Fibromyalgia by: Elizabeth R
Fibromyalgia is a chronic disorder that deals with musculoskeletal pain. This disorder affects 2% of the general population and tends to affect women more than men (Huynh, et al 2008). Fibromyalgia affects the muscles, ligaments, and tendons of the body. Some patients with fibromyalgia are affected mildly, while others have symptoms that impair their quality of life. The cause of fibromyalgia is unknown . Fibromyalgia may have a genetic component and is likely to run in families. In many cases fibromyalgia begins after a physical or emotional trauma such as a car accident. This seems to trigger the underlying abnormality and causes symptoms to begin (Dell 2007). Patients may have no evidence of inflammation. Fibromyalgia is also known as “ the invisible disability” because it has few signs that can be seen (Dell 2007). There are about 6 million patients in the United States with fibromyalgia. This statistic makes it the third most prevalent rheumatologic disorder in the country (Peterson 2007). Fibromyalgia is not a progressive disease. It is never fatal, and it will not cause damage to the joints, muscles, or internal organs. Over time the condition may improve (
Symptoms of fibromyalgia include chronic musculoskeletal pain, poor sleep, mood disorders, fatigue, and stiffness (Peterson 2007). Patients describe the pain as aching, throbbing, shooting, stabbing, or burning. Along with the pain, there may be muscle spasms which can be so severe that they prevent normal activities (Dell 2007). Pain occurs in tender points located over muscles or over sites where muscle inserts to tendons or bone. Tender points are located in areas such as, the low cervical, second rib, trapezius, lateral epicondyle, gluteal, and the patella (Peterson 2007). Tender points are areas of the body that are painful when gently touched. In addition to these symptoms many patients also experience irritable bladder, restless leg syndrome, hypoglycemia, and memory problems. The cognitive and memory problems include difficulty learning new things, retaining information, and finding the right word. These problems tend to increase during a flare up of symptoms ( Peterson 2005).
An accurate diagnosis of fibromyalgia can sometimes be difficult. Many patients with fibromyalgia tend to see many doctors before receiving the diagnosis ( It is imperative that a precise diagnosis is made using the American College of Rheumatology criteria. This criteria states that the patient must have widespread pain involving all four limbs and the trunk for at least three months. It also states that pain must occur in at least eleven of the eighteen tender point sites ( Abeles et al 2007). Diagnosis is made by a combination of patient history, physical examination, laboratory evaluations, and exclusion of other causes of symptoms confused with fibromyalgia (Peterson 2007). There is a lack of diagnostic testing for fibromyalgia, therefore diagnosis takes an average of five years to complete. This typically causes frustration for the patient. Many lab tests should be completed to rule out other conditions. Doctors should complete a blood cell count, erythrocyte sedimentation rate, and muscle enzymes (Dell 2007). When performing an exam the physician should pay close attention to sleep, fatigue, pain, mood and exercise intolerance (Peterson 2005).
Some muscles are encased with myofascia, a thin translucent film that wraps muscle tissue, gives shape to muscle groups, and holds them together. In patients with fibromyalgia, myofascia is thought to tighten and form fibrous bands in people with tender points, causing muscle spasms with squeezing of the nerves and blood vessels. When these nerves vessels pass through tightened muscle bands numbness occurs. Patients with fibromyalgia tend to get muscle pain from relatively mild exercise. Muscle fibers can tear if they are overworked with simple repetitive motion such as aerobic exercise or household chores. Patients with fibromyalgia may have to begin exercising for only two to five minutes a day going at a slower pace than a person without fibromyalgia. Strenuous exercise such as weight lifting, extensive swimming, and running are rarely tolerated. It is however, very important that the muscles move, stretch, and exercise daily (Peterson 2005).
Neurotransmitter levels are decreased in people with fibromyalgia. Low serotonin levels in patients with fibromyalgia are thought to lead to depression, pain, sleep disorders, anxiety and impaired smooth muscle function. Serotonin is known for its association with depression (Peterson 2005). Other neurotransmitter and hormone levels are also decreased in fibromyalgia patients. Low levels of dopamine, growth hormone, and thyrotropin releasing hormone are known to exist. The growth hormone is necessary for muscle metabolism and repair and is secreted during sleep (Peterson 2005).
The most striking laboratory abnormality, found in most fibromyalgia patients is an elevated, stable level of cerebrospinal fluid substance P. Substance P is involved in the transporting of pain impulses from peripheral receptors to the central nervous system. When substance P levels are increased, the sensitivity of nerves to pain also increase (Peterson 2007). It is projected that when serotonin levels are low and substance P levels are high, people feel more pain. This explains why patients with fibromyalgia experience high levels of pain ( Peterson 2007). Patients with fibromyalgia are thought to have as much pain as those with rheumatoid arthritis. Research regarding neurotransmitters is continuing. This information may help provide a better method for treating fibromyalgia in the future (Peterson 2005).
