Marion Pellicano Ambrose
Fibromyalgia is a
disorder characterized by widespread musculoskeletal pain accompanied by
fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia
amplifies painful sensations by affecting the way your brain processes pain signals.
Symptoms sometimes
begin after a physical trauma, surgery, infection or significant psychological
stress. In other cases, symptoms gradually accumulate over time with no single
triggering event.
The pain and fatigue
associated with this disease can be crippling. Constant pain and lack of
sleep,along with this fatigue often leads to depression. The fact that this is
an invisible disease also causes much distress. Family members, coworkers, and
sometimes even medical personnel tend to ignore or downplay the effects of this
disease. Unless one has experienced the horrific effects of Fibromyalgia, they
should not judge. This goes for scoffing at people using handicapped parking or
devices that “look perfectly healthy”.
Women are much more
likely to develop fibromyalgia than are men. Many people who have fibromyalgia
also have tension headaches, temporomandibular joint (TMJ) disorders, irritable
bowel syndrome, anxiety and depression.
While there is no
cure for fibromyalgia, a variety of medications can help control symptoms.
Exercise, relaxation and stress-reduction measures also may help.
The pain associated
with fibromyalgia often is described as a constant dull ache, typically arising
from muscles. To be considered widespread, the pain must occur on both sides of
your body and above and below your waist.
Fibromyalgia is
characterized by additional pain when firm pressure is applied to specific
areas of your body, called tender points. Tender point locations include:
·
Back of the head
·
Between shoulder
blades
·
Top of shoulders
·
Front sides of
neck
·
Upper chest
·
Outer elbows
·
Upper hips
·
Sides of hips
·
Inner knees
Fatigue and
sleep disturbances
People with fibromyalgia often awaken
tired, even though they report sleeping for long periods of time. Sleep is
frequently disrupted by pain, and many patients with fibromyalgia have other
sleep disorders, such as restless legs syndrome and sleep apnea, that further
worsen symptoms.
Coexisting
conditions
Many people who have fibromyalgia
also may have:
·
Fatigue
·
Anxiety
·
Depression
·
Endometriosis
·
Headaches
·
Irritable bowel
syndrome
Doctors don't know
what causes fibromyalgia, but it most likely involves a variety of factors
working together. These may include:
·
Genetics. Because fibromyalgia tends to run in families, there
may be certain genetic mutations that may make you more susceptible to
developing the disorder.
·
Infections. Some illnesses appear to trigger or aggravate
fibromyalgia.
·
Physical
or emotional trauma.
Post-traumatic stress disorder has been linked to fibromyalgia.
Why does it
hurt?
Current thinking centers around a theory
called central sensitization. This theory states that people with fibromyalgia
have a lower threshold for pain because of increased sensitivity in the brain
to pain signals.
Researchers believe
repeated nerve stimulation causes the brains of people with fibromyalgia to
change. This change involves an abnormal increase in levels of certain
chemicals in the brain that signal pain (neurotransmitters). In addition, the
brain's pain receptors seem to develop a sort of memory of the pain and become
more sensitive, meaning they can overreact to pain signals.
Risk factors for
fibromyalgia include:
·
Your sex. Fibromyalgia is diagnosed more often in women than in
men. Female reproductive hormones may play a part in how women experience pain.
·
Family
history. You may be more likely
to develop fibromyalgia if a relative also has the condition.
·
Rheumatic
disease. If you have a rheumatic
disease, such as rheumatoid arthritis or lupus, you may be more likely to
develop fibromyalgia.
Fibromyalgia
generally doesn't lead to other conditions or diseases. But the pain and lack
of sleep associated with fibromyalgia can interfere with your ability to
function at home or on the job. The frustration of dealing with an
often-misunderstood condition also can result in depression and health-related
anxiety.
Because many of the
signs and symptoms of fibromyalgia are similar to various other disorders, you
may see several doctors before receiving a diagnosis. Your family physician may
refer you to a rheumatologist, a doctor who specializes in the treatment of
arthritis and other inflammatory conditions.
