These sites cluster around the neck, shoulder, chest, hip, knee and elbow regions. During an examination the physician applies as much pressure as what would be required to cause a finger nail bed to blanch, or start to become white. Others have found over 75 different tender points but these are not used for diagnostic purposes. They do however cause individuals pain and discomfort.
The slight amount of pressure required to initiate pain points to the fact that these tender points are not deep areas but instead superficial, seemingly directly under the surface of the skin. The actual size is also usually very small. The cause of the pressure points are not known and while it would seem that inflammation is a part of the problem, researchers and physicians have not found signs of inflammation when the tissue has been examined.
Many other chronic pain illnesses will have the same symptoms that overlap with fibromyalgia so in 1990 the American College of Rheumatology published a multi-center study which evaluated a total of 558 different patients. Approximately half were classified as controls who were actually age, sex and pain matched individuals with known problems associated with neck pain, low back pain, tendinitis, rheumatoid arthritis, osteoarthritis, lupus and other painful disorders.
All of these patients had symptoms that mimicked fibromyalgia but the trained examiners in the study were not tricked and could pinpoint those who had fibromyalgia with 88% accuracy. This study was considered the benchmark for inclusion of fibromyalgia as a known physical disorder that could be distinguished from other pain disorders. Many physicians diagnosis fibromyalgia only on the number of tender points found on an individual but this criteria may not be accurate since it was originally created for research purposes and not as a means of diagnosis. (2)
Individuals who suffer from fibromyalgia will also experience overall fatigue, problems with irritable bowel, sleep disorders, chronic headaches, jaw pain which includes TMJ, morning stiffness, menstrual cramping, dizziness or lightheadedness and skin and chemical sensitivities. Symptoms also include a reduced tolerance for exercise and muscle pain which increases after exercise, a feeling of swelling in the hands and feet (without actual swelling), anxiety and depression and jaw or facial tenderness. Some individuals also suffer from an increased number of tension or migraine headaches. (3)
Approximately 2% of the population in the United States suffers from fibromyalgia and women are much more likely to suffer and be diagnosed than men. Some individuals find that the symptoms begin after a physical or emotional trauma but in other cases there appears to be no triggering events.
Physicians use several criteria to diagnose fibromyalgia, only one of which is the discovery of at least 11 different tender points from a list of 18. But even with these tender points the doctor will also do a thorough medical history and physical examination. During the medical history he will ascertain whether there is a history of fibromyalgia or other pain syndromes in the family, a past history of trauma or other possible triggers, as well as current problems with deep muscle pain, fatigue, sleep problems, depression or any of the other symptoms which often are present in individuals who suffer from fibromyalgia.
Unfortunately, there is no conclusive tests used to diagnose this condition and physicians rely on physical examination and medical history in order to accurately pinpoint a diagnosis and make treatment recommendations. Pain management is the first goal in the treatment of fibromyalgia. This involves a multifaceted program which often involves both traditional and alternative therapies. Some individuals find that their pain is well controlled using low doses of antidepressant medications while others get better control from stress management, exercise and hydrotherapy. (4)
Other pain management recommendations can include therapeutic massage to help ease the pain, muscle tension and spasms as well as daily moist heat applications to relieve stiffness. Stress management is a highly important means of gaining control because stress will increase the pain over tender points and decrease everyone’s ability to cope with pain. Avoid making too many commitments and make sure to block out each day for time to rest and relax. Most people also find additional help from deep breathing exercises, guided imagery or other relaxation techniques.
People who suffer from fibromyalgia will find specific factors that will make their pain worse. These things include anxiety, stress, depression, hormonal fluctuations, infections, physical exhaustion, changes in the weather and lack of sleep.
There is no conclusive test which identifies an individual who has fibromyalgia because at this time physicians are unaware of what actually causes the condition. They believe that it is most likely a variety of factors working together that can include genetics, infections and physical or emotional trauma. Repeated stimulation may cause the brains of individuals who suffer with fibromyalgia to change. The change likely involves an increase in the level of certain neurotransmitters that signal pain in the body.
Individuals who are at higher risk of developing this condition have factors that include gender, age, chronic disturbed sleep pattern, family history and rheumatic disease. Women are more likely than men to develop fibromyalgia and the condition often develops during early and middle adulthood. People who have sleep disorders, such as restless leg syndrome or sleep apnea, will also be at higher risk to develop fibromyalgia. Any type of rheumatic disease, such as rheumatoid arthritis or lupus will also place an individual at higher risk for developing fibromyalgia.
Treatment recommendations will also include reducing stress, getting enough sleep, exercising regularly, pacing yourself and maintaining a healthy lifestyle. Individuals who experienced fibromyalgia should limit their caffeine intake, eat healthy foods and find something that is enjoyable and fulfilling in every single day.
Some also find relief using acupuncture, physical therapy, chiropractic care, massage therapy and will do best when they receive support from their family, friends and the community of individuals who also suffer from fibromyalgia. Organizations such as the Arthritis Foundation and the American Chronic Pain Association provide classes and access to support groups where individuals find the level of help and advice they would not find anywhere else.
References
(1) Fibromyalgia Network: Diagnosis
http://www.fmnetnews.com/fibro-basics/diagnosis
(2) American College of Rheumatology: The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity
(3) MayoClinic: Fibromyalgia
http://www.mayoclinic.com/health/fibromyalgia/ds00079/dsection=symptoms
(4) American Family Physician: Treating Fibromyalgia
http://www.aafp.org/afp/2000/1001/p1575.htm
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