fitness articles

Fibromyalgia

What is Fibromyalgia?

The word fibromyalgia literally means "pain of the fibrous tissue (ligaments and tendons) and muscles." Fibromyalgia is a chronic, widespread musculoskeletal pain syndrome with tender points at multiple sites affecting the fibrous connective tissue and muscles. Chronic as it does not get better in three months or lesser time. Widespread in the sense that it is not limited to the neck or shoulder.  Very often the pain is experienced in all the four limbs as well as the neck, chest wall and the back. The pain affects muscles and joints as well as the ligaments, tendons, and skin. Syndrome for it is made up of a combination of many symptoms, such as pain, fatigue, sleeping problem, tingling and headaches.

It differs from arthritis in a way that, FM does not cause pain or swelling in the joints. Rather, it produces pain in the soft tissues located around joints and in skin and organs throughout the body. 

It  can be disabling and often accompanies other types of arthritis, particularly RA and systemic lupus. Fibromyalgia affects mostly women, causing fatigue, sleep disturbances, depression and widespread pain in muscles and tendons, particularly in the neck, spine, shoulders and hips. While it is not life-threatening, the extreme fatigue and pain can lead to disability and muscle weakness from  lack of activity.

What causes Fibromyalgia?

Fibromyalgia pain is not in the joints, but in the muscles, ligaments and tendons. It may be triggered by an infection, a physical trauma from an accident or surgery, or an emotional trauma from physical, sexual or other abuse which might affect the brain and central nervous system which in turn produce the condition that we know as fibromyalgia. A research conducted by Stuart Donaldson, Ph.D.; Mary Lee Esty, Ph.D.; and Len Ochs, Ph.D., suggests that FM may actually be a "CNS Myalgia" (central nervous system myalgia) caused by a  traumatic brain injury which results in abnormalities in the functioning of the brain and central nervous system.¹

Heredity: There is already evidence of a strong familial pattern in many cases of FM, with fibromyalgia often following the female side of the family.

The patients show low Hypoglycemic effect of insulin. Obviously they must be in pre diabetic phase an outcome of Pituitary Hypothalamic- Insulin like factors axis disturbances.

It is also connected with abnormal levels of substance P, which transports pain messages; a growth hormone serotonin, which helps regulate sleep, mood and pain perception. The core problem is immune system dysfunction resulting from an immune system overload.

Symptoms associated with Fibromyalgia:

FM has few symptoms that are outwardly visible, it has been nicknamed "the invisible disability" or the "irritable everything" syndrome. Besides, its symptoms are common to various other disorders,

Diagnosing Fibromyalgia

Difficult to diagnose, Fibromyalgia was once mistaken for fibrositis and is often confused with chronic fatigue syndrome. People with Fibromyalgia often do not look sick or show abnormalities in laboratory tests but say they have almost constant and  sometimes terrible pain.

As there is currently no reliable laboratory test available to make the diagnosis of FMS, the examining physician have to  rely on a patient's medical history and physical findings of tender points on examination. Palpation of muscles and muscle-tendon junctions will show many tender points.

In 1990, The American College of Rheumatology established criteria to make the diagnosis of FMS that include the presence of 11 tender points at 18 specified sites. A diagnosis is usually helpful because now you know there is a name for your symptoms. Usual laboratory tests come out negative.

Previously we did not know if anything was abnormal, but now it is clear that many neuroendocrine tests are abnormal (for example, serotonin is low, substance P is high, etc). A recently reported blood test (still in experimental stage) detected an antibody (called APA) in about 50% of Fibromyalgia patients studied. In the past 10-15 years significant progress has been made. A satisfactory test for FMS may be available in the future.

Treatment of Fibromyalgia

Successful treatment of your Fibromyalgia symptoms involves treating yourself with kindness and respect, both emotional and physical. Adopting and adhering to positive lifestyle habits will not only help ease the painful effects of Fibromyalgia, but also promote overall health. These are habits that could benefit anyone of any age and in any state of wellness. Best of all, these habits, when used as part of your everyday routine, will help prevent or reduce pain, disease and depression.