What you can
do
Before your appointment, you may want
to write a list that includes:
·
Detailed
descriptions of your symptoms
·
Information about
medical problems you've had in the past
·
Information about
the medical problems of your parents or siblings
·
All the
medications and dietary supplements you take
·
Questions you
want to ask the doctor
What to
expect from your doctor
In addition to a physical exam, your
doctor will probably ask you if you have problems sleeping, and if you've been
feeling depressed or anxious
In 1990, the American College of Rheumatology (ACR)
established two criteria for the diagnosis of fibromyalgia:
·
Widespread pain
lasting at least three months
·
At least 11
positive tender points — out of a total possible of 18
But fibromyalgia
symptoms can come and go. And many doctors were uncertain about how much
pressure to apply during a tender point exam. While the 1990 guidelines may
still be used by researchers studying fibromyalgia, less stringent guidelines
have been developed for doctors to use in general practice. These newer
diagnostic criteria include:
·
Widespread pain
lasting at least three months
·
No other
underlying condition that might be causing the pain
Blood tests
While there is no lab test to confirm
a diagnosis of fibromyalgia, your doctor may want to rule out other conditions
that may have similar symptoms. Blood tests may include:
·
Complete blood
count
·
Erythrocyte
sedimentation rate
·
Thyroid function
tests
In general,
treatments for fibromyalgia include both medication and self-care. The emphasis
is on minimizing symptoms and improving general health.
Medications
Medications can help reduce the pain
of fibromyalgia and improve sleep. Common choices include:
·
Analgesics. Acetaminophen (Tylenol, others) may ease the pain and
stiffness caused by fibromyalgia. However, its effectiveness varies. Tramadol
(Ultram) is a prescription pain reliever that may be taken with or without
acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs
(NSAIDs) — such as ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve,
others) — in conjunction with other medications.
·
Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may
help ease the pain and fatigue associated with fibromyalgia. Your doctor may
prescribe amitriptyline or fluoxetine (Prozac) to help promote sleep.
·
Anti-seizure
drugs. Medications designed to
treat epilepsy are often useful in reducing certain types of pain. Gabapentin
(Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while
pregabalin (Lyrica) was the first drug approved by the Food and Drug
Administration to treat fibromyalgia.
Therapy
Talking with a counselor can help
strengthen your belief in your abilities and teach you strategies for dealing
with stressful situations.
Many have found acupuncture and massage therapy helpful in controlling
the pain and fatigue of Fibromyalgia.
Besides dealing with the pain and fatigue of
fibromyalgia, you may also have to deal with the frustration of having a
condition that's often misunderstood. In addition to educating yourself about
fibromyalgia, you may find it helpful to provide your family, friends and
co-workers with information.
Living with fibromyalgia
Even with
the many treatment options, patient self-care is vital to improving symptoms
and daily function. In concert with medical treatment, healthy lifestyle
behaviors can reduce pain, increase sleep quality, lessen fatigue and help you
cope better with fibromyalgia.
Here are
some self-care tips.
·
Make time to
relax each day. Deep-breathing
exercises and meditation will help reduce the stress that can bring on
symptoms.
·
Set a regular
sleep pattern. Go to bed and wake up
at the same time each day. Getting enough sleep lets your body repair itself,
physically and mentally. Also, avoid daytime napping and limit caffeine intake,
which can disrupt sleep. Nicotine is a stimulant, so those with sleep problems
should stop smoking.
·
Exercise
often. This is a very important part
of fibromyalgia treatment. While difficult at first, regular exercise often
reduces pain symptoms and fatigue. Patients should follow the saying,
"Start low, go slow." Slowly add daily fitness into your routine. For
instance, take the stairs instead of the elevator, or park further away from
the store. After awhile, do more physical activity. Add in some walking,
swimming, water aerobics and/or stretching exercises. It takes time to create a
comfortable routine. Just get moving, stay active and don't give up!
·
Educate
yourself. Nationally recognized
organizations like the Arthritis Foundation and the National Fibromyalgia
Association are great resources for information. Share this information with
family, friends and co-workers.
Points to remember
·
Look
forward, not backward. Focus on what you need to do to get better, not what
caused your illness.
·
As your symptoms
decrease with drug treatments, start increasing your activity. Begin to do
things that you stopped doing because of your pain and other symptoms.
·
With proper
treatment and self-care, you can get better and live a normal life.
It's also helpful to
know that you're not alone. Organizations such as the National Fibromyalgia
Association and the American Chronic Pain Association can help put you in touch
with others who have had similar experiences and can understand what you're going
through.