What is Fibromyalgia

Coining the Term Fibromyalgia

 

What is fibromyalgia? What makes someone with fibromyalgia wince even at the thought of a hug -- even from a loved one? Fibromyalgia has been around a long time.  This is a description by a famous medical doctor, William Oslo, in his book Principles and Practice in Medicine, “Sleepiness is frequently present; the aching pain in the back of the neck is the most constant complaint and the response of local tendons in the spine”.  Now, the date of this publication: 1869. In 1990, a group of rheumatologists who were doing research and wanted to have a better definition of widespread pain syndrome they were seeing in their clinics got together. This way they could compare any treatments or findings.  So, they coined the term fibromyalgia and the so called "tender point examination" came into being.  This is where the doctor pushes on different areas of the body and if there are 11 out of 18 tender points, or painful points, in three areas of the body, it indicates you have fibromyalgia. More recently, that same group of researchers published a symptom severity score chart and a widespread pain index.  That doesn't sway from the need of the trigger point exam, which obviously is very prone to examiner error -- I could push hard or I could push lightly.

Fibromyalgia is a Real Disorder

 

There have been many studies documenting differences between fibromyalgia and other pain states, even those who don't have pain.  These have shown differences in the brain scans, in stress, growth and thyroid hormones, as well as lower androgens.  There are also automatic nervous system changes and decreased concentration of certain neurotransmitters and neuromodulators. So no longer can anyone claim there are no biochemical or MRI, functional MRI, changes that can be seen in fibromyalgia and it is a fictitious illness.  This is incorrect.  The tests are complex and primarily available only for research purposes but the results are in: fibromyalgia is a real disease or syndrome. We think these changes and others may lead to central sensitization of the nervous system-- that's where the brain, even when they have non-painful sensations, the brain says it is pain.  That is why pain is widespread.  It doesn't come from the muscles themselves but from the central nervous system that misinterprets input.

So, why do people get it? Bottom line is we really don't know.  There may be a genetic susceptibility that's made apparent only after a viral illness or an accident such as whiplash.  We know that relatives of someone with fibromyalgia are 8 times more likely to suffer from it themselves.   Females are 6 to 10 times more likely to suffer from it than males.

Lifestyle Habits to Treat Fibromyalgia

 

How do you treat it? Well firstly, you need to improve your sleep.  Sleep hygiene is really how to set up for a restful night sleep, and there's plenty of advice for that to be found on the web.  So, if you have sleep apnea- a disorder where you snore and stop breathing.   Or maybe you have restless leg syndrome. Both are medical problems that need treatment. Good sleep is very important.  In fact, some people think fibromyalgia is primarily a sleep disorder. Two, lose weight.  If you are obese, losing weight may significantly decrease your pain. Three, stop smoking.  Every time you smoke, for about an hour afterwards the carbon monoxide you take in smothers the red blood cell and it stops oxygen going to the tight muscles. People with fibromyalgia who smoke have more pain. Four, exercise regularly.  Learning to pace your self is the key.  Do too much and what happens? You crash and burn.  Pacing is important.  Five, settle the mind.  Cognitive behavioral therapy and mindfulness meditation are methods where you are beginning to use your brain to turn down the volume control.  These approaches can be found on YouTube. Six, is medication.  These have a moderate effect at best.  The FDA has approved three drugs that have proved to be effective.   More effective than placebo in studies, Pregabalin or Lyrica, which like it's older cousin Gabapentin or Lorontin, work by decreasing the “pain messages” going up to the brain.  There is no evidence that anti-inflammatories, such as, Advil, Aleve, benzodiazepines (e.g. Valium), or sleeping pills work.  There is no evidence at all that narcotics or opioids work and in the long term opioids may make things worse as they can actually increase the pain of fibromyalgia.  It is referred to as opioid-induced hypoalgesia.

Last Question--Is there hope for the future? Well, as our knowledge of this very common disorder improves, our treatments are also improving.  We are beginning to use an anti-opioid or an anti-narcotic called naltrexone in small doses and, in some cases, it is working.  Researchers are using repeated magnetic pulses to change the brain processing.  What the future holds is unclear.  But one thing is for certain -- fibromyalgia is a pain disorder that clearly demonstrates when a person starts looking after themselves mentally and physically, they can improve immensely.

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