Fibromyalgia Syndrome (FMS) has been given many labels. However, the most persistent descriptive term that outweighs all the others is mysterious. This complex condition afflicts three to six million people in the United States, of which 80% to 90% are women between the ages of 20 and 55 years. The cause and cure are unknown even though this is the third most prevalent rheumatological disorder in the country.
FMS has earned the description of mysterious because so much of what is known about it is unexplained and controversial. Medical professionals have even disagreed on how it should be classified. It was first described in 1816 by William Balfour, a surgeo at the University of Edinburgh. Before that, it was known either as chronic rheumatism, myalgia, or fibrosis. It has since been described as a syndrome, malady, chronic condition, or chronic disorder, but not as a disease or psychological disorder.
In 1987, the AMA (American Medical Association) recognized FMS as a true illness and a major cause of disability. The NIH (National Institute of Health) recently classified it as a true disease. However, there is still some disagreement. Most authorities contend that FMS does not technically fall into the category because diseases have known causes and what produces the symptoms is well understood.
However, it does fit the description of a syndrome, which means a group of symptoms that occur together. The primary and two most common symptoms of fibromyalgia are widespread musculo-skeletal pain and debilitating fatigue. Other symptoms include morning stiffness (lasting for more than 15 minutes), sleep problems, numbness or tingling, anxiety, dry mouth, irritable bowel syndrome, headache or facial pain, abdominal discomfort, cognitive disorders (lack of concentration), environmental sensitivity, depression and anxiety, disorientation (getting lost easily), short-term memory loss, and the list goes on and on. The diagnosis becomes very complicated because there is such a wide variety of symptoms that can vary in intensity, but can also fluctuate from day to day, or hour to hour. Making it even more confusing is the fact that many of the symptoms mimic other disorders.
In 1990, the ACR (American College of Rheumatology) established specific criteria to diagnose FMS.
Pain in 11 of 19 tender point sites. Tender points must be pressed hard enough to whiten the thumbnail and produce pain directly over the site being pressured. (See illustration of pressure point sites)
Tender points can also cluster around an injury, such as a strain, degenerative, or inflammatory problem.
THEORIES ABOUND
This complex syndrome has prompted an incredible amount of research, which in turn, has produced many controversial theories regarding its cause, treatment, and management. Several doctors, who have experienced FMS firsthand and battled it personally, have investigated the condition and have developed their own theories. Here are just a few of the theories. These descriptions will show you how varied the research has been:
Jeffrey M. Thompson, M.D., Physical Medicine Specialist, Mayo Clinic
Thompson's theory is based on the fact that muscles have nerves that are activated by pressure. Microscopic injury to the muscle, such as strain that may occur from sitting at a desk all day, causes the nerves to become hypersensitive. The overactive nerves keep the muscles in a constant state of contraction.
Roland Staud, M.D., University of Florida
Staud theorized that FMS pain was due to receptor proteins in the muscles that were abnormally sensitive to pain stimuli. He found that the abnormal receptors transmitted pain signals along the nerves to the spinal cord and brain where they were processed and amplified. Researchers concluded that the unusual pain sensitivity in FMS was due to abnormal pain processing in the spinal cord and abnormal pain receptors.
Alice Larson, Ph.D., Prof. of Neuroscience, University of Minnesota, and I. Jon Russell, M.D., Ph.D., University of Texas
These researchers studied nerve growth factor and Substance P--chemicals known to be major players in pain transmission. These chemicals were 3-4 times higher in people with FMS compared with the general population. Research continues to ascertain the pathological significance of these chemicals.
Laurence Bradley, Ph.D., University of Alabama
Bradley measured changes in blood flow of the brain when mild painful stimuli were applied to several body sites. He concluded that abnormal blood flow to various structures in the brain could account for symptoms of low pain threshold, sleeping difficulties, and reduced stress tolerance as seen in people with FMS.
Iris Bell, M.D., Ph.D., University of Arizona
Bell's chemical sensitivity studies suggest that chemical intolerance may correlate with the brain's tendency to amplify sensations, including pain.
