We all get tired. Most of us have experienced sadness or mild depression at times. And who doesn’t feel achy and stiff every now and then, especially after a weekend of sports or yard work? But for those with fibromyalgia syndrome (FMS), these debilitating symptoms occur daily for months to years on end, and are relentless, causing poor quality of life.
What is Fibromyalgia Syndrome?
Fibromyalgia syndrome (FMS) is a complex rheumatic-type disorder characterized by widespread pain, decreased pain threshold, and incapacitating fatigue. These symptoms affect millions of Americans, mostly women ages 25 to 60. In fact, women are 10 times more likely to get this disease than men. While there is no specific laboratory test or abnormal X-ray finding to diagnose fibromyalgia, the symptoms of the disease can be successfully treated once a proper diagnosis is made by a physician.
Years ago it became apparent to doctors that patients (usually women) who told of having muscle pain, achiness, fatigue, disordered sleep, anxiety, and depression were harboring a distinct syndrome, or collection of symptoms, that make a disease. Yet in test after test the results were always normal. Even in recent years doctors simply sent these patients home.
Today doctors know differently. Years of comprehensive studies done on this enigmatic syndrome confirm that fibromyalgia is very real, and although the symptoms vary from patient to patient, they are not imagined. For rheumatologists, fibromyalgia is one of the most common diseases. Yet in primary-care practices it is vastly underreported. That’s why seeking an accurate diagnosis for fibromyalgia is very important; even though evasive, it can be successfully treated once diagnosed.
What You Might Feel: Signs and Symptoms
Fibromyalgia causes you literally to ache all over. Symptoms may include, but are not limited to the following:
• fatigue upon awakening in the morning
• difficulty maintaining sleep or light sleep
• hypersensitivity to cold and/or heat
• abdominal pain
• chronic headaches
• numbness or tingling in the fingers and feet
• irritable bowel syndrome
• anxiety and depression
• inability to concentrate (called fibro fog)
• poor circulation in hands and feet (Raynaud’s phenomenon)
• restless legs syndrome
• dryness in mouth, nose, and eyes
• painful menstrual cramps
What Causes It?
At this time the causes of fibromyalgia are virtually unknown. Investigators have been looking at hormonal disturbances and chemical imbalances that affect nerve signaling. While just speculation, it may be that lower levels of serotonin in the blood of patients lead to lowered pain thresholds. (Serotonin, a neurotransmitter in the brain, is associated with a calming, anxiety-reducing reaction.) This is thought to be caused by the reduced effectiveness of the body’s natural endorphin painkillers and the increased presence of substance P, which increases pain perception. Still, these theories are merely speculative.
Most FMS patients experience nonrestorative sleep, such as insomnia or light and unrefreshing sleep. It may be that disordered sleep leads to the lower levels of serotonin, resulting in increased pain sensitivity. Researchers have demonstrated what amounts to lower pain threshold induced by sleep deprivation in healthy women (which is also associated with an abnormal brain-wave pattern).
Some researchers theorize that stress and poor physical conditioning are both major factors in the cause of fibromyalgia. Other researchers believe that because fibromyalgia is accompanied by low-grade depression, there may be a link between the two illnesses. Another theory states that fibromyalgia is caused by biochemical changes in the body and may be related to hormonal changes or menopause. Still other studies reveal that fibromyalgia may result from sudden trauma to the central nervous system.
No matter what the cause, fibromyalgia is a chronic and extremely debilitating musculoskeletal condition and one marked by fatigue. This means that it lasts for months and years unless the proper treatment is administered to control the symptoms.
How Is It Diagnosed?
Although today’s high-tech medicine usually has a specific test to help doctors arrive at a diagnosis, there is no laboratory test or X-ray that can diagnose fibromyalgia. That’s why a comprehensive physical examination and your medical history are both important, as well as a diagnosis of exclusion, ruling out other diagnoses that can be causing similar symptoms. Your doctor will also use a diagnosis of inclusion—making sure that your symptoms satisfy the diagnostic criteria outlined by the American College of Rheumatology. These criteria include widespread pain (pain in the right and left sides of the body, above and below the waist, involving the chest, neck, mid or lower back) that persists for at least three months, and pain evoked by a specific pressure in at least 11 to 18 specific anatomic sites.
Your doctor will run some specific blood tests, such as a complete blood count (CBC), a test that measures hemoglobin levels and gives a count of red blood cells, white blood cells, and platelets. This will let your doctor rule out blood disorders, such as anemia, that may cause fatigue. The blood chemistries will tell how your kidneys and liver are functioning and will give your cholesterol numbers. Tests of other chemicals, such as glucose, that can create similar problems to those of fibromyalgia will be done, as well as thyroid tests. An underactive thyroid (hypothyroidism), caused by reduced hormone production by the thyroid gland, can cause problems similar to those of fibromyalgia, with the fatigue, muscle aches, weakness, and depression.
