What Is Fibromyalgia?
Fibromyalgia Syndrome (FMS) is characterized by widespread pain often accompanied by fatigue, sleep problems, and/or mood issues. It is believed that Fibromyalgia amplifies painful sensations by affecting the way the brain processes pain signals. Women constitute as high as 95% of those diagnosed.
What Are The Most Common Symptoms of Fibromyalgia?
FMS pain is often described as a constant dull ache of varying intensity, arising from the muscles. Pain is widespread, meaning that it occurs on both sides of the body, both above and below the waist.
Tender Points: In addition to diffuse aching, additional pain may be experienced when firm pressure is applied to specific muscle points. Prior to 2010, 11 of the 18 points must have been painful for Fibromyalgia to be diagnosed. Since 2010, tender points are no longer a necessary criterion for diagnosis, but are still considered a common symptom. Tender point locations include:
- The base of the skull
- Between the shoulder blades
- On top of the shoulders
- The front sides of the neck
- The upper chest
- The outer elbows
- The upper hips
- The sides of the hips
- The inner knees
Is Chronic Fatigue Related to Fibromyalgia?
Chronic fatigue is a very common symptom in those with Fibromyalgia. In fact, some researchers believe the two diagnoses to actually be the same syndrome. Individuals experience non-refreshing sleep, awaking tired despite sleeping for extended periods of time. Sleep is often disrupted by pain, and comorbid sleep disorders are common including Restless Legs Syndrome, Sleep Apnea, and various forms of Insomnia.
I’ve Heard the Term “Fibro-Fog” Used, What Exactly Is It?
“Fibro-fog” is a term used to describe the various temporary cognitive problems that can occur during flare-ups of FMS. A high percentage of individuals with FMS describe a “haze” or “fog” that descends and creates memory, language, and learning difficulties. The sensation can last a few hours to several days or weeks. Although the cause for this “fog” is unknown, a combination of common FMS symptoms is likely involved (i.e. sleep deprivation, chronic pain, mood issues, decreased blood flow to parts of the brain).
Common temporary Fibro-Fog symptoms include:
- short term memory loss
- difficulty remembering where items were placed
- difficulty remembering plans
- difficulty with language, including trouble holding conversations, understanding conversations, and expressing thoughts
- difficulty finding the “right” word to use in conversation
- trouble remembering simple numbers
- difficulty transposing letters and numbers
- trouble concentrating and focusing
- difficulty retaining new information
Is Myofascial Pain Syndrome the Same Thing As FMS?
Fibromyalgia Syndrome and Myofascial Pain Syndrome are now grouped together under the umbrella term Central Sensitivity Syndromes, which includes other conditions in which the brain misinterprets pain signals. While these two conditions have some overlapping symptoms, it is very important to obtain proper diagnosis because treatments differ.
- Myofascial Pain Syndrome: Small, hard knots (trigger points) develop within muscles which can be painful and often cause referred pain to other areas of the body where the muscles attach. The cause for these trigger points is largely unknown, but appears to have to do with repetitive usage of the muscle or a physical trauma, combined with malformations where the nerve cells connect to the muscle cells.
- Overlapping symptoms: muscle pain, headaches, disturbed sleep, dizziness, tinnitus, memory problems, worsening symptoms due to stress/weather changes/physical activity.
- Symptoms more likely related to FMS: chronic fatigue, allergies, sensitivity to high levels of sensory input.
- Symptoms more likely related to MPS: numbness in extremities, clicking joints, limited range of motion in joints, blurry vision, unexplained nausea.
- Treatment differences: The primary difference in treatment involves the tender points in FMS and trigger points in MPS. Whereas direct treatment to the Fibromyalgia tender points yields few results, direct treatment to Myofascial trigger points can help the knotted muscles to relax and greatly reduce pain.
Is there any medical research that supports the existence of Fibromyalgia? What causes the widespread pain?
Like so many disorders, the specific cause of Fibromyalgia is unknown. However, research tends to show that susceptibility to developing Fibromyalgia may be inherited. Also, periods of extreme physical or emotional stress may trigger the development of symptoms in some individuals. But regardless of the cause, medical research has made significant progress identifying physiological differences in those diagnosed with Fibromyalgia. Two, of the many, research findings are described below, demonstrating that Serotonin production and muscle sensory receptors react quite differently in those diagnosed with FMS.
Serotonin: Serotonin is a neurotransmitter that, among other functions, acts as a buffer for the experience of pain and stress. Having low levels of this neurotransmitter appears to be involved with FMS. The low levels of serotonin, over time, yield increased amounts of physical stress which eventually cause changes in the muscles and levels of experienced pain. Whereas the natural response to stress is a short-term “fight-or-flight” reaction in the body, FMS can produce long-term “fight-or-flight” reactions which damage the body. Because women tend to produce less serotonin than men, they are particularly sensitive to developing FMS.
Nociceptor Oversensitivity: Nociceptors are sensory receptors inside muscles that send pain signals to the spinal cord. Research has demonstrated that the C-fiber nociceptors (which carry basic sensory information like light touch or mild pain) of those with FMS are hypersensitive, sending significantly more signals than is typical. Because the spinal cord cannot process the quantity of signals from the C-fibers, the body compensates by sending some of the C-fiber information through A-delta-fibers. The problem is that A-delta-fibers are meant to only carry very harmful signals, so the brain interprets every signal that comes from an A-delta-fiber as highly painful. Thus, FMS patients not only experience an increase in the quantity of pain signals because of the hypersensitive C-fibers, but also a significant increase in the intensity of pain because of the rerouting of signals from C-fibers to A-delta-fibers.
