Back To My Journey With Fibrmyalgia
Fibromyalgia is a chronic condition that causes widespread pain and profound fatigue, as well as a variety of other symptoms. Fibromyalgia primarily affects the soft tissues of the body. Fibro = fibrous tissues (such as tendons and ligaments) my = muscles algia = pain. Unlike arthritis, fibromyalgia does not cause pain or swelling in the joints; rather it produces pain in the soft tissues around joints and throughout the body. The pain of fibromyalgia usually consists of diffuse aching or burning, often described as head-to-toe. Its severity varies from day to day and can change location, becoming more severe in parts of the body used more often (i.e. the neck, shoulders and feet. In some people, the pain can be intense enough to interfere with daily activities that in others it causes only mild discomfort. Fibromyalgia pain is often accompanied by muscle spasm.
Other Symptoms
Sleep disturbance, stiffness, increased headaches or facial pain (Temporomandibular joint dysfunction), abdominal discomfort (digestive disturbances, abdominal pain, bloating, constipation and/or diarrhea=Irritable Bowel syndrome), irritable bowel, paresthesia (numbness and tingling in the arms, hands or feet), Raynaud's Phenomenon (cold hands, feet, ears or nose), skin problems, (rashes, hives, dry or blotchy skin), sensations of swelling, chest pains (costochondralgia – muscle pain which occurs where the ribs meet the chest one), cognitive disorders (difficulty concentrating, memory lapses), depression and anxiety (as a result of the chronic pain associated with fibromyalgia).
Diagnosis
No routine laboratory test or x-ray is available to diagnose fibromyalgia. Diagnosis is made using the official criteria developed by the American College of Rheumatologists (ACR) in 1990.
1. Chronic, widespread, musculoskeletal pain for longer than three months, in all 4 quadrants of the body (above and below the waist and on both sides of the body)
2. **Absence of another systemic disease that could cause the underlying pain, (e.g. rheumatoid arthritis, lupus or thyroid problems
3. Multiple tender points. A patient must have 11 of the 18 tender points when approximately 4 kilos of pressure (9 pounds) in applied.
**A diagnosis of fibromyalgia requires a 'hands-on' evaluation by a physician skilled in fibromyalgia diagnosis. Since patients are not always aware of the specific origin of their pain, only a doctor who is familiar with fibromyalgia can locate specific, painful tender points.
As the symptoms of fibromyalgia
mimic several other diseases, it is necessary to rule out those diseases.
Conditions mimicking fibromyalgia include:
· Systemic lupus· Polymyalgia rheumatica
· Myositis and polymyositis
· The nerve damage of diabetes
· Thyroid disease
· Tendinitis and bursitis
· Chronic fatigue syndrome and others.
A complete medical
history and physical must be done.
**Another important role of the diagnosis physician (usually a rheumatologist or physiatrist) is to validate the diagnosis. Often, when a patient receives a correct fibromyalgia diagnosis, they feel immediate relief. The longer it takes a patient to get a correct diagnosis, the more difficult the treatment process can be. For example, if it takes 2-5 years to get a diagnosis, 'layers of disease' can build making the treating physician's job more complex and the patient's improvement more problematic.
Research
Daniel Claw, M.D. of Georgetown University Medical Center suggests that individuals with fibromyalgia are more sensitive to painful stimuli throughout the body, not just the tender point areas.
The brain neurotransmitter
serotonin appears to be deficient in patients with fibromyalgia. Serotonin
is important because it decreases the intensity of pain signals reaching
the brain. Substance P exists in increased amounts in fibromyalgia patients.
Substance P signals the brain to register pain. The result of these 2 neurotransmitters
in the brain is that a fibromyalgia
patient has an amplified
sensation of pain.
Fibromyalgia patients have decreased levels of growth hormone (GH) in the brain. Growth hormone is secreted during deep (delta) sleep. Tryptophan has also been found to be deficient in fibromyalgia patients.
Tryptophan deficiency usually causes diffuse, achy stiffness. Other important substances thought to be deficient in fibromyalgia patients are:
Dopamine, adrenaline and cortisol.
Some people with fm may have some of these conditions some of the time with their fibromyalgia.
