Fibromyalgia – Symptoms, Causes and Treatments
Fibromyalgia can be best defined as the pain of the muscles and connective tissue fibers, including the ligaments and tendons. But unlike rheumatic diseases, fibromyalgia does not cause joint pain or tissue inflammation. Another distinguishing factor is that while the pain can be just as disabling as that caused by rheumatoid arthritis or lupus, fibromyalgia does not lead to joint deformity or muscle and organ damage.
The muscle pain, stiffness and fatigue, the typical signs of fibromyalgia, also happen to be the hallmarks of an entirely different illness, chronic fatigue syndrome. Chronic fatigue syndrome and fibromyalgia are often being confused because the majority of patients with chronic fatigue syndrome also fit the criteria for fibromyalgia, and vice versa. Because of these similarities it is hard to estimate the exact number of fibromyalgia sufferers but there is no question that most of them are women of childbearing age.
Causes of Fibromyalgia
The exact cause of fibromyalgia is yet unknown but scientists believe that some of the contributing factors may include:
- A defect in the nervous system. Studies indicate that fibromyalgia sufferers have low levels of the brain neurotransmitter serotonin, which increases their sensitivity to pain. Reduced levels of serotonin in the brain are also linked to depression, migraines and gastrointestinal distress, all of which often accompany fibromyalgia. Some researchers also believe that reduced blood flow to the parts of the brain that process pain may cause the disorder.
- Sleep deprivation, especially a lack of deep, restorative sleep. Although poor sleep is a common symptom of fibromyalgia, the theory has it that it is a cause as well.
- Infection. Some studies show that certain infections (Epstein-Barr virus, Lyme disease) may be a triggering factor.
- Trauma or injury. There is some evidence to suggest that emotional pain or injury to the upper spine can also cause fibromyalgia in some people.
- Genetic predisposition. Research shows that you are at an increased risk for developing fibromyalgia if your mother also has it.
Symptoms and Diagnosing Fibromyalgia
There is no specific test that can confirm a diagnosis of fibromyalgia. The only possible approach is to use blood tests or x-rays to rule out other conditions such as rheumatoid arthritis, lupus, multiple sclerosis, Lyme disease and thyroid problems. If the tests come back negative, the doctor will do a physical exam to determine the cause of your pain. It may be necessary to observe your symptoms over time in order to firmly establish a diagnosis of fibromyalgia.
Most symptoms of fibromyalgia can come and go and are not specific to this disorder. But there are two symptoms that appear in all cases of fibromyalgia and are thus mandatory for making a diagnosis. They include:
- Widespread pain that affects all four quadrants of your body such as your shoulders, neck, upper chest, elbows, knees and hips that feel intensely painful when touched. Some sufferers will say they “hurt all over”.
- Persistent pain lasting for at least three months.
Other common symptoms include:
- Muscle stiffness. The muscle stiffness, just like the pain, is usually worse in the morning, especially after a poor sleep.
- Irritable bowel syndrome. Depending on the statistics, between 30% and 70% of fibromyalgia patients suffer from diarrhea, constipation, bloating and abdominal pain caused by irritable bowel syndrome.
- Fatigue and sleep disturbances. Patients with fibromyalgia tend to wake up tired, feeling weak and unrefreshed, even after a long night of sleep.
- Chronic headaches and facial pain. Fibromyalgia can be often accompanied by tension headaches and migraines. Many patients with fibromyalgia also experience pain and tenderness in the muscles and ligaments around the jaw.
- Increased sensitivity to environmental factors. Many fibromyalgia sufferers are known to be sensitive to noise, bright lights, weather changes but also odors and foods that intensify their body pain.
- A variety of other symptoms which may include depression, mood changes and anxiety, memory problems and trouble concentrating, dizziness, chest pain or pelvic pain, numbness or tingling in the hands and feet, dry eyes and mouth and irritable bladder.
Exercise. Since there is no cure for fibromyalgia, treatment involves relieving its symptoms in order to improve the patient’s day-to-day functioning. Treating fibromyalgia is a long-term commitment while relapses can occur. Any fibromyalgia treatment should begin with regular exercise to ease sore muscles, improve their mobility and to promote deep sleep. Most doctors recommend walking, swimming, stretching and biking. Shedding extra pounds can help to significantly ease pain in overweight patients.
Adjusting lifestyle. It is important to establish a regular sleep routine by getting up and going to bed at the same time each day. Balance work with rest periods throughout the day. Reduce your stress as much as you can. Limit what you try to accomplish in one day, doing the most important things first, when you have the most energy. But do not abandon your daily routine totally. Fibromyalgia patients who quit work or drop all activities tend to do worse than those who remain active.
Medications can help ease the muscle pain, improve sleep and lift depression and anxiety. The most commonly prescribed medications to treat the symptoms of fibromyalgia, such as pain, depression and muscle stiffness, include Lyrica (pregabalin), Cymbalta (duloxetine) and Savella (milnacipran). Lyrica was originally approved to treat seizures and ease the pain associated with nerve damage. It was later found that it also helps to calm down overly sensitive nerve cells in fibromyalgia sufferers. Cymbalta is a serotonin and norepinephrine reuptake inhibitor primarily used to treat depression. This medication is prescribed to improve mood and help suppress feelings of pain in patients with fibromyalgia. Like Cymbalta, Savella is a serotonin and norepinephrine reuptake inhibitor typically prescribed to treat depression and psychiatric disorders. This drug is approved for use in fibromyalgia sufferers to reduce sensitivity to pain and to decrease fatigue.
Other drugs that your doctor may prescribe to treat the symptoms of fibromyalgia include tricyclic antidepressants Elavil (amitriptyline) and Pamelor (nortriptyline), anticonvulsant Neurontin (gabapentin), the common over-the-counter pain reliever acetaminophen (Tylenol), the muscle relaxant Flexeril (cyclobenzaprine), the narcotic-like pain medication Ultram (tramadol) and benzodiazepines such as Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam) due to their anti-anxiety, sleep-inducing, anticonvulsant and muscle relaxant properties. Sleeping pills and narcotic painkillers such as OxyContin and Percocet (oxycodone) and Lortab and Vicodin (hydrocodone) are usually only prescribed if the pain is too severe or other therapies are ineffective. These drugs can only be used for short periods and under your doctor’s strict supervision.
Alternative treatments are being increasingly used to help manage pain and stress in people with fibromyalgia. Meditation can reduce sleep deprivation, fatigue and pain whereas acupuncture can be successfully employed to manage pain by increasing circulation near tender points. Other possibilities include hypnosis, biofeedback, massage, chiropractic manipulation, posture and movement training, the application of ice, heat and ultrasound, the dietary supplement dubbed SAMe and even medical marijuana.