 |
Fibromyalgia - The Nature of the Disease
There is far more to fibromyalgia than merely the three components required for its diagnosis. Let's look at those components in more detail, as well as discussing some of the other factors often present in patients with this debilitating condition.
Fatigue
The fatigue in fibromyalgia can be overwhelming. Patients often say that they have virtually no energy; that even doing simple tasks (for example, balancing a checkbook, fixing coffee) can leave them so drained that they have to sit down for a half-hour or more just to recover. This symptom can be very hard for others around them to understand - they may be accused of being lazy or wallowing in self-pity. This is one area where fibromyalgia is similar to another serious medical problem - chronic fatigue syndrome. Often, fibromyalgia patients find it necessary to treat their energy like money in a bank account. They have to conserve themselves to "save up" for tasks they have to do. As a result, if they have a PTO meeting in the evening, for example, they may not be able to do housework in the afternoon.
Poor Sleep
Fibromyalgia patients may sleep more, less, or the same as any other person. The problem is that sleep doesn't seem to do them any good. They typically report waking up in the morning feeling as tired as they were before they went to bed. This can be incredibly frustrating. They also commonly report that they sleep very lightly and wake up at even the slightest disturbance.
Sleep researchers have reported a specific type of sleep disorder in FM patients. There are four basic levels of sleep - Phase I (dozing), Phase II (light sleep), Phase III (deep sleep), and Phase IV (sleeping like the dead). Whenever a FM patient goes from Phase II to Phase III or IV, it appears they have a burst of activity on their EEG that raises them back up into the lighter states of sleep. As a result, their sleep is of very poor quality, and, when they awaken, they still feel tired.
Low-dose antidepressants appear to have the specific effect of causing a person to spend more of their time in Phase III and IV sleep. This is one on the most compelling reasons for their use in fibromyalgia. Also, in some or most cases, when trigger points are treated, fibromyalgia patients notice an immediate improvement in their sleep patterns.
Pain
The pain in fibromyalgia can be severe. It tends to be a chronic, deep, aching feeling, though it can also be burning, stabbing, or tingling. One of the typical features of FM pain is that it is distributed all over the body - in the head, torso, arms, and legs. There are 18 tender points on the body (nine on each side) that are used to diagnose FM. These include:
- Where the neck meets the back of the head
- Halfway down the neck on the side
- The mid-trapezius (the muscle that sweeps from the shoulder to the back of the neck)
- The inside border of the shoulder blade about 1/2 of the way down
- Between the 2nd and 3rd rib about one inch from the breastbone
- Just past the outer (lateral) prominence of the elbow
- Just behind the prominence at the lateral hip region
- The mid-portion of the buttocks
- Just above the inside of the knee
(Note - These points are very specific on the body; a non-technical description cannot pinpoint them precisely. As a result, it's important to rely on a trained person and not try to find them yourself without having been shown exactly where they are.)
One of the great misperceptions about FM pain is the idea that it is due to inflammation. Muscle biopsies have shown that this is rarely true. This means that anti-inflammatory medicines cannot treat the underlying problem, although their pain-killing effect can be somewhat helpful. To treat inflammation, doctors used to inject cortisone-type medications into trigger points; this is now no longer recommended.
It's also important to distinguish "tender points" from "trigger points." Tender points are specific tender areas in fibromyalgia. While tender, the pain they cause is typically localized to the tender spot, not referred. Also, a knot of tense muscle in the area may or may not be present. Trigger points, on the other hand, are often present at spots other than the 18 sites associated with fibromyalgia, cause generalized, achy pain that shoots to surrounding areas, and are typically associated with a hard knot of muscle. While a trigger point may be present at a tender point, it doesn't have to be.
Other Associated Symptoms
There are many other symptoms that fibromyalgia patients may experience, including:
- Morning stiffness*
- Muscle spasms*
- Weakness (general or local)*
- Headaches (inc. migraines)*
- Swelling*
- Localized tingling or numbness
- Memory lapses
- "Brain fog"
- Blurred vision (brief, transient)
- Depression
- Anxiety (inc. panic attacks)
- Acid indigestion (heartburn)
- Spastic colon
- Temperature intolerance (esp. cold)
- Reynaud's condition
- Allergies (worsening of symptoms)
- Bladder irritability
- Dry skin
(Symptoms with an asterisk often respond to myofascial trigger point therapy.)
Although many of these symptoms may improve as fibromyalgia responds to treatment, some may require their own specific treatments.
Fibromyalgia - Diagnosis
In order to receive the diagnosis of fibromyalgia, a patient must meet the three criteria already discussed - at least three months of sleep disorder, at least three months of life-altering fatigue, and significant tenderness in at least 11 of the 18 tender points mentioned.
It is important to realize, however, that this disease can be present on a continuum; in other words, a person could have profound fatigue, sleep problems, and tenderness at nine points, and they would still need to be treated. We refer to this condition as "subclinical fibromyalgia," despite the fact that this is a term that has not yet been widely accepted. Still, a person would probably be greatly helped by the same treatments that help fibromyalgia patients.
Once fibromyalgia has been diagnosed, it's important to rule out other conditions that can cause its symptoms. Hypothyroidism (low thyroid hormone) is one of the big ones; every patient with these symptoms should have a thyroid profile. Dr. McNett has found that a large number of patients with fibromyalgia have all the symptoms of hypothyroidism but have normal thyroid lab tests. These patients tend to respond extremely well to some of the more cutting-edge treatments we do at Paragon.
Diseases that cause muscular inflammation (as a class, these are called "myopathies") can also cause a similar picture. The cholesterol-lowering "statin" drugs can sometimes cause this type of pain. Arthritis and its related diseases (rheumatoid, lupus, etc.) can also cause FM-like symptoms. One type in particular, called polymyalgia rheumatica, should be ruled out by a simple lab test. Finally, if a person has severe myofascial dysfunction, she or he can look just like a fibromyalgia sufferer.
Another condition that can play a large role in many cases of fibromyalgia is candida hypersensitivity syndrome. While this is a disease that many people in medicine don't believe in, there can be no arguing with the results many FM patients have when treated for it. Dr. McNett has seen totally disabled fibromyalgia sufferers with evidence of this syndrome become completely symptom-free in a matter of months after starting treatment. As a result, we strongly encourage all fibromyalgia patients to be checked for this. While there are lab tests available, a simple questionnaire is just as accurate and cheaper.
Back - What is Fibromyalgia?
More - Fibromyalgia - Treatment
|
|