It is difficult to treat Fibromyalgia since the symptoms can vary so widely and the cause is unknown. Your doctor will work with you to develop a specific treatment plan, tailored to your condition and the severity of your symptoms of fibromyalgia. This may include a combination of :

1) Medication

2) Exercise

3) Physical Therapy

4) Dietary Modification

5) Management

Medication

• Analgesics -such as paracetamol, and even more powerful pain medications to relieve pain and help with sleep.

  It is important to avoid prescription tranquilizers and sleeping medications especially of the benzodiazepine group. While these may help you get to sleep, they suppress deep sleep and therefore often make fibromyalgia worse!

• Low doses of  antidepresssants and muscle relaxants to help with sleep and mood.

• Laser therapy- to improve pain intensity to a greater degree in combination with amitriptyline which has a greater effect on depression as reported by  investigators from the Dicle University School of Medicine in Diyarbakir and Abant Izzet Baysal University in D�zce, Turkey. The investigators compared three groups of 25 patients each that were treated with active gallium-arsenide laser, amitriptyline or placebo laser treatment. Laser treatment was performed for three minutes daily at each tender point for two weeks, excluding weekends. Placebo laser treatment used the same laser unit, but no beam was emitted. Amitriptyline treatment consisted of 10 milligrams daily at bedtime for eight weeks. Improvements in pain, number of tender points, skin fold tenderness, morning stiffness, sleep disturbance, muscular spasm and fatigue were assessed. Also, a psychiatrist evaluated depression based on the Hamilton Depression Rate Scale and DSM IV criteria. Quality of life was assessed by the Fibromyalgia Impact Questionnaire. The investigators conclude that both laser therapy and amitriptyline are effective for Fibromyalgia. Gallium-arsenide laser therapy could be used as a monotherapy or in combination with other therapies, they suggest.

• Note: The above mentioned medication is only for information purpose and not to be substituted for a Doctor's prescription.

Exercise

Exercise helps, although it might be the last thing you feel like doing if you're in a  lot of pain. It can be helpful in reducing muscle soreness. While no studies have found that exercise improves pain, it has been shown to help patients function better, improve mood, and reduce fatigue. (Reported by:Annals of Rheumatic Disease 2001; 60: 21-26).

In addition to improving strength and circulation, exercise can help increase your range of motion. It is important to stretch thoroughly, both before and after exercise to keep your muscles loose. Gentle stretching can be performed by physical therapists and/or practiced by patients at home. Stretching is important because it helps to relieve muscle tension and spasm. Patients can also perform stretching exercises using a "Theraband", a long elasticized strip which is manipulated in a number of ways, or an oversized, inflatable "Swiss ball" over which they can extend themselves in different ways to stretch and strengthen tight muscles.

Generally, low-impact exercise, such as water aerobics or walking are recommended for patients with fibromyalgia to prevent muscle atrophy (wasting), to promote the circulation of blood containing oxygen and other nutrients to muscles and connective tissue, and to build strength and endurance. A cardinal rule for fibromyalgia patients is to start extremely slowly and conservatively and build up exercise tolerance in increments. In fact, patients should find a form of exercise they like so that they will stick to it on a regular basis.

NOTE: Do not forget to take the permission of your doctor before starting on an exercise program.

Patients with Fibromyalgia can boost their strength and improve certain parameters with weight-bearing exercise, researchers from Finland have demonstrated, women with fibromyalgia completed a 21-week strength training program and it was found to reduce their levels of depression and fatigue, but pain levels did not change.

• Researchers divided 21 women with fibromyalgia into two groups.

• Eleven women went through the strength training program and 10 received no special care.

• An additional 12 healthy women went through the weight training program as "control" subjects.

Physical therapy

Physical therapy modalities also can be helpful in alleviating your symptoms. Physical therapists may use massage, heat or cold, ultrasound, electrical stimulation, or any combination of exercise, to help reduce your muscle soreness. Massage often combined with ultrasound and/or the application of hot/cold packs, may be performed in a number of ways and is useful in soothing and increasing blood circulation to tense, sore muscles. It can also help remove built-up toxins like lactic acid and re-educate muscles and joints which have become mechanically misaligned.

