Fibromyalgia, the condition that has baffled the medical community since being identified, is beginning to step into the light. The condition is characterized by fatigue, musculoskeletal pain, mood issues, sleep disturbance and, sometimes, memory issues. The pain and fatigue of fibromyalgia are often spread throughout the whole body, complicating efforts to locate a source.
People with fibromyalgia experience muscular pain, often in the form of a constant or semi-constant ache, both above and below the waist. There are 18 identified points on the body, named "tender points," that hurt when pressure is applied to them if you have fibromyalgia. Some of these tender points are found on the back of the head, the upper chest, the tops and sides of the hips, the inner knee and between the shoulder blades. Fatigue, sleep disorders, depression, headaches and irritable bowel syndrome often accompany fibromyalgia.
Diagnosing fibromyalgia is generally done by process of elimination. If blood tests and X-rays indicate no other reasonable cause, then fibromyalgia is considered. To officially diagnose the condition, doctors should confirm at least three months of widespread pain above and below the waste and, usually, 11 out of the 18 tender points causing pain for the individual. Some doctors have dispensed with tender point testing, being uncertain of how much pressure to apply during the examination. You may need to see a number of doctors before a diagnosis is reached.
What Causes Fibromyalgia?
The exact mechanisms through which fibromyalgia causes pain and other symptoms are not scientifically proven, but researchers are making important inroads that have allowed them to begin shaping a theory. The current theory states that abnormalities in pain processing centers of the brain and in biochemistry are responsible for the widespread pain that characterizes fibromyalgia. The brain of a person with this condition senses pain when there should be none, and so the individual feels pain. This altered biochemical state can be triggered by an injury, infection, or traumatic event. It can also arise with no identifiable trigger.
The above is not at all the same as saying that fibromyalgia pain is psychological. Mental or emotional states are not postulated as the cause of the abnormalities described in this theory; rather, the abnormalities are physiological.
UpToDate, a website featuring quality information on research into medical conditions, published an article entitled "Pathogenesis of fibromyalgia" that highlights some of the specific biochemical abnormalities that shape the budding theory. Studies of people with fibromyalgia show that they have:
1) fewer opioid receptors in the brain,
2) higher-than-normal levels of Substance P in their cerebrospinal fluid, and
3) increased blood flow in areas of the brain that sense pain.
Opioid receptors are needed to cope with pain. Endorphins, the body's natural pain-killers, lock into these receptors to reduce pain and create feelings of pleasure. Fewer opioid receptors means that your brain has a diminished defense against pain.
Substance P is a substance in the body that determines when a sensation begins being interpreted as painful. This is also called the pain threshold. Heightened levels of Substance P means that pain is experienced earlier than normal in people with fibromyalgia.
Finally, increased blood flow in areas of the brain that process pain signals indicates increased activity. This shows that either an unusually high number of pain signals are being sent to the brain or that the brain is processing a normal number of signals in an abnormal way.
Also significant is the lower level of serotonin some fibromyalgia patients exhibit, reports the Shore Health System of the University of Maryland. This neurotransmitter is a key player in the feeling of well-being and in pain modulation. Decreased serotonin levels are also linked to irritable bowel syndrome, migraine and depression, three conditions often present in those with fibromyalgia.
Some research has also shown that fibromyalgia patients may have low levels of phosphocreatine and adenosine, chemicals that regulate the amount of calcium in muscle cells. An insufficient amount of calcium in muscle cells reduces the muscle's ability to relax, causing it to become tight and inflamed.
Women are significantly more likely to develop fibromyalgia than men. This is likely due to hormonal and biochemical differences between men and women. Women have less testosterone than men, for example. Testosterone is important in preventing muscle fatigue. Cortisol, a stress hormone that helps to defend the body against damage from stress, is also generally lower in women than in men.
For more details on chemical factors of fibromyalgia, see http://health.shorehealth.org/patiented/articles/what_causes_fibromyalgia_000076_2.htm.
Fbromyalgia and Back Pain
Back pain is one of the most common medical complaints of our time. For people with fibromyalgia, back pain is highly likely.
