One might consider fibromyalgia to be one of the most confounding conditions around today. It is debilitating. It results in several quality of life issues. The confounding aspect of this condition is that it is difficult to diagnose. It is also difficult to treat. Most treatment modalities today recourse to treating one or more specific symptoms -- but there is no treatment that can comprehensively treat all the symptoms. (NIAMS, 2004) More holistic treatment modes however, are being researched, explored and considered. Fibromyalgia often presents symptoms of other diseases. Essentially therefore, fibromyalgia is characterized by widespread pain that cannot be localized to any part of the body. It is also associated with fatigue and other specific (though not necessarily widespread) symptoms that will be discussed later in this work.
Fibromyalgia syndrome is often referred to in its abbreviation FMS. Some of the symptoms (though not all) enjoy significant overlap with other conditions such as chronic fatigue syndrome (CFS), myofacial pain syndrome (MPS) and multiple chemical sensitivity syndrome (MCS). Some researchers have averred that FMS, CMS, MPS and MCS are part of a larger meta-syndrome called dysregulation spectrum syndrome (DSS). While there is no large concerted effort to identify DSS, the school of thought is the myriad syndrome with its varied epidemiologies and acuity of presentation of symptoms is have its associations in the human "neuro-hormonal" system according to Dr. Yunus at the University of Illinois College of Medicine. Yet others have even pointed to psychological and sociological factors. Put together Van Houdenhove and Egle provide a biopsychosocial component to fibromyalgia. They believe that any physiological manifestations come from stress. (Van Houdenhove & Egle, 2004)
Fibromyalgia can trace its etymology to a combination of three words from the Greek language. Perhaps in keeping with the confusing nature of the condition the name combines fibro (Gr. Fibrous), myo (Gr. Muscle) and algia (Gr. Pain). Fibromyalgia is known as a rheumatic disease because of the pain originating from the joint and the soft tissues. Rheum however, in Greek, means, to be in a state of flux. Not surprisingly, fibromyalgia is often confused with arthritis because of the chronic pain that comes from the joints. In addition, fibromyalgia can also afflict other soft tissue. Neither muscles nor bones, joints or ligaments are immune from pain for a person suffering from fibromyalgia. Even very slight pressure on certain parts of the body such as the neck, back and extremities can set in motion waves of pain. This work will be dedicated to an exploration of different aspects of fibromyalgia. It will explore the symptoms, causes, and different methods of diagnoses, treatment modalities chemical, conventional and holistic. Clinical studies are often conducted to identify, among other things, how the symptoms manifest or how the condition progresses or what treatment methods are most effective from an epidemiological standpoint.
To this point, fibromyalgia has not been referred to as a disease, but a condition. This is because a disease is often associated with a specific causative agent or agents. Diseases are also identified by the defined symptoms, and -- hopefully -- a well-defined treatment modality. Fibromyalgia can be more readily classified as a condition or a syndrome -- the latter being more effective -- because it is more a collection of symptoms without a well-defined cause. For fibromyalgia, there is no well-defined treatment modality.
In addition to the debilitating, constant, chronic pain, or pain that varies in intensity; other symptoms are often observed.
The pain that most people feel is often a shooting, throbbing and stabbing. Patients often complain that the pain comes deep from within the muscles. The pain and stiffness are worse in the morning (as has been averred before). Headaches recur.
Recurrent migraines are found in about 50% of the sufferers. Additionally, about one quarter of all patients suffer from an associated condition called temporomandibular joint dysfunction. TMJD is characterized by pain in the facial and jaw region. The pain is from the ligaments and muscles surrounding the jaw though not necessarily from the joints in the mandible. One of the most difficult problems with fibromyalgia that renders a person unable to perform daily functions or even remain employed is irritable bowel syndrome. Symptoms of this include upset stomachs, diarrhea, nausea, acidity and constipation. Not all fibromyalgics however, suffer from irritable bowel syndrome. The numbers are between forty and seventy percent. Another typical symptom of fibromyalgia is the extreme sensitivity to atmospheric temperature fluctuations. The person manifests the symptoms of a chill even during relatively warmer conditions. Cold- sensitivity affects about forty percent of sufferers. The symptomatic cause is the abnormal response of blood vessels in the hand, which gives rise to spasms that mimic the bodies' response to a stimulus of cold.
