The Reality of Fibromyalgia
Fibromyalgia (FM) is a chronic (long-lasting) pain syndrome.
Some believe that FM is an inflammation of fibrous tissue; however, this
is a misnomer because there is no confirmed inflammation in the soft tissues
(skin, ligaments, tendons, and muscles). Instead, FM is actually a collection
of signs and symptoms (not a disease) that affect several million people
in the United States. Most cases of fibromyalgia are found in females (90%),
usually in the third decade of life (20s); however, FM can affect males
and females of all ages. Symptoms include, but are not limited to, fatigue,
generalized muscle aches, spasms, soft-tissue swelling, difficulty sleeping,
migraine headaches, depression, anxiety, irritable bowel, and memory trouble.
The
mystery
FM is a troubling problem for both patients and medical professionals
because it is not diagnosable with any blood test, x-ray, or neurologic
examination. However, the American Academy of Rheumatology has developed
criteria for the diagnosis of FM. The criteria include the following:
- Having dispersed pain in the trunk and extremities (arms,
hands, legs, feet) for at least 3 months and
- Having at least 11 of 18 specific tender points detected
by physical examination.
What causes FM?
Despite ongoing research, the cause of FM is unknown. Most experts
believe that lack of sleep (leading to neurochemical deficiencies in the
brain) and psychological factors contribute to FM. Some studies have shown
that physical injury, viral infection, and emotional trauma can also lead
to FM symptoms. Specific soft-tissue abnormalities, however, have not been
associated with FM.
Is FM a disabling condition?
It depends on whom you ask. There is general agreement among medical
professionals that FM should not lead to disability claims. There is no
apparent disease of the muscles or joints, and a person will not become
disfigured or disabled from FM. Unfortunately, there is no existing "pain-o-meter"
(pain-measuring device) to validate its existence. The chronic pain cycle
in FM consists of pain, inactivity, and physical or emotional deconditioning.
Poor sleep and poor nutrition can worsen this condition. Unless the cycle
is broken, pain is certain to increase as a person's physical and emotional
health declines.
How is FM treated?
There has been no specific treatment approach to withstand the
rigors of scientific investigation, but some people with FM have had success
with a variety of treatment methods.
Initially, a person with FM symptoms should be formally
examined by a qualified medical professional to rule out any other specific
medical conditions, joint dysfunctions, or soft-tissue restrictions. The
focus would then be to address the deficiencies, break the pain cycle of
inactivity and deconditioning, restore proper sleep patterns, improve nutrition,
and increase emotional stability. Education is paramount, and information
is available to help cope with depression, stress management, physical
conditioning, energy conservation, nutrition, sleep, and chronic pain-management
strategies. This information can be obtained from sources such as health
professionals, local and state chapters of the Arthritis Foundation, the
Internet, and local support groups.
Nonsteroidal anti-inflammatory drugs (such as ibuprofen),
non-narcotic analgesics, muscle relaxants, and tricyclic antidepressants
are frequently prescribed for people with FM and have been helpful with
temporary relief of pain, restful sleep, and decreased morning stiffness.
Corticosteroids, immunosuppressants, and narcotic analgesics are not recommended.
Physical and occupational therapy is often ordered by
physicians to further evaluate and treat any detected musculoskeletal dysfunction.
If no movement dysfunctions are present, generalized stretching, strengthening,
and aerobic conditioning will follow. Some individuals may benefit from
other measures, such as heat, ice, nerve stimulation, and massage. Aquatic
or pool therapy may also provide a soothing environment for exercise. The
ultimate goal of rehabilitation efforts is to promote independence and
educate individuals on management techniques so they can return to their
normal activities.
Depending on the severity of the depression and anxiety,
psychological or psychiatric counseling may be recommended to address the
cognitive and behavioral aspects of dealing with chronic pain. Local support
or self-help groups may also fulfill emotional needs.
Despite the puzzling nature of FM, clinicians are hard
at work to discover its causes and to provide the best care possible. Remember,
it is important to consult your physician if you feel that you or anyone
close to you may be suffering from FM. Only then will you be taking the
first step in coping with this problem.
Richard J. McKibben, M.S., P.T.
Columbus, Georgia