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Fibromyalga


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Fibromyalgia

 Stephen Hendon
2007

      Fibromyalgia, formerly know as fibrositis, is a chronic condition that causes pain, stiffness, and tenderness of the muscles, tendons, and joints (Mayo Clinic.com, 2007 ). Fibromyalgia is also accompanied by restless and unrefreshing sleep, feeling tired, fatigue, anxiety, depression, and improper bowel function (Wikipedia, 2007).  The causes of fybromyalgia are unknown and while very painful to the muscles and tissues there is no inflammation nor bodily damage or deformity to the sufferer (Wikipedia, 2007).

     Researchers have found elevated levels of a nerve chemical signal, called substance P, and nerve growth factor in the spinal fluid of fibromyalgia patients (Gilliland, 2007).  Individuals suffering from fybromyalgia suffer from low levels of the brain nerve chemical serotonin (Chaitow, 1995). Some research has suggested that the individual’s brain and the central nervous system may be somehow supersensitive (Chaitow, 1995). Researchers note that there seems to be a diffuse disturbance of pain perception in individuals with fibromyalgia (National Institute of Health, 1998). In addition, individuals suffering from the disorder have impaired non-Rapid-Eye-Movement, or non-REM, sleep phase (Roizenblatt, et. al 2001). This helps explain the common syndrome of waking up fatigued and unrefreshed. The initial onset of fibromyalgia has been linked with psychological distress, trauma, and infection (Wikipedia, 2007).

     While anyone can get fibromyalgia it primarily affects women with over eighty-percent between the ages of 35 and 55 (Meyer & Lemley, 2000). While some studies have shown the ratio of women to men seeking treatment is about seven to one, community samples have shown that the ration of women to men at about three to one.(Turk & Gatchel, 2002).  Fybromyalgia is also more likely to develop in individuals already suffering from rheumatoid arthritis or lupus (Lupus & MCPD, 2005). The prevalence of fibromyalgia suffered between nations varies. In Sweden and Britain about one percent of the population is affected by fibromyalgia, while in the United States, approximately two percent of the population has fibromyalgia (Answers.com, 2007).

     Individuals suffering from fibromyalgia often suffer from widespread muscle pain and fatigue. (Turk and Gatchel, 2002). Individuals suffering from fibromyalgia describe the pain as throbbing, aching, stabbing or shooting in nature. Many fibromyalgia patients say that they tend to ache all over their bodies. Often it is associated with stiffness, which like the pain may be worse first thing in the morning (Answers.com, 2007). Triggers such as stress, fatigue, changes in the weather and physical activity can aggravate the pain (Turk and Gatchel, 2002). Tender points that are characteristic of fibromyalgia affect specific parts of the body that are located at the elbows, around the neck, the front of the knees and the hip joints (Fibromyalgia Netwrok, 2007).These points are often very painful in response to the slightest pressure. Many people suffering from fibromyalgia report unrefreshing sleep that is accompanied by turning and twisting during the night (Fibromyalgia Netwrok, 2007). In addition to these symptoms sufferers also report headaches of a severe nature, numbness in various body parts, tingling and depression (Turk and Gatchel, 2002). Fibromyalgia differs from arthritis as it does not cause inflammation or result in damage to the joints or muscles (Rutstein & Rosenberg, 2007). Most individuals with fibromyalgia find their symptoms tend to wax and wane over time, although for some the symptoms are constant (Turk and Gatchel, 2002).

     Over fifty-percent of the individuals suffering from fibromyalgia eventually suffer from mental and or emotional disturbances (Fibryomyalgia Network, 2007). These symptoms include poor concentration, forgetfulness, mood changes, irritability, depression, and anxiety (Gotlieb, 2007). Due to the lack of any test that can directly identify fibromyalgia many individuals suffering from depression are misdiagnosed as having mental or emotional disorders (Gotlieb, 2007). Individuals with fibbromyalgia  also suffer from severe migraine and tension headaches, numbness or tingling of different parts of the body, abdominal pain related to irritable bowel syndrome and irritable bladder, causing painful and frequent urination (Turk and Gatchel, 2002).   Irritable bowel syndrome can result in severe abdominal pain and other bowel disturbances (National Digestive Disease Information Clearing House, 2007 ). Each fibromyalgia sufferer is unique since there are so many combinations of disorders one can suffer from.

     Due to no test being available for the diagnosis of fibromyalgia, diagnosis is made solely on clinical grounds that are based on the patient’s history and physical examination (Gotlieb, 2007)  Those individuals who suffer from widespread body pain, the diagnosis can be made by identifying point tenderness areas. In most cases, the patient will have pain in at least eleven of the eighteen classic tender points (Fibromyalgia Netwrok, 2007). The examination must rule out any other medical conditions that may result in the same conditions. Other conditions that must be ruled out are low thyroid hormone level, parathyroid disease, muscle diseases, bone diseases, elevated blood calcium, and infectious diseases (The Pain Clinic, 2007). Other rheumatic disorders can occur along with fibromyalgia (Medline Plus Medical Encyclopedia, 2006). These rheumatic conditions associated with fibromyalgia include systemic lupus erythematosus, rheumatoid arthritis, polymyositis, and polymyalgia rheumatica (Gotlieb, 2007). 

