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Fibromyalgia is a debilitating chronic illness characterized by diffuse pain, fatigue, and a wide range of other symptoms. It is a syndrome, not a disease. It is not contagious, and is probably genetic. It affects more women than men, mostly between ages 20 and 50. It is seen in 3-10% of the general population. The nature of fibromyalgia is not well understood.
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The primary symptom of fibromyalgia is widespread, diffuse pain, often including heightened sensitivity of the skin (that may make the touch of clothing painful), achiness around joints, and nerve pain . Other symptoms often attributed to fibromyalgia (though possibly due to another "comorbid" disorder) are physical fatigue, irritable bowel syndrome, genitourinary symptoms, dermatological disorders, headaches, and symptomatic hypoglycemia. Although it is common in fibromyalgia sufferers for pain to be widespread, it may also be localized in areas such as the shoulders, neck, back, hips, or other areas. Not all patients have all symptoms.
Symptoms are often aggravated by exercise, unrelated illness, or changes in the weather. Fibromyalgia does not cause inflammation, nor are there any diagnostically abnormal laboratory findings. Symptoms may present periodically or may be continual. Fibromyalgia can start as a result of some trauma (such as a traffic accident) or illness, but there is no strong correlation between any specific type of trigger and the subsequent initiation of fibromyalgia. Symptoms can have a slow onset, and many patients have mild symptoms beginning in childhood such as growing pains.
Fibromyalgia symptoms can become more tolerable or less tolerable throughout daily or yearly cycles. Most sufferers find that, at least some of the time, the disease prevents them from performing normal activities such as driving a car or walking up stairs.
Fibromyalgia is considered a diagnosis of exclusion, and laboratory testing should be completed to rule out other similar conditions such as endocrine disorders, arthritis, and Polymyalgia Rheumatica. Most physicians use a diagnostic technique of palpating tender points, specific spots on the body that are usually very pressure-sensitive in individuals with the disorder. This technique was developed by the American College of Rheumatology as a means of confirming the diagnosis for clinical studies, and required participants to have 11 of 18 identified tender points. While many fibromyalgia patients express pain on palpation, patients with a high pain tolerance may not feel any pain during this exam. In recent years this has caused researchers to rexamine this diagnostic criteria but it has not yet been entirely abandoned. There is stated evidence that chronic fatigue syndrome is the same disorder as fibromyalgia in individuals with high pain tolerance.
Another method of diagnosis is a specialized technique called mapping that is a gentle palpitation of the muscles to detect lumps and areas of spasm that are thought to be caused by an excess of calcium in the cytosol of the cells. This is especially useful to physicians who believe fibromyalgia can be reversed. This theory of the cause of fibromyalgia is known as the Guaifenesin Protocol.
The cause of fibromyalgia is currently unknown. Over the past few decades many theories have been presented, and the understanding of the disorder has changed dramatically. Most current theories explain only a few symptoms of the disorder and are thus incomplete.
The sleep disturbance theory postulates that fibromyalgia is related to sleep quality. Circumstances that interfere with "stage 4" deep sleep (such as drug use, pain, or anxiety) appear to be able to cause or worsen the condition.
According to the sleep disturbance theory, an event such as a trauma or illness causes sleep disturbance and, possibly, some sort of initial chronic pain. These initiate the disorder. The theory supposes that "stage 4" sleep is critical to the function of the nervous system, as it is during that stage that certain neurochemical processes in the body "reset". In particular, pain causes the release of substance P in the spinal cord, and substance P has the effect of amplifying pain and causing nerves near the initiating ones to become more sensitive to pain. Under normal circumstances this just causes the area around a wound to become more sensitive to pain, but if pain becomes chronic and body-wide then this process can run out of control. The sleep disturbance theory holds that deep sleep is critical to reset the substance P mechanism and prevent this out-of-control effect.
An interesting aspect of the sleep disturbance/substance P theory is that it explains "tender points" that are characteristic of fibromyalgia but which are otherwise enigmatic, since their positions don't correspond to any particular set of nerve junctions or other obvious body structures. The theory posits that these locations are more sensitive because the sensory nerves that serve them are positioned in the spinal cord to be most strongly affected by substance P. This theory does not explain slow-onset fibromyalgia, fibromyalgia present without tender points, or patients without heightened pain symptoms. It also does not address the multitude of non-pain symptoms present in the disorder.
