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Fibromyalgia

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Fibromyalgia: What It Is and How to Manage It

What is fibromyalgia?

Fibromyalgia is a condition that causes pain in the muscles, joints, ligaments and tendons. The pain occurs in areas called "tender points." Common tender points are the front of the knees, the elbows, the hip joints and around the neck.

Fibromyalgia affects up to 5% of the population, including children. This disorder might be hereditary (run in families), so you may have family members with similar symptoms.

What are the symptoms of fibromyalgia?

Increased sensitivity to pain is the main symptom of fibromyalgia. Many other symptoms also occur in people with this disorder. Symptoms may come and go.

You may have some degree of constant pain, but the pain may get worse in response to activity, stress, weather changes and other factors. You may have a deep ache or a burning pain. You may have muscle tightening or spasms. Many people have migratory pain (pain that moves around the body).

Most people with fibromyalgia feel tired or fatigued (out of energy). This fatigue may be mild or very severe. You may also have trouble sleeping, which may add to the fatigue.

You may have feelings of numbness or tingling in parts of your body, or a feeling of poor blood flow in some areas. Many people are very sensitive to odors, bright lights, loud noises and even medicines. Headaches and jaw pain are also common.

In addition, you may have dry eyes or difficulty focusing on nearby objects. Problems with dizziness and balance may also occur. Some people have chest pain, a rapid or irregular heartbeat, or shortness of breath.

Digestive symptoms are also common in fibromyalgia and include difficulty swallowing, heartburn, gas, cramping abdominal pain, and alternating diarrhea and constipation.

Some people have urinary complaints, including frequent urination, a strong urge to urinate and pain in the bladder area. Women with fibromyalgia often have pelvic symptoms, including pelvic pain, painful menstrual periods and painful sexual intercourse.

Why do I feel depressed?

Depression or anxiety may occur as a result of your constant pain and fatigue, or the frustration you feel with the condition. It is also possible that the same chemical imbalances in the brain that cause fibromyalgia also cause depression and anxiety.

Does fibromyalgia cause permanent damage?

No. Although fibromyalgia causes symptoms that can be very uncomfortable, your muscles and organs are not being damaged. This condition is not life-threatening, but it is chronic (ongoing). Although there is no cure, you can do many things to help you feel better.

Is there any medicine I can take to help my symptoms?

Several medicines can help relieve symptoms of fibromyalgia. Many of these medicines are taken before bedtime and improve your sleep. They also help the pain and other symptoms.

You will probably begin to notice the benefits of these medicines in about 6 to 8 weeks. When you begin taking these medicines, it is common to feel very groggy the following morning. Other possible side effects include dry eyes and mouth, nightmares, constipation and increased appetite. These side effects are worse when you begin taking the medicine and improve with time.

What else can I do to relieve my symptoms?

One of the best things you can do is low-impact aerobic exercise. Examples of this type of exercise include swimming or water exercise, stationary bicycling and exercising on ski-type machines. You may need to begin at a very low level of exercise (5 minutes every other day is helpful at first). Continue to increase the length and frequency of exercise until you are exercising for at least 30 to 60 minutes at least 4 times a week. Once you reach this point, you can consider switching to high-impact exercises, like walking, jogging and tennis.

Because the symptoms of fibromyalgia are made worse by stress and poor sleep, it is important to cut stress out of your life whenever possible and to get as much sleep as you need. Since alcohol and caffeine cause poor sleep, avoid these substances around bedtime.

Other simple lifestyle changes may be helpful. For example, try keeping your activity level the same each day. Many people with fibromyalgia try to do as much as possible on "good" days, which leads them to have several "bad" days. If you keep your activity level even, you may not have as many "bad" days.

Other Organizations

Fibromyalgia Network
http://www.fmnetnews.com
P.O. Box 31750
Tucson, AZ 85751-1750
800-853-2929

Arthritis Foundation
http://www.arthritis.org
800-283-7800

How do I know if I might have chronic fatigue syndrome?