     For the treatment of fybromyalgia the most effective medications are tricyclic antidepressants (Rosenbaum,2003). These medications have traditionally been used in treating depression. When using them for the treatment of fybromyalgia they are taken at bedtime in doses that are a fraction of those used for treating depression (National Institute of Arthritis, Musculoskeletal and Skin Diseases, 2004). They appear to reduce fatigue, relieve muscle pain and spasm, and promote deep restorative sleep in individuals with fibromyalgia. It is believed that tricyclics work by interfering with a nerve transmitter serotonin located in the brain (Lupus & MCPD, 2005). Some examples of tricyclic antidepressants commonly used in treating fibromyalgia include amitriptyline (Elavil) and doxepin (Sinequan) (Drug Facts and Comparisons, 2006). Other studies have shown that adding fluoxetine (Prozac) to low dosees of amitriptyline (Elavil) further helps reduce muscle pain, anxiety, and depression in patients with fibromyalgia (Drug Facts and Comparisons, 2006). The combination of the two medications also promotes restful sleep, and gives a sense of overall well-being. Also on the positive side, these two medications tend to cancel out certain unwanted side effects each has (Drug Facts and Comparisons, 2006 ). Tricyclic medications can cause tiredness and fatigue while fluoxetine can make patients more cheerful and awake ((Drug Facts and Comparisons, 2006). Recent studies of those individuals with severe or resistant fibromyalgia have discovered that lorazepam (Ativan) is very effective for reducing pain and improving sleep (American Fibromyalgia Syndrome Association, 2004).  

     Other prescription drug treatments for fybromyalgia include the local injection of analgesics and/or cortisone medication directly into the soft tissue trigger points can help reduce pain (Chen, Goldman-Knaub, & Pullman,-Mooar, 2005).  The pain relievers tramadol (Ultram) and tramadol/acetaminophen (Ultracet) can reduce the muscle pains of fybromyalgia (Drug Facts and Comparisons, 2006 ). To reduce pain and improve sleep the muscle relaxant cyclobezaprine (Flexeril) is helpful (MayoClinic.com., 2006).  Nonsteroidal antiflammatory drugs (NSAIDs) have only a limited value in treating fibromyalgia pain (WebMD, 2005). Narcotic pain relievers and cortisone medications have not show to be of much use in the treatment of fybromyalgia (Wolfe, Smythe, Yanes, & Bennett,  2005). There are new drugs being developed that will block substance P or nerve growth factor to relieve pain of fibromyalgia (Dickinson, 2007).  Due to the risky and very detrimental side effects, narcotics and cortisone medications are best avoided. Biofeedback, standard acupuncture, and electroacupuncture have proven successful for some patients (Chaitow, 1995).

       Research has shown that when fibromyalgia patients increase his or her psychological ability to deal with the specific conditions of his or her disorder, he or she is more inclined to experience physical improvement (Turk and Gtachel, 2002). The use of cognitive-behavioral therapy increases the patient’s belief in his or her own abilities to develop methods to deal with stressful situations (Bruckenthal, P. 2000 ). It is a known effective method for dealing with chronic pain from arthritic conditions.  The main goals of cognitive-behavioral therapy are to change any distorted perceptions that individuals have of the world and of themselves and to change any self-defeating behaviors accordingly (Little, 2007). By utilizing specific tasks and self-observation, patients gradually alter his or her previous conceptions that he or she is helpless against the pain that dominates his or her life.

     Cognitive therapy helps in defining and setting limits. Often many individuals suffering from fibromyalgia live their lives in extremes (A.D.A.M., Inc. 2003). Cognitive therapy helps these individuals discover a middle route, whereby he or she can prioritize their responsibilities and drop some of the less important tasks or delegate them to others (A.D.A.M., Inc. 2003 ).  This type of lifestyle alterations will eventually lead to a more manageable life. Unfortunately, cognitive therapy is usually rather expensive and not covered by insurance (University of Maryland medical Center, 2002). The duration is usually brief and consists of six to twenty one-hour sessions. People involved in this type of therapy also keep a diary and attempt task they have avoided because of negative attitudes (Woodlands Healing Research Center, 2007). Other key points of cognitive-therapy include; confronting negative or discouraging thoughts, setting limits so to limit physical and mental stress, seek out personal pleasurable activities, eliminate or delegate less critical tasks, and accept that relapses will be part of the program and this is not a sign of failure (Woodlands Healing Research Center, 2007). The alternatives to cognitive-behavioral therapy include group psychotherapy and managed support groups (Buse, Loder, & McAlary, (2005 ).

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