Fibromyalgia is a syndrome that causes chronic, wide spread musculoskeletal pain, and it is often associated with one or more other symptoms, such as fatigue, stiffness, and insomnia. The pain of fibromyalgia syndrome (also know as FMS) typically includes particular areas of increased sensitivity called tender points.
How is Fibromyalgia Diagnosed?
Approximately 2% of the U.S population meets the criteria for FMS that the American College of Rheumatology (ACR) established for research purposes. These criteria require patients to have widespread pain, both above and below the waist and on both sides of the body, for at least three months, in combination with a minimum of 11 of 18 specified tender points.
In actual clinical practice, however, physicians often diagnose FMS in patients who may not meet these criteria. Instead, the diagnosis may be made in people who have a generalized lowering of the pain threshold along with other typical characteristics.
How Common Is Fibromyalgia?
Fibromyalgia affects more than 3.5million Americans, it affects women, men and children. People with other rheumatic diseases such as lupus or rheumatoid arthritis are at greater risk for fibromyalgia.
Causes of Fibromyalgia
The cause of FMS remains unknown. The current research shows that it is a combination of genetic and environmental factors that leads to a process called ‘central sensitization’. A sensitization of the central nervous system is the proposed mechanism for pain. This means that there is an abnormal pain signaling process in the brain and spinal cord. The disturbance of sensory processing is most likely a general sensory processing disorder and not pain specific. People with fibromyalgia are also frequently sensitive (hyper-responders) not just to pain but also to temperature changes, loud noises, bright lights, smells, medications and chemicals.
Onset and Development
While the symptoms of FMS often develop gradually, up to one-quarter of patients can remember a physical or emotional trauma preceding the onset of symptoms. Precipitating factors can include both physical trauma including hypermobility, and mental stress and or mental trauma. Infectious diseases are also commonly seen prior to the onset of fibromyalgia. Fibromyalgia has been reported to follow numerous infections, including viral hepatitis C, parvovirus, Epstein Barr virus, and bacterial infections including Lyme. People with chronic autoimmune diseases such as lupus and rheumatoid arthritis often develop symptoms of fibromyalgia as well.
Current Fibromyalgia Research
Research has shown a number of abnormalities in patients with fibromyalgia. These include sleep disturbances, hormonal abnormalities, metabolic abnormalities and abnormalities in sensory processing.
Sleep Abnormalities and Fibromyalgia
Insomnia is a frequent complaint of patients with fibromyalgia, and abnormalities are commonly seen on sleep electroencephalography (EEG).
Many patients have endocrine abnormalities; there can be abnormalities in the hypothalamic-pituitary- adrenal axis (the brain and hormone interactions that regulate the stress response). Some patients have low levels of insulin like growth factors and growth hormone, which may contribute to postexertional muscle pain. Others may have under an active thyroid.
Several abnormalities in central nervous system fluid have been observed. These include increased levels of substance P (known to influence pain perception) and lowered levels of serotonin (known to influence both mood and pain perception).
Fibromyalgia patients have differences in pain perception (with an overall increase in pain sensation) due to central sensitization, which causes a generalized disturbance in the processing of sensory information within the central nervous system. There is extensive evidence supporting this hypothesis. ‘The volume is set too high’. People with fibromyalgia feel pain from stimuli that would not ordinarily be painful to others. This happens because their brain and spinal cord are either augmenting normal pain processing or missing some of the filters that usually dampen painful sensation from the periphery. The end result is that the brain receives more signals indicating pain or other unpleasant sensations.
Diffuse musculoskeletal pain and tenderness are the clinical hallmarks of fibromyalgia. In general, widespread muscle pain is the predominate symptom. While the sensation of join swelling and pain is not uncommon there is not objective evidence of swelling.
Other symptoms include fatigue, stiffness, muscle tenderness, post-exceptional pain/ fatigue, trouble sleeping, and parenthesis (sensations of numbness). Some people may have heightened sensitivity to temperature changes, smells, sounds, medications and or chemicals. Stress, anxiety, lack of sleep may make symptoms worse. Many people have cognitive problems, such as difficulty with memory and vocabulary.
Other central sensitization syndromes
Many patients with fibromyalgia may also have migraines, premenstrual syndrome, irritable bowel syndrome, restless leg syndrome, and Raynaud’s syndrome. The degree of overlap may be significant; for example, one-third of patients with fibromyalgia also fulfill criteria for irritable bowel syndrome (IBS). These conditions are felt to be a part of the central sensitization syndrome.
Importance of Confirming Diagnoses
It is important to get the right diagnosis and rule out other causes. Physical exam is usually normal, except for tender points or (allodynia). Allodynia is the term for the pain evoked by ordinarily non-painful stimuli.
Laboratory tests in fibromyalgia are usually normal. The following tests should be done to make sure you don’t have any other disorders. These include: complete blood count (CBC), chemistries (including muscle enzyme tests CPK and aldolase, thyroid function tests, urinalysis, erythrocyte sedimentation rate (ESR), and a check of autoimmune blood markers such as antinuclear antibody (ANA) and rheumatoid factor (RF). Other tests may be ordered depending on your history.
Fibromyalgia/ Coexisting Autoimmune Diseases
People who have already been diagnosed with a connective tissue disorder also may develop fibromyalgia syndrome. FMS patients may have symptoms that are common in autoimmune disorders (such as systemic lupus erythematous and rheumatoid arthritis). Fibromyalgia may coexist with autoimmune disease in up to one-quarter of patients with systemic lupus and other connective tissue disorders. However, these other diseases have abnormal laboratory tests and/or other signs to differentiate them from FMS.
Our Philosophy for Treatment
We take an integrative approach, combining Western medicine, therapeutic lifestyle changes, with complementary and alternative therapies. A patient centered holistic approach is taken, which takes into account all aspects of our patients, including physical, mental, and emotional. We seek to support the body’s natural healing process. First we do a comprehensive evaluation, which includes a detailed history, review of your records, and physical. Appropriate tests are used to confirm your diagnosis. This is the most crucial part of your first consultation. Your individual treatment plan will include a comprehensive plan looking at all aspects, physical, mental, and emotional. We address every symptom as part of a whole. There is a complex interconnection between mind and body. We look to support the body’s natural healing system. We start by evaluating your diet. Recommendations are based on your needs as well as evaluation of any food sensitivities. We may recommend medical foods, medications, herbs, nutritional supplements, or vitamins based on your unique needs.
We Also Focus on Teaching Stress Management and Relaxation Skills
We focus on mind body techniques to elicit the relaxation response to reduce the harmful effects of stress on your health. The relaxation response helps your body heal.
We want to educate our patients on so they can take control of their health/wellness: We are here to guide and support our patients and help them strengthen and heal.
Another integral part of healing includes Cognitive Restructuring Techniques
Cognitive restructuring techniques are taught to stop automatic negative thoughts from worsening your physical symptoms. Replacing them with thoughts that heal your body.
Exercise is essential for the healing process. Exercise (the right amount) is part of every treatment plan. We may also recommend medical acupuncture and or laser acupuncture. Acupuncture helps the body heal and has been found to be very beneficial in treating pain syndromes and relieving stress. Additional recommendations may include, but are not limited to, massage, physical therapy, chiropractic, and cognitive behavioral therapy.