Physical Conditions:
Allergies, bruising, clumsiness, dizziness, dropping items, dry eyes and mouth, feelings of swelling, hair loss, high or low temperature, irritable bladder, irritable bowel, lack of stamina, migraine headaches, mouth sores, muscle spasms, nocturnal myoclonus (restless legs), numbness and tingling, photophobia (sensitivity to light), skin itch, mottling, rash, sleep apnea, sore throat, morning stiffness, swollen glands, tender lymph nodes, tension headaches, visual changes and eye pain
Mental and Emotional Problems:
Anxiety, confusion, mood swings, irritability, memory blanks, panic attacks, work mix-ups, trouble concentrating
Allergies: It may be that some 'allergic reactions' are just part of the heightened sensitivity to the environment that goes with fibromyalgia.
Chest Pains: Although fibromyalgia does not involve the heart, some people with fibromyalgia will experience pains on the left side of the chest. The pains can be severe and quite frightening. Since chest pain can be a warning sign of a serious heart condition, it should be reported to a doctor. However, it is more likely to be diagnosed as chest wall pain, called costochondritis.
Dropping Things: The most common complaint is picking up a glass or plate only to have it fall and break for no apparent reason.
Muscle Spasms: A lot of people with fm have muscle spasms, particularly in their legs, back and buttocks. One theory suggests that spasms may occur because the muscle tissue is short of oxygen due to reduced blood flow. Another is that the spasms are caused by the reflex reaction of a muscle in a generally painful condition life fm.
Another cause of spasms could be muscle microtrauma - the tearing of small muscle fibers. Doctors think that people with fibromyalgia are very susceptible to muscle microtrauma, perhaps because of a genetic predisposition.
Nocturnal Myoclonus: This
term refers to spasm in the arms and/or legs when sleeping. Some people
have 'restless legs,' which is a condition that lifts
or jerks the limbs.
Numbness and Tingling: Many with fm report they often have a sensation of numbness and/or tingling in their arms, legs, hands and feet. The medical term is 'parestheia.'
Sensitivity to the Environment: People with fm are extremely sensitive to cigarette smoke, noise, bright lights and cold temperatures. We are hyperirritable to the environment.
Weather may also affect you and you may feel like a 'walking barometer.'
Sicca Syndrome: (dry eyes and dry mouth). Eyes may burn or itch, or there may be a sensation of having a small foreign body like a grain of sand in the eye. Dry mouth may also be caused by some medications.
Skin Irritations: An itch may be accompanied by hives or a rash or have no outward sign at all. Hot baths, heavy clothing, most medications (especially codeine) and even minor stress will often make it worse.
Mottle skin, especially on the inner arms and thighs, is also seen with fibromyalgia.
Swelling: Swelling, especially of hands and feet, is often experience with fm. Such swelling is usually slight - just enough, to make a ring hard to remove - and usually cannot be observed by anyone else. Some people may even have a sensation of swelling where none exists, referred to as 'subjective swelling.'
Raynaud's Phenomenon: If your fingers and toes (sometimes nose and ears) turn very white or bluish purple when exposed to even moderate cold, the change may be due to the constricted arteries of Raynaud's Phenomenon. You may not have full-fledged Raynaud's. For instance, your fingers may hurt with cold even if you are just running cold water over your hands.
Temporomandibular Dysfunction (TMJD): Facial pain affects about 25% of people with fm. It can be part of the diffuse pain of fm or can arise from TMJD. Some of the common symptoms of TMJD are: pain on chewing, pain in front of the ear (near the TM joint), muscle tightness, difficulty opening the mouth wide, noises when the jaw moves and ringing in the ears. A person may also have neck and shoulder pain, which could be referred pain from trigger points in the jaw area or lower neck.
Treatment
Treatment aims at managing fibromyalgia symptoms, just as individual manifestations of fibromyalgia vary from patient to patient, so do successful forms of treatment.
Medications, physical medicine and rehabilitation:
Aquatherapy, behavior modification (posture and movement training), counseling, low impact aerobic exercise, myofascial release, craniosacral, Tai Chi, relaxation therapy.
To date, learning to manage the condition seems to be the most successful way of dealing with fibromyalgia. A combination of treatment modalities combined with activity modification and stress reduction can enable the patient to maintain a productive life.
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