Olof Zachrisson, M.D., Institute of Clinical Neuroscience, Gotenborg University, Sweden
Zachrisson studied the theory that nickel worsens the symptoms of FMS by disrupting an already compromised immune system. He advocates that people with FMS should avoid nickel-objects containing nickel, foods rich in nickel (cocoa, nuts, shellfish, raspberries, seeds, dried beans, and many food additives), and tobacco fumes, which are also rich in nickel.
If you're unsure about a product's nickel content, call the company's toll free number which is listed on most product labels.
R. Paul St. Armand, M.D. Endocrinologist
St. Armand's working theory suggests an inheristed defect in phosphate metabolism, causing a build-up of calcium phosphate, which attracts small amount of water into the muscle cells. Those lumps of water are what cause pain. He found that guaifenesin, an over-the-counter medicine that loosens phlegm and mucus, removes excess uric acid and phosphorus from the body. This therapy is not for everyone. As stored toxins and excess phosphates are released, symptoms may become more intense. Also, anything containing salicylates blocks guaifenesin from working. All products with salicylate must be elminated (aspring, Pepto-Bismol, aloe, Listerine) to name a few. 1 Ask your pharmacist to help you find nonsalicylate alternatives.
RESEARCH PROGRESS
This complex medical phenomenon still baffles doctors. Research is ongoing and new information comes forward almost daily. Although there is not enough evidence to support a single cause, research indicates there is a malfunction in the communication system that sends messages from the nerves and hormones to the organs, muscles and brain. There may also be a genetic predisposition. Several triggers have been identified:
- physical trauma (i.e., auto accident)
- emotional trauma (i.e., death or divorce)
- repetitive motion (i.e., repetitive computer use)
- environmental stress (i.e., excessive noise)
- infections (viral)
- delayed food allergies
- hormonal changes
Also noteworthy are the similarities between FMS and CFS (chronic fatigue syndrome). They are so closely related that many speculate that they are the same illness. Approximately 75% of the patients who meet the diagnostic criteria for FMS also meet the diagnostic criteria for CFS.
MANAGEMENT OF FMS
Prioritizing and Pacing
Plan each day according to how you feel. Eliminate non-essential activities. Make a to-do list. Break up larger tasks into smaller ones. Take a ten minute break after each task.
Postural Alignment
Align your spine throughout the day to conserve energy.
Relaxation Breathing
Extend the outbreath 2 to 3 times longer than the inhalation. Relaxation breathing quiets the nervous system and improves blood flow to the muscles (deep breathing tips).
Quiet the Mind
Use daily meditation and visualization to boost the immune system.
Exercise
Since pain and fatigue factor in to produce inactivity, it's important to set realistic goals and exercise guidelines. The main exercise goal is to maintain function. Sustained overhead movements should be avoided. Five to ten minute bouts of walking should be emphasized. Stretching to the point of resistance will help release tight muscles and provide pain relief. Avoid early morning exercise. Listen to your body. The right amount of exercise is the amount that makes you feel better, not worse.
Rest
Resting often and for short periods of time will decrease pain and fatigue levels. Listen to soothing music as you rest.
Humor
Rent funny movies, listen to radio shows while driving that make you laugh or smile (my favorite is Car Talk with the Click and Clack brothers on national public radio) or read cartoons and fictional comedy. Humor and laughter stimulate the immune system.
Positive Attitude
Maintaining a positive attitude is one of the most important traits you can cultivate in coming to terms with FMS. Focus on what you CAN DO, not on what you can't. BE GRATEFUL for the many good things and supportive people in your life. Begin to reclaim your life by cultivating a positive attitude and a spirit of hope.
1 Starlanyl, D, Copeland, ME. Fibromyalgia & Chronic Myofascial Pain Syndrome: A Survival Manual. Oakland, CA: New Harbinger Publishing; 1996, p. 224.
Copyright © 2000, 2008 SIT AND BE FIT