The majority of patients with fibromyalgia suffer form a sleep disorder. Individuals without fibromyalgia tend to have uninterrupted delta waves in stage four, the deepest sleep. With fibromyalgia stage four sleep is interrupted by alpha waves, causing lighter sleep. Therefore, patients have an alpha-delta sleep pattern of light sleep and very little deep sleep ( Peterson 2005). For most patients with fibromyalgia sleep only lasts about four hours with much tossing and turning. Disturbances in sleep can include delay in falling asleep, non-refreshing sleep, and restless leg symptoms. For these patients poor sleep depends on the amount of pain and fatigue they are experiencing ( Peterson 2007).
In patients with fibromyalgia cognitive and memory problems can be a burden. Some people refer to this as “fibro fog”. This consist of many elements such as difficulty processing information, and difficulty organizing, planning, setting, and meeting goals (Peterson 2005). Decreasing cognitive function, including short-term memory loss and poor multitasking is also reported in association with fibromyalgia (Huynh et al 2008). The decreased neurotransmitters of the central nervous system may be responsible for the memory problems. Decreased sleep and increased pain add to the cognitive difficulties. It is hard to determine if the increased anxiety in fibromyalgia patients comes from these biological components or if it is the patient responding to the frustrating symptoms of the disorder (Peterson 2005).
Treatment for fibromyalgia is geared toward controlling pain and improving function. Two main treatment goals are to improve sleep disorders and establish a regular exercise program. Some form of exercise is necessary for patients with fibromyalgia. Walking 10 to 20 minutes three times a week, swimming, or gentle aerobic classes are good examples. The key is gentle exercise rather than vigorous exercise (Peterson 2005). Patients should know that improvement may take months and symptoms may worsen if the patient is not well conditioned. Patients who have failed exercise programs many times because of pain or fatigue may benefit from an exercise program with a physical therapist (Huynh et al 2008). Physical therapy helps in stretching and loosening muscles. Heat treatments, ultrasound and deep massage are effective. Muscle stretches for the muscle groups around the tender points are best taught by a physical therapist. Any exercise is better than no exercise. Patients should be encouraged to exercise at their own pace (Peterson 2005).
The vast majority of fibromyalgia cases are treated with a combination of medications. Tricyclic antidepressants and selective serotonin re-uptake inhibitors alone or in combination can help patients. Muscle relaxants can also help reduce pain. Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen have not been proven effective when used alone. This is because patients with fibromyalgia have no evidence of inflammation. When used in combination with other medications these drugs have been proven effective (Peterson 2005). Other medications that are used to treat fibromyalgia are, Pregabalin, an anticonvulsant that has been found to decrease pain severity, improve fatigue, sleep and the patients quality of life. Tizanidine, an antispastic that can lower substance P levels, easing pain and improving sleep. Sodium oxybate which increases deep sleep and growth hormone levels which reduces fatigue and pain ( Dell 2007).
Mind-body therapies such as cognitive behavior therapy and meditation based relaxation can improve patients quality of life. Many patients with fibromyalgia find it hard to maintain a positive outlook. These therapies as well as counseling and support groups can help them to remain positive and teach them coping skills (Dell 2007).
Research suggests that fibromyalgia is caused by a problem in how the body processes pain. Therefore, researchers are focusing on ways the body processes pain in order to determine why patients with fibromyalgia have increased pain sensitivity. One of theses studies includes the use of imaging methods to evaluate the status of the central nervous system responses in patients diagnosed with fibromyalgia compared to those with another chronic pain disorder. Another study is examining the use of cognitive behavioral therapy in patients. Researchers hope this will advance their knowledge of the role of psychological factors in chronic pain as well as new treatment options for fibromyalgia (
While there is still no cure for fibromyalgia, better ways to diagnose and treat this disorder continue to be developed. Although many steps have been made in the last decade, fibromyalgia remains a challenging condition. Studies have shown that fibromyalgia patients can reduce symptoms through several treatment options. Working with healthcare professionals, motivated patients can experience a major improvement in their symptoms and quality of life ( Patients with fibromyalgia need to understand their illness and know that their healthcare provider also understands it. Patient education has a therapeutic effect. The most successful way to reduce chronic symptoms in a fibromyalgia patient is a combination of education, exercise, psychological therapy, and medications. It is important that healthcare professionals understand the concerns of the patient affected by this disorder. The goals of treatment are to control pain, improve well-being and daily functioning of the patients ( Peterson 2007). What is most understood is that patients with fibromyalgia experience pain differently than the general population. To be successful, future therapies for fibromyalgia will need to address the pain pathways involved in fibromyalgia (Abeles et al 2007).
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