What is Fibromyalgia?
Fibromyalgia (FM) is a condition that affects muscle and soft tissues, causing widespread pain and other symptoms that vary depending on the individual affected. It is common for laboratory testing to be inconclusive with respect to this illness, which effectively promotes the development of hypochondria or of an obsession with the idea of having an illness that is not easily diagnosed. Ever since 1990, medical research debates took place over what are the most accurate ways of diagnosis, with some general guidelines being developed as late as 2010. Still, even now people have to wait for the symptoms to be consistently present for at least three months and test for other possible pain sources in order to be sure.
As a disease, it occurs in 2-8% of the population and it has no age restrictions, meaning that even children or the elderly can suffer from fibromyalgia. However, women seem to be more predisposed to developing FM, with a rate of anywhere from 7 to 9 times more likely than men. Due to the fact that other symptoms may also occur, the term fibromyalgia syndrome or FMS was coined.
The causes of fibromyalgia have yet to be determined due to insufficient evidence. Most doctors look at fibromyalgia as a result of physically or emotionally stressful events, the kind of happenings that become traumatic to one’s past and generate major behavioral changes their lives, such as car accidents or murders. Similarly, researchers have also pointed to repetitive injury as a possible cause for fibromyalgia. The truth is that opinions diverge to the extent that you may encounter spontaneous occurrence denominated as a cause by seasoned researchers. At this point, efforts are directed towards the examination of the central nervous system, both the brain and the spinal cord, due to the fact that state of the art MRI and complementary medical equipment makes it possible to compare people suffering from this illness with those who do not.
On the other hand, gene research brought the hypothesis of a genetic factor as a cause. It seems that several genes occur more predominantly in people suffering from fibromyalgia, changing the way they perceive stimuli in the sense that something which would otherwise be perceived as harmless to most people is experienced with a great degree of pain and sensitivity. Overall, it seems that stress plays a major role in the outset of this illness, particularly since people with different backgrounds seem to develop it along with other stress-related disorders such as posttraumatic stress, depression, irritable bowel or chronic fatigue syndrome.
Signs & Symptoms
These are some of the most common symptoms of fibromyalgia:
- Chronic muscle pain, spasms or tightness.
- Severe fatigue, decreased energy levels.
- Difficulty performing simple cognitive tasks commonly referred to as “fibro fog”.
- Migraines, headaches or similar tension.
- Insomnia, the feeling that sleeping is not resting at all.
- Constipation, bloating, nausea, abdominal pain or diarrhea – what doctors call irritable bowel syndrome.
- Stiffness when waking or from sitting in a position for too long.
- Depression or anxiety feelings.
- Tingling or numbing sensations in the extremities or face.
- Feeling of swelling in hands or feet.
- Very low tolerance for exercise or the muscle pain that comes with it.
Even though fibromyalgia is associated with widespread pain, this can also be localized in areas such as the shoulder, neck, hips, low back (lumbar) or other parts. In addition, there is extensive pathophysiology associated with FMS, from dopamine dysfunction to metabolism of serotonin, neuroendocrine disruption and cerebrospinal fluid abnormalities. Nonetheless, the degree of involvement that fibromyalgia has with any of these is still debatable and pertains to each particular circumstance, thus requiring further investigation.
The clearest abnormal brain involvement of fibromyalgia is provided by neuroimaging. Repeated investigations concluded that the blood-flow in several areas of the brain, including the thalamus, is altered in patients with fibromyalgia. At the same time, the neural activity of the patients registered differential activation as a response to painful stimulation. Hyperactivity was recorded in the prefrontal, supplemental motor and the cingulate cortices. What’s more, it seems that normal-age related brain atrophy is exponentially increased in people with this condition up to 9.5 times the rate of a normal person, per year.
There is absolutely no test that ensures a person has fibromyalgia, which is why a two decade long debate was initiated in 1990 about what should be considered an essential diagnostic criterion. Many voices argued that establishing the presence of this disease objectively was actually impossible to begin with. Initially, a history of widespread pain and tender points were used as a reference for the diagnosis of fibromyalgia, but in 2010 a more rigorous system was developed. Even so, it is common for people suffering from fibromyalgia to visit many doctors before getting a clear indication because pain and fatigue can be caused by several factors. In some cases, doctors may even tell patients there’s nothing that can be done or that their pain is not real, which can end up causing even more issues for the patient.
