Fibromyalgia

1 January 2017

Are these people simply hypochondriacs? Do you wonder if their pain is an excuse to obtain prescription narcotics? If so, you are not alone! At present this perception is still shared by many doctors refusing to recognize Fibromyalgia as a genuine ailment worthy of treatment and continued research. My hope is that by the conclusion of this essay you will have a different view of Fibromyalgia. My goal is to provide you with enough information to see this medical mystery from a new perspective. I became pregnant with my first child at the age of 28, and up until that time was relatively healthy.

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This pregnancy wreaked havoc on my body, and serious complications resulted in an emergency C-section at 30 weeks gestation. After this birth I began experiencing all over body aches, joint stiffness, and I consistently felt like I needed to sleep. I had my second child four years after the first (also via C-section), and my body has never been the same since. I remember thinking that at my age I SHOULD NOT feel like I am eighty years old. I continuously felt as though I had the flu, my skin hurt, and most days my body felt like it had been run over by a MAC truck.

Each morning I would maneuver out of bed, my limbs like brittle twigs that would snap with the slightest bend. It was increasingly difficult to care for my infant and soon to be five year old; I always welcomed assistance with my motherly duties. I began asking my doctor what could be wrong with me. I was in constant pain, and it was difficult to stay awake during the day; I’d catch myself falling asleep at work, at school, and in the car. Driving was terrifying as I found myself regularly nodding off at the wheel. One morning after 7 hours of sleep, I fell asleep at the wheel and totaled my new car.

My passengers preferred to be drivers, and as a passenger I was usually asleep within 15 minutes of being on the highway. My sleep was unrestorative; I could sleep as little as 5 hours or as much as twelve – without interruption – and still wake up feeling as though I hadn’t slept at all. My doctor became concerned about my symptoms and referred me to a sleep specialist. After a series of sleep studies, no definitive answers were found. When I was alert, my senses were often irritated by everyday noise, casual touch, and light.

A ringing phone often sent my nerves jumping out of my skin. My daughters’ hugs made me cringe as the sensation of touch was at times unbearable. My eyes were dry and irritated, sore from squinting as a result of being highly sensitive to the light, particularly natural light & reflections. For years I reported my symptoms to my primary doctor with no concrete answers. After a series of tests ruled out things like Multiple Sclerosis, Rheumatoid Arthritis, Lupus, and Thyroid Disease, I was diagnosed by a rheumatologist as having Fibromyalgia Syndrome (FMS).

Even with its reputation of being a ‘waste basket’ diagnosis, I was relieved to finally have an explanation of my symptoms, and it was comforting to know my primary doctor of ten-plus years supported it. I began researching FMS in an effort to find out all I could. Fibromyalgia affects numerous areas of a sufferer’s life, and its symptoms can interfere with the accomplishment of daily activities. The symptoms of Fibromyalgia can be just as debilitating to the person experiencing it as it would be if the person were suffering from Rheumatoid Arthritis, and/or severe depression, both of which are accepted medical diagnosis.

Fibromyalgia is a legitimate medical condition, and it has been proven to be more than just a psychosomatic illness. Over the past few decades, researchers have made great progress in finding clues as to the cause of Fibromyalgia pain. Such research has provided evidence which supports that the pain felt by sufferers is “real”. The past 15 years have seen an increase in the seriousness given to this condition; a condition which lacks proper testing to verify its presence. Continued research is crucial in finding more definitive causes of FMS, better diagnostic testing, and additional treatment options.

Information taken from FibroCenter. com provides us with a brief history. The symptoms of Fibromyalgia were first described by doctors in the early 1800s. Tender points were discovered in the early 1820s by a Scotland doctor. The term “fibrositis” was initially used some eighty years later, as it was believed that inflammation was thought to be the cause of the pain. In 1976, upon determining that inflammation was NOT the cause of the pain, the name was changed to Fibromyalgia. The American Medical Association began recognizing Fibromyalgia as a genuine illness in 1987 (Nagy).

In the early 1990s, the World Health Organization declared fibromyalgia a significant medical problem and included it in its 10th International Classification of Disease, which was published in 1992. As of July 2011 an excess of five million adults, 80-90% being women, have been diagnosed with Fibromyalgia according to the National Institute of Arthritis and Musculoskeletal and Skin Disease. Fibromyalgia is not a disease with a specific cause and recognizable symptoms, but rather a syndrome- a collection of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause (NIAMS).