Another theory involves phosphate and calcium accumulation in cells that eventually reaches a level to impede the ATP process, possibly caused by a kidney defect or missing enzyme that prevents the removal of excess phosphates from the blood stream. This theory posits that fibromyalgia is an inherited disorder, and that phosphate build up in cells is gradual (but can be accelerated by trauma or illness). Calcium is required for the excess phosphate to enter the cells. The additional phosphate slows down the ATP process; however the excess calcium prods the cell to continue producing ATP.
While this theory does not identify the causative mechanism in the kidneys, it proposes a treatment known as guaifenesin therapy. This treatment involves administering the drug guaifenesin to a patient's individual dosage, avoiding salicylic acid in medications or on the skin, and, if the patient is also hypoglyemic, a diet designed to keep insulin levels low.
The phosphate build-up theory explains many of the symptoms present in fibromyalgia (though it does not explain the uniqueness of the "tender points", nor does it explain why the "excess" phosphate does not show up in lab tests) and proposes an underlying cause. The guaifenesin treatment, based on this theory, has received mixed reviews, with some practitioners claiming many near universal success and others (probably the majority) reporting no success at all. Only one controlled clinical trial has been conducted to date, and it showed no evidence of the efficacy of this treatment protocol.
Other theories relate to various toxins from the patient's environment, viral causes, growth hormone deficiencies, neurotransmitter disruptions in the central nervous system, and erosion of the protective chemical coating around sensory nerves. Due to the multi-systemic nature of illnesses such as fibromyalgia and chronic fatigue syndrome (CFS), an emerging branch of medical science called psychoneuroimmunology is looking into how the various theories fit together.
Fibromyalgia has been studied since the early 1800s and referred to by a variety of former names, including muscular rheumatism, neurasthenia, and fibrositis. The term "fibromyalgia" was coined in 1976 to more accurately describe the symptoms, from the Greek my-, meaning muscle, and algia, meaning pain. "Systemic Dysenergism" has been proposed as a better name to encompass the vast array of symptoms, the common denominator of which is low energy.
Fibromyalgia was once termed an autoimmune disorder, but lab results reveal no disturbance of the immune system. It was also once classified as a psychosomatic disorder, although few specialists currently would classify it as such. Because the understanding of this disorder has grown so rapidly in the 1990s and 2000s, many texts on the subject are out of date.
There is no cure for fibromyalgia, but many treatment options are available. Patient usually try many routes of treatment under the guidance of a physician to find relief. Treatments range from prescription medication to herbal medicine to exercise therapy. Most treatments only ease some symptoms. The most popular treatment involves conventional analgesics to reduce the effects of fatigue and pain. Antidepressants are often prescribed as well to adjust nerve response and help to deal with the psychological effects of constant fatigue and pain. Low doses of antidepressants, often tricyclic antidepressants like amitriptyline, have also been used to treat the insomnia associated with fibromyalgia. Physicians may also prescribe exercise in an attempt to build up muscle bulk and reduce stress on the muscles, but it is often poorly tolerated in the more severe cases.
Many patients find temporary relief by applying heat to painful areas, through physical therapy, lymphatic drainage, or massage. Occupational therapy may assist patients in maintaining employment. Some patients find the Guaifenesin Protocol particularly effective when followed properly. Some have even reported a full reversal of symptoms through the application of this treatment, though it is not a cure.
A more popular alternative treatment in the Spanish-speaking world uses a mineral salt formula developed by a former fibromyalgia sufferer named Alfred Blasi. Its clinical effectiveness has not been proven as of 2004, but some patients claim considerable improvements in their symptoms using this over-the-counter remedy.
Fibromyalgia can affect every aspect of a person's life. There is some evidence that fibromyalgia sufferers are more at risk of suicide than the general population, although this is probably true of all chronic pain syndromes. Many sufferers are unable to maintain a full-time job.
In the United States, those affected by fibromyalgia may qualify under programs for those whose work is adversely affected by disabilities. Employed Americans may apply for coverage under the Americans with Disabilities Act. Children and college students may be granted more time to take tests, changes in physical education requirements, and college housing closer to class locations.
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