In addition, physical or occupational therapists may work on your posture or gait to help improve your ongoing symptoms. Posture or movement training is often required to undo lifelong bad habits which increase pain and to re-educate muscles/joints that have become mechanically misaligned. Physical therapists can help with posture while professionals trained in the "Alexander Technique" can provide movement training. FM patients who have significant problems with foot pain resulting from poor posture or body mechanics may also benefit from special shoe inserts (orthotics) prescribed by a podiatrist.

Meditation, deep breathing, practicing yoga, visualization and other mind body practices, such as tai chi and qigong, have been found to ease some symptoms- sometimes dramatically. Patients however, need to receive initial training for many of these but can often continue practicing the concepts they have learned on their own. Books, audiotapes, and classes are widely available to help.

Dietary Modification

Modifications brought about in dietary pattern might prove helpful in counteracting stress, ridding the body of toxins, and restoring nutrients which have been mal-absorbed or robbed from the body.

Adding magnesium to diet by consuming food sources like, legumes, grains, seeds, resin, tofu, kelp, dark green vegetables, and nuts. Low magnesium levels might lead to muscle spasm, which then causes muscle pain. Combining magnesium with the Krebs cycle intermediate malic acid can decrease pain in as little as 48 hours. Typical total daily doses of magnesium required are 500-1000 mg, while 1200 to 2400 mg of malic acid is needed.

Other nutrients which have been found to be of value in treatment include niacinamide, a form of Vitamin B3 which helps reduce muscle inflammation. Doses of 1000 up to 4000 mg daily are required, which, because of the size of the dosage, necessitates monitoring of liver function. Vitamin C in large doses, such as several grams daily, in combination with 400 to 1200 IU of Vitamin E daily can assist in cartilage repair, as well as control of inflammation. Eicosapentanoic acid (EPA), the omega-3 essential fatty acid found in fish, also contributes to the anti-inflammatory effect, and should be taken in doses of 1800 mg a day. The minerals selenium and zinc are also of benefit. Selenium levels are typically quite low in fibromyalgia, and selenium works in conjunction with Vitamin E to control inflammation. 200 mcg a day should be taken, while zinc in doses of 25-50 mg a day helps promote tissue repair.

Some studies suggest that over 50% of fibromyalgia patients also have carbohydrate intolerance with associated hypoglycemia. A diet which emphasizes elimination of simple sugars and encourages moderate protein intake at the expense of carbohydrates may help many patients. There are a few other dietary modifications which may be of value. Apples are a rich source of malic acid, which as noted above is beneficial in this disease. Increasing intake of apples and apple containing products is a valuable adjunct.

Nutritionists commonly urge fibromyalgia patients to limit the amount of sugar, caffeine, and alcohol they consume since these substances have been shown to irritate muscles and stress the system. In addition, avoidance of foods in the nightshade family such as tomatoes, potatoes, eggplant, and peppers may be helpful to some patients.

Management

About 90% of people with fibromyalgia are women. It is all too easy for women with FM to be excessively hard on themselves. It takes enormous energy as well as courage to adjust to FM and find treatments that work well without wasting precious energy on guilt, self- deprecation, and doubt.

Attitude is often one of the strongest predictors of how well a patient will be able to manage Fibromyalgia. Patients who are not actively engaged in taking charge of their illness simply aren't as likely to get better. Patients need to take up effective stress management program in consultation with their.

Try to follow a regular sleep pattern: Patients with FMS must get to bed by the same time every night and sleep as long as they need to. Staying up just one hour late may precipitate an exacerbation that lasts for several days. Many patients with fibromyalgia have exacerbations triggered by the change over to or from Daylight Savings time.

For best results, you need to be actively involved in your treatment and to have as clear an understanding of this complicated disorder as possible.

Rheumatologist and FM specialist Russell Rothenberg, M.D., has words of hope to share. Just because someone starts out with severe symptoms doesn't mean that (s)he cannot find worthwhile improvement with a skillfully devised and comprehensive treatment program. "Patients need to know that medication, judicious rest, exercise, physical therapy, and good diets can do more than just control the symptoms of fibromyalgia; they can control the disease process as well. There is no cure for FM, but people do get better! Hopefully, as better medications that are more specific for fibromyalgia are developed, and people are diagnosed earlier in their illness, more individuals with fibromyalgia will go into remission, or at least partial remission, and feel better."