Fibromyalgia Syndrome (FMS) is complex and multi-faceted. It affects numerous areas of a person’s life and its symptoms can interfere with their ability to carry on daily activities. Fibromyalgia impairs the joints and/or soft tissues resulting in severe & chronic pain; in this way it resembles arthritis. However, because it doesn’t cause inflammation or permanent damage to the joints, muscles, or other soft tissues, it is not considered a true form of arthritis (NIAMS).

The many symptoms of FMS include sleep disturbances & unrestorative sleep; generalized morning stiffness; headaches; irritable bowel syndrome; painful menstrual periods; numbness, tingling, and/or weakness of the extremities; restless leg syndrome; temperature sensitivity; and sensitivity to loud noises, bright lights, touch, and even smell. One of the more challenging symptoms is “Fibro Fog”—an experience of confusion and forgetfulness, the inability to concentrate, and the loss of short-term memory.

Although medical scientists are unable to determine the exact causes, they have concluded that Fibromyalgia Syndrome is a legitimate medical condition – a physiological (physical) disorder – dismissing the theory that it is psychosomatic (psychological) (Fabiola). Biomedical evidence has been found supporting the pain felt by FMS sufferers. For most, FMS developed following a “triggering incident” in which the body’s system is thrown off track (Barrett). This incident could have been a virus or prolonged illness, repetitive injuries, persistent stress, physical or emotional trauma, sleep deprivation, or a combination of these.

I strongly believe that my “triggering incident” was my first pregnancy. Prior to receiving a diagnosis of Fibromyalgia, most individuals suffer through years of untreated pain and sleep disturbances, they have seen a gamut of doctors, and experienced a myriad of medical tests and procedures. This process can be difficult and tremendously discouraging. Because there are no physical sings of FMS, individuals appear to be in perfect health when they are physically examined, and doctors are often tempted to conclude that FMS is actually a psychosomatic illness (all in the head)—which is NOT the case.

Although the concept of Fibromyalgia remains relatively vague, modern medicine has found important clues that suggest the physiological aspect of FMS. Currently the diagnosis process is more elaborate and certainly more conclusive than it was in the 1800s. Dr Robert Bennett, Professor of Medicine at OHSU, explains the principal symptom of Fibromyalgia as widespread body pain. Many sufferers have tender skin and an overall reduction in pain threshold. Tender points, which occur at muscle tendon junctions, have been identified in all those diagnosed with FMS.

Sufferers experience intense pain in particular regions of the body which reveals the implication of the nervous system in causing FMS. By using Computerized Tomography (CT, a technique that produces images of cross sections through a patient’s body using low levels of radiation) the neurological aspect of FMS is confirmed, revealing abnormal activity in several areas of the brain. This information proves that FMS is the result of neurological dysfunctions (Fabiola). Hereditary Sensory Neuropathy (HSN) is the medical category under which disorders of pain sensitivity fall, specifically the lack of pain sensation.

Being aware of this, it then stands to reason that the opposite is also true; this appears to be the case with FMS. Patients have a heightened sensitivity to pain, with the majority of this pain originating in the muscle (Bennett). MRI scans given to FMS patients reveal a heightened sensitivity to pain stimuli; pain is experienced far out of proportion to what would be considered normal. Additional causes of Fibromyalgia may be: underlying hormonal problems, poor nutrition, stress and lack of sleep, deficient levels of serotonin, and oor muscle oxygenation. Research has shown that those who suffer from FMS have abnormally high levels of the pain neurotransmitter substance P; and depressed levels of serotonin & growth hormone, which are responsible for restoring muscle regeneration (Barrett). A common complaint of sufferers is the lack of restorative sleep. Studies show that patients often fail to achieve sufficient amounts of stage 4 (delta) sleep. The inability to reach slow-wave deep levels of sleep could be an originating factor behind the pain of FMS.

Although Fibromyalgia Syndrome is now getting recognition in the medical field, much research is still needed in order to find definitive causes, better diagnostic testing, and additional treatment options. Continued research will help us to better understand the specific struggles that cause or accompany Fibromyalgia, which will benefit physicians in recognizing, treating, and caring for those with FMS. In order to better comprehend why people with FMS have increased pain sensitivity, The National Institute of Health supported researchers are focusing on ways in which the body processes pain.

It is believed that Fibromyalgia is caused by abnormalities in how the body processes pain resulting in hypersensitivity to stimuli that normally isn’t painful. NIAMS supported researches are investigating other possible causes of FMS, including whether or not genes cause the sufferer to react more strongly to stimuli that most people would not perceive as painful. Increased knowledge of FMS and the mechanisms involved in chronic pain are enabling researches to find effective treatments for it (NIAMS).