For women, who suffer from fibromyalgia more than men, menstruation is more painful. Though studies have shown the middle aged, post-menopausal women suffer from this syndrome the most. Cognitive problems also occur. There is a problem with motivation and concentration. Work is affected severely, as is the memory. The latter is called being in a "fibromyalgic fog." Some of the cognitive problems arise from what is known as "brain fatigue." Patients complain that being constantly attacked by pain results in the pain taking over, leaving little ability to focus on other activities. Dry eyes, muscle stiffness, sensitivity to bright lights, loud noises and some odors, dizziness are common symptoms. In addition to muscle pain, twitching in the muscles and painful and swollen extremities are other symptoms.
Those afflicted suffer from numbness and tingling (in addition to pain) in the extremities. During sleep, which is a problem, restless leg syndrome or the constant twitching of legs is all to common. These sleep disturbances do not allow those with fibromyalgia to get into the stage of deep sleep. Therefore the person wakes up feeling tired and this exacerbates any other symptoms from fibromyalgia. There is enough evidence that this pain is also prevents proper sleep. The problems with lack of the ability of sleep come from a condition known as alpha EEG (electro encephalogram) anomaly. (Gibson, Littlejohn, Gorman, Helme, & Granges, 1994) EEGs of people suffering from fibromyalgia showed that while falling asleep was not different from normal, sudden spurts in brain activity during sleep prevented test subjects from achieving the fourth stage of sleep or deep sleep. This part of sleep was constantly interrupted. This part of sleep is when the person often gets the best rest from the body repairing itself by slowing down its metabolism. Other disorders associated with sleep are sleep apnea, sleep myoclonus (this is the jerking of the arms and legs while asleep) and the previously mentioned leg restlessness (RLS -- restless leg syndrome). In addition, recently researchers have identified another problem. This is associated with breathing. It is called airway resistance syndrome.
It affects normal sleep patterns for the fibromyalgia patient.
If one considers FMS to be part of a larger system of conditions called DSS (explained in the Introduction), then consider which symptoms of Chronic Fatigue Syndrome are common with FMS. To keep this work focused, effort will be expended to bringing about the relationships and associations with symptoms of only CFS and not MCS or MPS. CFS is characterized by chronic feelings of tiredness that are not commensurate with the amount of physical, mental or intellectual effort put forth by a person. CFS is also characterized by the onset of symptoms at a specific point and has no genetic disposition to extreme or chronic fatigue. Interestingly however, most of symptoms of CFS closely parallel that of FMS discussed previously in the section.
These symptoms include: impaired cognitive function, widespread non-arthritic pain, muscle pain, headaches, impaired and disturbed sleep patterns, and unrelenting fatigue. Also in keeping with the neuroendochrinal nature of FMS, another condition confounds one of the symptoms of FMS -- namely, dizziness. The same problems are seen in the renin-angiotensin-aldosterone system (a hormonal system). (Denko & Malemud, 2004)
Depression is one of the primary symptoms of FMS, though it is known not to cause FMS. The lack of causative evidence will be discussed at length later in this work. A study by Ania Korszun showed that it was sleep impairment that caused the eventual depression. (Korszun, Young, Engleberg, Brucksch, Greden, & Crofford, 2002) The respondents in this study were divided into four groups. A control group who had no signs of FMS or depression, an FMS group that did not show signs of depression, a depressed group without other symptoms of FMS, and a FMS group that also showed signs of depression.
This study was conducted using a technique called actigraphy. An actigraph is a device that measures the levels of activity. It is placed on the non-dominant arm. The levels of activity can then be measured throughout the day, including the sleep. It was discovered that patients with FMS and depression showed abnormal levels of nighttime activity. The worst results were observed among FMS patients who showed signs of depression. Even…