Fibromyalgia (FMS) Kathleen Gallardo, LMT

Years ago, Medical professionals looked at patients with fibromyalgia and saw a group of mainly middle aged women who were complaining of diffuse and widespread symptoms. They were convinced the condition was related to menopause and didn’t peruse it further. Some didn’t even told patients, “It’s all in your head!”

Physicians once thought that fibromyalgia was a type of arthritis. However, current research tells us that fibromyalgia is not an inflammatory condition. Patients often relate pain in the joints or near joints. Consequently their doctors would probe for signs of arthritis. When no signs of inflammation were found, some physicians would throw up their hands in frustration and dismiss the patient. Other thoughts: “fibromyalgia is essentially a sleep disorder”, “symptoms are caused by depression”, this is chronic fatigue syndrome”.

Around 1990, the American College of Rheumatology established the criteria for accurately diagnosing patients with fibromyalgia. There are two components;

1. Patients must have persistent pain in three of the four quadrants of their body. The pain must have no clear cause.
2. Patients must display excessive sensitivity to light pressure at 11 of the 18 “tender points” located bilaterally throughout the body.

The same examination of a non-fibromyalgia patient would not result in pain localized at the “tender points”. Tender points are specific criteria when describing fibromyalgia. They are not merely sore areas, but are rather exact points that are inappropriately reactive to a moderate amount of pressure. The pain is not dull or diffuse, but rather sharp and focused. Hypersensitivity is noted at these points.

Microscopic examination of muscle tissue from tender point areas shows a breakdown of protein and other physiological distortions that may explain the hypersensitivity. The diagnostic points are as follows.

On the front of the body:

• Base of the neck where it meets the shoulder.
• Above the collar bone near the mid-point.
• Beneath the clavicle 2” from center of the sternum.
• Inside the bend of the elbow on the thumb side.
• Adjacent to the knee cap on inside of leg.
  

On the back of the body:

• Occipital ridge, (base of the skull), 2” from center.
• The inside point of spine of the scapula.
• 2” lateral of sacrum where gluteus maximus and medius cross.
• On the Greater Trochanter, (large bony prominence on the lateral upper thigh)

Diagnosing a patient with fibromyalgia means that they must endure a battery of tests to rule out other possible conditions which may be contributory to their particular symptoms. Example: headaches may be triggered by food or environmental allergy, so patients may undergo an allergy screening. Fatigue may be due to anemia or hypo-thyroidism. Neurological disorders may be cause symptoms; the only way to determine is with diagnostic tests such as nerve conduction velocity or magnetic resonance imaging to confirm or rule out tumors and lesions. It is not unusual for several years to transpire before reaching an accurate diagnosis.

The symptoms of fibromyalgia are so varied that it seems impossible for them all to be related to one particular condition. At times, patients will report different symptoms on different days. Symptoms may come and go at different intervals or affect different parts of the body over time.

By far, the most common complaint is pain. Patients describe their pain differently, ranging from persistent dull aches, to immobilizing pain confining them to bed for days. The next most common symptom is fatigue. For some time, physicians thought that fibromyalgia and Chronic Fatigue Syndrome were related, or perhaps two parts of the same condition. Current research indicates that the two conditions are not the same. Sleep disorders are also among common complaints. Physicians call this non-restorative sleep.

Fibromyalgia patients consistently score high on anxiety and depression scales, indicating that the symptoms are not limited to the physical body alone. Dealing with pain on a daily basis, can erode a patient’s mood, leave them feeling depressed, and result in a negative outlook. Other symptoms may include headaches, TMJ disorder, muscle weakness, irritable bowel syndrome (alternating bouts of constipation and diarrhea), cognitive disorders, and memory loss (fibro-fog).

Theoretical Causes:

1. Triggering Event: This theory states that there is a single event, or a series of events, that somehow breaks down the body’s ability to handle the stresses of everyday life. Examples of these events may be a car accident, an allergic reaction, an exposure to a toxin, severe illness or emotional trauma. There is some link to the appearance of the symptoms and extremely high levels of stress hormones over an extended period of time.
2. Serotonin Deficiency: Patients with fibromyalgia have a lower than normal level of serotonin which could explain many of the symptoms of their condition. Serotonin is a neurotransmitter that plays an important role in sleep, pain perception, and a person’s mood. Serotonin is thought to be related to melatonin, a hormone that is released at night. A common medication that increases serotonin levels is called SSRI (Selective Serotonin Re-uptake Inhibitors). SSRI seems to help with all three situations; sleep, pain, and mood.
3. Substance P: Substance P is a neurochemical that increases a person’s perception of pain. The more substance P a person has, the more pain they perceive. Some fibromyalgia patients have three times more substance P than the average.
4. Cerebral Blood Flow: This is a dysfunction in the area of the brain that perceives pain. Research has shown that fibromyalgia patients have about a 15% deficit in blood flow to these areas of the brain. Two specific areas affected are the thalamus and the caudate nucleus, located in the basal ganglia of the brain. These structures help determine if a certain stimuli is painful. If it is painful, just how painful we perceive it to be. If there is a dysfunction to these areas, sensations could be amplified to an exaggerated level.
5. Sleep Disorder: When a person does not go deep enough into sleep, the body does not repair itself. One will wake up as sore as when they went to sleep. If this sleep dysfunction is chronic, a patient’s symptoms would begin with muscle aches and pains, headaches, and uncontrollable muscle twitches. It then escalates to mental confusion, irritability, forgetfulness, the inability to focus on tasks, and emotional distress. Hallucinations are one of the advance symptoms of non-restorative sleep.
6. Oxygen Deficiency/Hypoxia: Without sufficient oxygen to create energy aerobically, the body breaks down the protein in muscle tissue as a source of raw material. This is the production of ATP using anaerobic means. The pain fibromyalgia patients experience could be the result of continual breakdown of protein from muscle tissue to use in the production of energy. This would also explain the fatigue.
7. Immune Dysfunction: There may be a certain percentage of the population that have specific combinations of genetic and environmental factors, which result in the production of defective antibodies. These antibodies mistakenly attack the patients’ own tissues as if they were pathogens to be destroyed. This results in a breakdown in many parts of the body because the immune system is not limited to one area.
8. Chronic Dehydration: Dr. F. Batmanghelidj claims that any pain that is not otherwise explained is the body’s cry for water. He maintains that your body needs an absolute minimum of six 8-ounce glasses of water a day. Alcohol, coffee, tea and soda do not count as water. As a minimum, one class of water should be taken 30 minutes before each meal and then 2.5 hours after each meal. If you are not having a bowel movement at least once a day, it is a sign of dehydration. (www.watercure.com)

Treatment/Management:
Since there is no known cure for fibromyalgia and the symptoms are so widespread, management and treatment must be multi-faceted. Patients who become actively involved in their own treatment seem to do better than those who rely exclusively on physicians and medications to get better.

1. Medications to improve sleep: Narcotics are not used because they actually prevent the patient from entering the deep sleep state they need, called REM sleep. Benadryl is a popular choice because it is considered to be safe and there are virtually no reported side effects.
2. Medications to increase serotonin: One class of medication is called Selective Serotonin Re-uptake Inhibitors (SSRI). Examples include Prozac, Paxil, Zoloft, and Klonopin. Another class is called Tricyclics. Some of the common ones are Elavil, Sideburn, Desyrel, Pamelor, and Norpramin.
3. Medications to decrease pain: Termed analgesics. Acetaminophen (Tylenol), Naproxen Sodium (Aleve), Ibuprofen (Advil, Motrin), Salicylates (aspirin), and Codeine are popular choices.
4. Massage: Improves blood circulation, and releases endorphins, which decrease pain perception. Massage increases lymphatic drainage to assist in removal of toxins. Of note is the fact that there is a high correlation of the “tender points” to large groupings of lymph nodes.
5. Moderate aerobic exercise: Increases blood flow to the muscles firsts and the entire body second. Exercise encourages deep breathing for more oxygen acquisition and delivery. Also includes light to moderate stretching such as Pilates.
6. Relaxation techniques: For example, yoga, meditation, hypnosis, and biofeedback.
7. Therapeutic Nutraceuticals: These are pharmaceutical grade nutritional supplements such as whole food vitamins, whole food minerals, and whole food herbs.
8. Support Groups/Counseling: Patients who involve themselves in support or educational groups tend to have better success managing their condition. Knowing other people are experiencing the same problems can decrease their sense of isolation. Groups are also great resources for learning about current research, treatment, and coping strategies.

Resources:

1. American Fibromyalgia Association, 6380 E. Tanque Verde Rd, Suite D, Tucson, AZ 85715 (520) 733-1570
2. Fibromyalgia Alliance of America, PO Box 21990, Columbus, OH 43221-0990 (614) 457-4222
3. Fibromyalgia Network, BO Box 31750, Tucson, AZ 85751 (800) 853-2929
4. National Chronic Fatigue and Fibromyalgia Assn, PO Box 18426, Kansas City, MO 64133 (800) 283-7800
5. Your Body’s Many Cries for Water. F. Batmanghelidj, MD (www.watercure.com)