If you answer yes to any of the questions listed below, you may have chronic fatigue syndrome (CFS), which is also called chronic fatigue immune dysfunction syndrome (CFIDS).

  1. Have you been tired (fatigued) for a long time--more than 6 months--even though you are getting enough rest and are not working too hard?
  2. Has your doctor been unable to find illnesses that could explain your symptoms?
  3. Are you able to do less than half of what you used to do, because you feel tired?
  4. Have you had recurrent or persistent problems for 6 months or more with 4 or more of the signs and symptoms listed below?
    • Sore throat
    • Tender or painful lymph nodes in neck or armpits
    • Unexplained muscle soreness
    • Pain that moves from joint to joint but doesn't include redness or swelling
    • Headaches that are different from the kind you usually get, or headaches that make your whole head hurt
    • Trouble with short-term memory or concentration
    • Feeling very tired for more than 24 hours after exercise that didn't bother you before
    • Trouble sleeping

People with CFS may have other symptoms as well.

What causes chronic fatigue syndrome?

No one is certain about what causes CFS. The symptoms may be caused by an immune system that isn't working well. Or they may be caused by some kind of virus. Researchers are looking for the cause of CFS.

How is chronic fatigue syndrome treated?

The first step is to see if there is a medical cause for your fatigue. Your doctor will probably want to review your symptoms and medical history, and give you a physical exam.

Your doctor may also want to do some blood tests, but lab testing is not often helpful. Some of the symptoms, such as muscle aches, sleep problems, anxiety and depression, can be treated with medicine. The medicine is intended only to reduce your symptoms and allow you to be more active, not to cure the fatigue. So far, there is no medicine that cures the entire syndrome. Most symptoms improve with time.

How can I help myself?

  • Keep a daily diary to identify times when you have the most energy. Plan your activities for these times.
  • Keep up some level of activity and exercise, within your abilities. Your doctor can help you plan an exercise program to maintain your strength at whatever level is possible. Exercise can help your body and your mind.
  • Give yourself permission to recognize and express your feelings, such as sadness, anger and frustration. You need to grieve for the energy you have lost.
  • Ask for support from family and friends. Look for support groups or counseling in your community. Your doctor is another important source of help. Emotional support is important in coping with a chronic health problem.
  • If your memory and concentration are affected by chronic fatigue, keep lists and make notes to remind yourself of important things. Also, give yourself more time to do things that take concentration. Medicine may also help you sleep better, which might improve your memory and concentration.

How can my doctor help?

Your doctor can work with you to provide symptom relief and to help you find ways of coping with the changes CFS makes in your life. Chronic fatigue affects you physically, emotionally and socially. When you address all of these factors, you have the best chance of adjusting to your illness and feeling more satisfied with your life.

If you have CFS, a good long-term relationship with your doctor helps. This relationship is the key that can help you feel less frustrated.

Where can I get more information?

National Chronic Fatigue Syndrome and Fibromyalgia Association
P.O. Box 18426
Kansas City, MO 64133
816-313-2000 (24-hour number)

Chronic Fatigue and Immune Dysfunction Syndrome Association of America, Inc.
P.O. Box 220398
Charlotte, NC 28222-0398
800-442-3437 (24-hour number)
www.cfids.org

Centers for Disease Control and Prevention
National Center for Infectious Diseases
Mailstop A15
Atlanta, GA 30333
888-232-3228
www.cdc.gov/ncidod/diseases/cfs/cfshome.htm

 
 
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Often times RSD Patients experience Fibromyalgia, so we figured it being appropriate to have a page here for that as well.

http://www.fibrohugs.com/site_map2.html  

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FIBROMYALGIA AWARENESS is our responsibility. You can do your part by wearing the Awareness Pin and explaining it's significance.

WHAT IS FIBROMYALGIA SYNDROME?