Doctors who are familiar with the practices of the American College of Rheumatology identify fibromyalgia if the patient has a history of pain that goes back at least 3 months, as well as a combination of the other possible symptoms, such as fatigue, waking unrefreshed or cognitive problems. They will also employ a widespread pain index (WPI) and a symptom severity scale (SS), accounting for at least 19 known areas on the body associated with fibromyalgia. Ultimately, a composite score is made and if there are no other diagnosable illnesses that can explain the pain, the patient is diagnosed with fibromyalgia.
Treatment for Fibromyalgia
Given that not all doctors are familiar with fibromyalgia, treating this disease can be problematic, making it all the more important to find a professional who is acquainted with this condition. Furthermore, dealing with fibromyalgia usually involves a team-effort that brings together your physician, a physical therapist, possible other healthcare advisors and yourself playing an active role in trying to combat the symptoms. The most immediate and noticeable change patients undergo when establishing this team is the improvement in their quality of life. A lot of individuals suffer greatly from lack of proper attention and professionalism awarded to their illness, which then impacts their levels of stress and makes them more prone to the onset of depression and anxiety. This being said, fibromyalgia is a chronic disease that can last for years on end and while there is no effective treatment to help patients fight against it, emotional and psychological balance are vital. It may also be helpful to keep in mind that fibromyalgia is neither fatal, nor a progressive disease and that it will never do permanent damage to your body.
The main reason for which there is no accurate diagnosis is that global research in this field did not manage to fully understand the underlying cause of fibromyalgia, which would have to be dealt with in order to cure the condition. Therefore, it is expected that the treatment for fibromyalgia can be only related to the symptoms and their management so that the patients can live a full life. The U.S. Food and Drug Administration approved only 3 types of medication for this illness. These are pregabalin, milnacipran and duloxetine, but side-effects can greatly vary from one to the other and some are more severe than others. If the first product was developed to help people deal with neuropathic pain coming from the nervous system, the second and third are clearly designed to fight against depression, whether in general or only for patients who have fibromyalgia.
Other commonly prescribed substances are analgesics and non-steroidal anti-inflammatory drugs. Most doctors are wary of prescribing analgesics or painkillers since there are no solid findings that demonstrates their effectiveness when used to treat the chronic pain of fibromyalgia, whereas non-steroidal anti-inflammatory drugs may ease the muscle pain, headaches and menstrual cramps in people with this condition, but at the cost of a multitude of side effects such as skin rashes, digestive issues, blood pressure, fluid retention or, even worse, heart, liver or kidney problems. The more a person uses non-steroidal anti-inflammatory drugs or NSAIDs, the more serious and complicated the side effects get.
Besides medicine, there are multiple ways in which people suffering from fibromyalgia can significantly minimize the impact of fibromyalgia on their lives. These are:
1. Having a regular sleep schedule. Many people suffering from fibromyalgia have symptoms that interfere with their normal sleep, which results in them waking up unrefreshed. Sleeping right can ease the pain and fatigue of the illness. Therefore, it is important to talk to your medical healthcare advisor who can prescribe the appropriate medication for the symptoms that prevent you from getting a good night’s sleep.
2. Changing your professional life. You will not be able to work in the same way if you develop FM. From cutting down the number of hours to switching to a less demanding position or, if possible, adapting the conditions of your current employment to suit your needs, you must make consistent changes in your work routine. These can include giving up intense physical activities and sitting in uncomfortable positions.
3. Regular exercises. Even if it seems that exercising is one of the hardest aspects for a person suffering from this illness, rigorous studies have concluded that repeated and regular exercises help with pain management. If you find it difficult to begin, start with walking or other gentle activities and build your endurance from that point onward. Remember that exercises are not necessarily physical. Mind-games that allow you to start on a comfortable level of difficulty and can be scaled are also beneficial when experiencing symptoms such as lack of concentration or “fibro fog”.
4. Healthy, balanced diet. Unlike exercises, there are no consistent findings about what foods FM patients should avoid. Still, a great number of them reported that they feel better when avoiding certain foods. Consequently, it may also prove helpful to have a diet that is rich in vegetables, plants and fruits, particularly since they have high amounts of anti-oxidants, nutrients and vitamins. Studies have proven that a balanced in-take of nutrients provide you with more energy, make you feel better, as well as aid in the prevention of other health issues.