To summarize, medical research has demonstrated that individuals with FMS experience pain more frequently and intensely, and have fewer natural defenses against pain than is typical.
What other medical/emotional conditions are often associated with Fibromyalgia Syndrome?
Chronic fatigue syndrome
Irritable bowel syndrome
Feeling overwhelmed by high levels of sensory input
Does medication help?
Physicians prescribe a wide variety of medications for the treatment of FMS, with each individual responding uniquely. While lifestyle changes can be very effective for the alleviation of some symptoms, medication may also be helpful with the careful guidance of a family physician or rheumatologist. The following are the most common medication classifications:
- SSRIs: Selective Serotonin Reuptake Inhibitors are designed to increase the amount of Serotonin in the brain, thus improving the regulation of pain. SSRIs can also help with Depression associated with chronic pain. Examples include Effexor and Cymbalta.
- Muscle Relaxants: Muscle Relaxants can decrease the amount of pain experienced by relaxing the muscles and increasing Serotonin. However, the effects are typically too brief to bring the necessary relief of FMS symptoms alone. These medications also tend to create drowsiness and dry-mouth. The most common muscle relaxant is Flexeril.
- Sleep Medications: It is widely agreed that sleep issues are related to, and perhaps the ultimate cause of, FMS. Thus, sleep medications are often very helpful in alleviating symptoms. Ambien, Lunesta, and Restoril are commonly prescribed. Some doctor’s also prescribe anti-anxiety medications such as Xanax due to their sedating effects. Neurontin has also been found to be an effective medication for sleep maintenance.
- Pain Medication: Pain medicines such as Oxycontin, Norco, and Vicodin, may be prescribed for severe pain, but must be used with caution. These medications can be addictive, and the costs and benefits of usage must be weighed carefully by the individual and prescribing medical professional
Does diet affect Fibromyalgia symptoms?
Absolutely. Many individuals have claimed they have reduced or eliminated their symptoms through dietary changes. The following is a brief summary of general nutritional tips for potential FMS symptom reduction. Of course, you should always discuss nutritional changes with your medical professional before implementing a dietary change.
- Nutritionists recommended eating foods containing Tryptophan, which transforms to Serotonin in the body. Examples include meat, soybeans, nuts, cheese, milk, beans, broccoli, bananas, cucumbers, kale, tomatoes, mushrooms, cabbage, spinach, brown rice, oats, barley, etc.
- Eat three meals a day with light snacks in-between to regulate sugar levels. Sugar fluctuations are read as stress by the body.
- Have a dark salad five days a week.
- Eliminate processed and fast foods. Low Serotonin levels means that FMS individuals are likely more sensitive to chemicals added to foods.
- Systematically identify food sensitivities. Low Serotonin is associated with a higher degree of sensitivity to chemicals, as stated above, which includes food. Undiagnosed food sensitivities/allergies can cause FMS flares and discomfort.
- Increase organic fruits and vegetables in your diet.
- Eliminate caffeine and alcohol. Both substances produce stress and sharp fluctuations in the body that can trigger flares. Both substances also interrupt the natural sleep cycle.
Does exercise help or hurt?
Exercise can be a catching point for those with FMS. On the one hand, exercise is essential for a healthy body, and on the other hand, chronic pain and fatigue can make motivation to exercise quite difficult. In general, low impact exercises and stretching yield good results which can alleviate some symptoms and improve overall health. It is recommended that individuals work with their medical professional to develop an appropriate exercise regimen.
I am thinking about seeking counseling to better cope with my Fibromyalgia. What should I keep in mind?
Individuals with FMS are encouraged to seek counseling with a professional who has solid working knowledge of Fibromyalgia and chronic pain. All aspects of the person should be addressed including how the symptoms affect family, work, faith, hobbies, self-esteem, etc. It is essential to focus not only on specific coping skills for the chronic pain, but for the individual to explore their personal views/emotions/experiences surrounding the symptoms. However, it is equally important to remember that FMS does not define the individual, and to focus on the multitude of other aspects/attributes of the person.
I know someone with Fibromyalgia and would like to be supportive. How can I help?
- Assist them to ensure they were properly and professionally diagnosed.
- Reassure the individual of the medical “reality” of the syndrome. People have often been repeatedly told that their symptoms are imagined, that they are “hypochondriacs”, or they have a “low threshold” for pain.
- Encourage them to seek out supportive professionals who take FMS seriously and have experience in its treatment.
- Point the individual to basic medical research as described above. This information can help make FMS feel more “real” to the individual and provide her/him with a means to explain FMS to family and friends.
- Validate the emotions associated with dealing with an “invisible” disorder. Many individuals with FMS “look” healthy and therefore find little validation from others when they share their experience of pain.
- Encourage self-care, including rest and stress-reduction.
- Be mindful that your friend may have unexplained “low-energy” days. These can sometimes occur in accordance with weather/barometric changes, but often the triggers are difficult to identify. Understanding of this phenomenon and empathy with the resulting emotions can go a long way to making your friend feel supported.
Healing Fibromyalgia by David Edelberg, MD
Fibromyalgia and other chronic painful conditions – 2nd Edition
The Patient’s Guide And Survival Manual For Obtaining Proper And
Effective Medical Care by Jeffrey B. Loomer, M.D., FACP, FACR
Ending Fibromyalgia & Auto-Immune Disease: A Comprehensive Holistic
Protocol By Tony Xhudo M.S., H.N., B.C.
Fighting Fatigue www.fightingfatigue.org
National Fibromyalgia & Chronic Pain Association www.fmcpaware.org