FMS (fibromyalgia syndrome) is a widespread musculoskeletal pain and fatigue disorder for which the cause is still unknown. Fibromyalgia means pain in the muscles, ligaments and tendons--the fibrous tissues in the body. FMS used to be called fibrositis, implying that there was inflammation in the muscles, but research later proved that inflammation did not exist.

Most patients with fibromyalgia say that they ache all over. Their muscles may feel like they have been pulled or overworked. Sometimes the muscles twitch and at other times they burn. More women than men are afflicted with fibromyalgia, but it shows up in people of all ages.

To help your family and friends relate to your condition, have them think back to the last time they had a bad flu. Every muscle in their body shouted out in pain. In addition, they felt devoid of energy as though someone had unplugged their power supply. While the severity of symptoms fluctuate from person to person, FMS may resemble a post-viral state and this is why several experts in the field of FMS and CFS believe that these two syndromes are one and the same.

SYMPTOMS AND ASSOCIATED SYNDROMES

Pain - The pain of fibromyalgia has no boundaries. People describe the pain as deep muscular aching, burning, throbbing, shooting and stabbing. Quite often, the pain and stiffness are worse in the morning and you may hurt more in muscle groups that are used repetitively.

Fatigue - This symptom can be mild in some patients and yet incapacitating in others. The fatigue has been described as "brain fatigue" in which patients feel totally drained of energy. Many patients depict this situation by saying that they feel as though their arms and legs are tied to concrete blocks, and they have difficulty concentrating.

Sleep disorder - Most fibromyalgia patients have an associated sleep disorder called the alpha-EEG anomaly. This condition was uncovered in a sleep lab with the aid of a machine which recorded the brain waves of patients during sleep. Researchers found that fibromyalgia syndrome patients could fall asleep without much trouble, but their deep level (or stage 4) sleep was constantly interrupted by bursts of awake-like brain activity. Patients appeared to spend the night with one foot in sleep and the other one out of it. In most cases, a physician doesn't have to order expensive sleep lab tests to determine if you have disturbed sleep. If you wake up feeling as though you have just been run over by a Mack truck--what doctors refer to as unrefreshed sleep--it is reasonable for your physician to assume that you have a sleep disorder. It should be noted that most patients diagnosed with chronic fatigue syndrome have the same alpha-EEG sleep pattern and some fibromyalgia-diagnosed patients have been found to have other sleep disorders, such as sleep myoclonus or PLMS (nighttime jerking of the arms and legs), restless leg syndrome and bruxism (teeth grinding). The sleep pattern for clinically depressed patients is distinctly different from that found in FMS or CFS.

Irritable Bowel Syndrome - Constipation, diarrhea, frequent abdominal pain, abdominal gas and nausea represent symptoms frequently found in roughly 40% to 70% of fibromyalgia patients.

Chronic headaches - Recurrent migraine or tension-type headaches are seen in about 50% of fibromyalgia patients and can pose as a major problem in coping for this patient group.

Temporomandibular Joint Dysfunction Syndrome - This syndrome, sometimes referred to as TMJD, causes tremendous face and head pain in one quarter of FMS patients. However, a 1997 report indicates that as many as 90% of fibromyalgia patients may have jaw and facial tenderness that could produce, at least intermittently, symptoms of TMJD. Most of the problems associated with this condition are thought to be related to the muscles and ligaments surrounding the joint and not necessarily the joint itself.

Multiple Chemical Sensitivity Syndrome - Sensitivities to odors, noise, bright lights, medications and various foods is common in roughly 50% of FMS or CFS patients.

Other common symptoms - Painful menstrual periods (dysmenorrhea), chest pain, morning stiffness, cognitive or memory impairment, numbness and tingling sensations, muscle twitching, irritable bladder, the feeling of swollen extremities, skin sensitivities, dry eyes and mouth, frequent changes in eye prescription, dizziness, and impaired coordination can occur.