Over the past few years the FDA has approved three medications for the treatment of FMS-Lyrica, Cymbalta, and Savella-with other medications being developed. Scientists continue to work on developing new medications intended to ease the symptoms of Fibromyalgia. Due to the fact that the symptoms of Fibromyalgia leave no physical traces, it cannot be detected using traditional medical tests. An article in the July 2011 issue of the Fibromyalgia Network Journal reported on the identification of Fibromyalgia blood markers; researchers are refining the results in anticipation of producing a diagnostic blood test for FMS.

Dennis Ang, M. D. and his team at Indiana University are looking at the potential for a quick, rather simple lab test for objectively measuring disease severity, in particular, the pain levels in people with fibromyalgia. FMS sufferers have elevated levels of substance P and CRH (Corticotrophin-releasing hormone) which result in the nervous system becoming highly sensitive, magnifying pain signals. Blood tests are not sufficient for measuring these chemicals as their elevated values can only be found in the spinal fluid (Thorson).

So many factors are clearly abnormal in the nervous system, and getting the information is only available by obtaining spinal fluid. The techniques used to for obtaining spinal fluid measurements are only done in research studies, and are not available for treating physicians. The article further explains: Ang’s team is testing a method which would evaluate what is happening inside the nervous system by testing two substances in the blood that may be caused by elevations in SP and CRH (both elevated in fibromyalgia). Elevated SP and CRH result in the release of chemicals IL-8 AND MCP-1 (two immune system chemicals).

Improvements in fibro pain corresponded to reductions in both IL-8 and MCP-1. The results are only preliminary, but offer hope that objective disease severity markers can be developed for FMS. “If our findings are replicated in a larger group of patients, IL-8 and MCP-1 may facilitate the prediction of prognosis and monitoring of treatment response in the future” (Thorson). Although a chronic condition, the symptoms of FMS can be managed, it’s not progressive or fatal, and it does not damage the joints, muscles, or internal organs (NIAMS).

There is presently no cure for FMS. Sufferers learn to manage the symptoms using medication, physical therapy/exercise, massage, chiropractic therapies, good nutrition, counseling, and alternative treatments such as acupuncture. Working in conjunction with knowledgeable healthcare professionals, motivated and informed patients can experience significant improvement in their symptoms and quality of life. Developing an individualized self-management plan, from identifying effective treatments approaches to making necessary lifestyle changes, will further improve one’s health.

For some, FMS may remain invisible until its cause and cure are discovered. The good news is that because of continued research, we are getting closer to discovery. Experts in the field meet regularly to share findings, and the increase in publications on the topic continues to bring about greater awareness and understanding. It’s been about five years since I received a diagnosis of Fibromyalgia. I still have many of the symptoms I had before my diagnosis, but at a lower intensity. By understanding the symptoms of FMS and what exacerbates them, I can come up with small changes to help diminish them.

I am extremely sensitive to the cold and can be found wearing long underwear and toe warmers (all over my body). On bad days the slightest touch or noise can send me climbing the walls, so I stay close to home with the noise level low. I take a variety of medication to help with some of the more unbearable symptoms, and continue to battle with the feeling of sleep deprivation. Good days are productive as I take advantage of the momentum. This usually results in severe body pain and muscle stiffness because I end up over-doing it. My aunt also suffers from FMS and we share with each other our experiences, and what we have found that works.

The majority of my friends and family understand FMS and are supportive of what my needs and limitations are. The symptoms of Fibromyalgia are real and at times very debilitating. Knowing that FMS is a real medical condition, I can seek appropriate treatment, make certain lifestyle and environmental adjustments, and continue with a productive life. If you or someone you know has been diagnosed with Fibromyalgia Syndrome, I encourage you to find out all you can. Acceptance and Knowledge are half the battle! Works Cited Barrett, Deborah A. “What is Fibromyalgia? ” 2000. Pain Tracking. December 2011 <http://www. paintracking. com/whatisfms. html>. Bennett, Robert M. “Science of Fibromyalgia. ” n. d. National Fibromyalgia Association. 16 November 2011 <http://www. fmaware. org/site/PageServerccdf. html? pagename=fibromyalgia_science>. Fabiola, Groshan. “Fibromyalgia Information: Is Fibromyalgia a Psychosomatic Disorder. ” n. d. Fibromyalgia. 20 November 2011 <http://www. efibromyalgia. com/FibromyalgiaInfo/2. php>. FibroCenter. History of Fibromyalgia. n. d. 16 November 2011 <http://www. fibrocenter. com/fibromyalgia-disease. aspx>. Nagy,

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