The back, particularly the lower back, is highly mobile. Even individuals with sedentary lifestyles use their back muscles frequently, since they are used while sitting. These muscles help the spine to support the weight of the upper body; they are also needed to maintain proper alignment of the spine. Lower back muscles undergo the most flexing, contracting and twisting given their connection to the pelvis. Since fibromyalgia can cause normal movement to be interpreted as painful, the mobility of the back makes it a prime target for pain.
This situation could be exacerbated by the fact that the muscles of the back are situated very close to the spinal cord, the bundle of nerves running through the spine to various parts of our bodies and back to the brain.
The pain and fatigue felt within muscles can itself create more pain by limiting activity. Weakened back muscles (as well as the abdominal and pelvic muscles that help the lower back muscles) lead to a lack of support for the spine. This can eventually cause a spinal condition, such as misalignment and disc damage. People with fibromyalgia are at risk of this cyclic decline in health due to inactivity. That is why treatment must involve a plan to keep active and work through the pain.
Treatment for Fibromyalgia
There are two prongs of fibromyalgia treatment: pain management and keeping active. Conventional treatment for the condition tends to revolve around medication; anti-inflammatory drugs, muscle relaxants and anti-depressants are prescribed en masse, along with lifestyle advice to exercise lightly and get enough sleep. Luckily, there are more well-rounded treatments for those who wish to avoid drugs.
There are a number of ways to manage the pain of fibromyalgia naturally.
Capsaicin, for example, which is the active ingredient in chili peppers, has been shown to deplete levels of Substance P while administered topically in the form of creams. The reduction of Substance P means a reduction of pain. Eating foods containing cayenne pepper may have the same effect on an internal level.
Massage therapy is an option for those whose muscles are tight, possibly due to their diminished ability to relax. A massage therapist can locate tense muscles and work them out with a variety of tissue manipulation techniques.
The compound SAMe (S-adenosylmethionine) assists in a variety of neurotransmitter processes, including the production of serotonin. Taking SAMe in supplement form may reduce pain in people with fibromyalgia.
Acupuncture, a traditional form of Chinese medicine, involves the use of small needles to stimulant specific points of the body. It operates on the premise that energy meridians run throughout the body, and, in cases of illness or pain, need to be opened up to allow for proper energy flow. It has shown effective in a number of pain management trials.
Chiropractic care is performed to realign the spine and increase range of motion of the facet joints that link vertebrae together. If weak core muscles have allowed your spine to come out of alignment, a chiropractor may be able to reverse this damage. Of course, preventing the recurrence of misalignment will entail finding a workout plan to strengthen the core group.
Unfortunately, a health system largely funded by pharmaceutical industries has not allowed for a wealth of research into alternative medicines. Still, these alternative options exist with a little evidence and a lot of sound reason behind them. A review of studies on alternative pain management treatments for fibromyalgia with a list of references can be found at http://nccam.nih.gov/health/pain/fibromyalgia.htm.
Managing pain makes physical activity possible. Exercise and stretching can increase strength, flexibility, endorphin levels and help to maintain cardiovascular health. Exercise also increases the number of stem cells available to the body. Stem cells can become any cell in the body, which means they help to repair damaged tissues, such as muscles, tendons and ligaments effected by fibromyalgia.
Slow, focused movement programs like yoga, tai chi and qi gong may be the best options for those with fibromyalgia. These techniques activate both mental and physical resources to overcome pain and strengthen the body. Each program emphasizes focus, breathing and awareness of movement. Since stress management is an important part of coping with this condition, exercise programs that incorporate calming and centering the mind can be most helpful. Meditation and breathing exercises have been shown to modulate the physical experience of pain. Keeping active is easier when pain is kept in check, so the best types of exercise programs for those with fibromyalgia are those that ease the immediate experience of pain.
While the book on fibromyalgia is certainly not closed, there is enough information to empower you to make safe, effective choices for yourself. Covering up the pain with drugs is an inferior treatment method to addressing the biochemical abnormalities more directly. By learning techniques to modulate your experience of pain and supplementing your diet, you may be able to impact your biochemistry directly and safely.
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