Aggravating factors - Changes in weather, cold or drafty environments, hormonal fluctuations (premenstrual and menopausal states), stress, depression, anxiety and over-exertion can all contribute to symptom flare-ups.

POSSIBLE CAUSES

The cause of fibromyalgia and chronic fatigue syndrome remains elusive, but there are many triggering events thought to precipitate its onset. A few examples would be an infection (viral or bacterial), an automobile accident or the development of another disorder, such as rheumatoid arthritis, lupus, or hypothyroidism. These triggering events probably don't cause FMS, but rather, they may awaken an underlying physiological abnormality that's already present in the form of genetic predisposition.

What could this abnormality be? Theories pertaining to alterations in neurotransmitter regulation (particularly serotonin and norepinephrine, and substance P), immune system function, sleep physiology, and hormonal control are under investigation. Substance P is a pain neurotransmitter that has been found by repeat studies to be elevated threefold in the spinal fluid of fibromyalgia patients. Two hormones that have been shown to be abnormal are cortisol and growth hormone. In addition, modern brain imaging techniques are being used to explore various aspects of brain function--while the structure may be intact, there is likely a dysregulation in the way the brain operates. The body's response to exercise, stress and simple alterations in position (vertical versus horizontal) are also being evaluated to determine if the autonomic nervous system is not working properly. Your body uses many neurotransmitters, such as norepinephrine and epinephrine, to regulate your heart, lungs and other vital organs that you don't have to consciously think about. Ironically, many of the drugs prescribed for FMS/CFS may have a favorable impact on these transmitters as well. 

COMMON TREATMENTS

Traditional treatments are geared toward improving the quality of sleep, as well as reducing pain. Because deep level (stage 4) sleep is so crucial for many body functions, such as tissue repair, antibody production, and perhaps even the regulation of various neurotransmitters, hormones and immune system chemicals, the sleep disorders that frequently occur in fibromyalgia and chronic fatigue patients are thought to be a major contributing factor to the symptoms of this condition. Medicines that boost your body's level of serotonin and norepinephrine--neurotransmitters that modulate sleep, pain and immune system function--are commonly prescribed. Examples of drugs in this category would include Elavil, Flexeril, Sinequan, Paxil, Serzone, Xanax and Klonopin. A low dose of one of these medications may be of help. In addition, nonsteroidal, anti-inflammatory drugs (NSAIDs) like ibuprofen may also be beneficial. Most patients will probably need to use other treatment methods as well, such as trigger point injections with lidocaine, physical therapy, acupuncture, acupressure, relaxation techniques, osteopathic manipulation, chiropractic care, therapeutic massage, or a gentle exercise program.
 

WHAT IS THE PROGNOSIS?

Long term follow-up studies on fibromyalgia syndrome have shown that it is chronic, but the symptoms may wax and wane. The impact that FMS can have on daily-living activities, including the ability to work a full-time job, differs among patients. Overall, studies have shown that fibromyalgia can be equally as disabling as rheumatoid arthritis. On the other hand, follow-up of people meeting the chronic fatigue sydnrome criteria indicates that as many as 40% may significantly improve but few are thought to completely recover from this syndrome. Longer term follow-up studies are not available to indicate whether these "improved" CFS patients later relapse with an increase in symptoms. A preliminary follow-up study by the CDC (Centers for Disease Control) reveals that for those individuals with chronic fatigue syndrome who do not recover or significantly improve after five years duration, their most prominent symptom changes from fatigue to muscle pain with concentration problems (sounds a lot like the permanent syndrome of fibromyalgia but the CDC is not checking patients for tender points).

According to a research study by Dedra Buchwald, M.D., people who meet the criteria for both FMS and CFS tend to be at the more severe end of the spectrum of symptoms and are more likely to become work-disabled. Buchwald says her findings underscore the importance of recognizing concurrent fibromyalgia and chronic fatigue syndrome (Rheumatic Disease Clinics of North America 22(2):219-243, 1996).