Although fibromyalgia does not cause changes that show up on X-rays, your doctor may still want to rule out more serious causes of pain by taking routine X-rays or even ordering an MRI (magnetic resonance imaging).
Help for Fibromyalgia
There is no accurate way to diagnose FMS, and there is also no known cure. However, many experts are finding success with a multifaceted treatment program that includes a combination of natural therapies to reduce the pain, anxiety, depression, and fatigue, while increasing healing sleep. Here are a few ways to help relieve the suffering:
Hydrotherapy helps boost blood flow to the painful site. Many FMS patients find relief with hydrotherapy, either hot or cold water to ease the discomfort. In fact, balneotherapy, or the use of hot baths or spas to alleviate pain, is a centuries-old therapy that helps to increase muscle relaxation, boost blood supply to the site, and relieve rigidity and spasms in the muscles of patients with fibromyalgia.
• Foods high in complex carbohydrates
Soothing foods high in complex carbohydrates help reduce anxiety. When serotonin levels are increased in the brain, it is associated with a calming, anxiety-reducing effect and, in some cases, a drowsiness effect. Also, a stable serotonin level in the brain is associated with a positive mood or feeling good over a period of time.
• Foods High in Protein
Many with this syndrome suffer from fibro fog, the inability to concentrate and be attentive. Fortunately, some foods promote mental attentiveness. Studies show that people are more alert when the brain is producing the neurotransmitters dopamine and norepinephrine. Foods rich in protein help to increase the amino acid tyrosine, which boosts the levels of dopamine and norepinephrine. This, in turn, creates a feeling of alertness and improves our concentration. Try, for example, legumes or soy products to boost mental alertness.
Activity can tone muscles and alleviate pain. Lack of exercise and inactivity can aggravate low serotonin levels. Not only does exercise act as nature’s tranquilizer, helping to boost serotonin in the brain, but studies have shown that exercise also triggers the release of norepinephrine. For those with fibromyalgia who feel stressed out frequently, exercise can help to desensitize the body to stress.
Set up a regular exercise program that includes stretching; aerobic activities, such as walking, bike riding, and swimming; and resistance training or weight lifting. Household activities such as gardening, mopping, vacuuming, sweeping, and window washing all count as exercise––so include them in your exercise program.
Start slowly and increase the exercises as you are able. Remember, if you are out of shape, it took a long time to get that way. Likewise, it will take a while to increase your fitness level, so be patient.
• Stress-relieving Activities
Learning how to handle and release stress can reduce anxiety and improve quality of sleep. There are many ways to destress. For those with fibromyalgia, support groups may be of particular benefit.
You may also find help from simple relaxation techniques, such as watching the sunset or breathing deeply while listening to music. Prayer also helps ease anxiety and increase feelings of hope.
Cognitive behavioral techniques, such as positive self-talks in which you contradict any negative thoughts with optimistic ones help to switch your body from the “fight or flight” stress alert system into a calmer relaxation mode.
• Herbal Therapies
Some FMS patients find benefit from herbal therapies, particularly those herbs that act as anti-inflammatories or aid in sleep. Here are some common herbs used to help relieve FMS symptoms:
Boswellia (relieves inflammation)
Chamomile (helps to calm nervousness, anxiety, and cramps)
Feverfew (inhibits inflammation and acts similarly to aspirin)
Meadowsweet (helps reduce inflammation)
Pine bark (stimulates circulation and reduces inflammation)
Valerian (acts as a sedative and helps to reduce inflammation)
While herbs are natural, they still can have a negative effect on the body. Always check with your doctor before using an herb to make sure it will benefit your health and not interact negatively with medications.
• Healing Sleep
Disturbed sleep and the resulting exhaustion you feel cause reduced physical fitness and lead to a vicious cycle of inactivity and sleep disturbance. Because patients with fibromyalgia have a specific type of disordered sleep, it’s important to take time before going to bed to create a restful atmosphere and reduce feelings of wakefulness. Try the following tips to boost healing sleep:
• Excessively warm rooms disturb sleep, so keep your room at a moderate temperature.
• Reduce noise. If your room is noisy, buy earplugs at your pharmacy to shut out annoying sounds.
• Exercise daily. A steady daily amount of exercise helps to deepen sleep.
• Go to bed only when sleepy.
• Use the bed only for sleeping; do not read or watch TV while in your bed.
• If you cannot sleep, move to another room. Stay up until you are really sleepy; then return to bed. The goal is to associate the bed with falling asleep quickly.
• Set the alarm and get up at the same time each day, regardless of how much you slept during the night. This helps your body acquire a constant sleep-wake rhythm.
• Do not nap during the day.
• Massage Therapy
Massage can give great relief to those with fibromyalgia. Studies released from the University of Miami Touch Research Institute concluded that the benefits of massage include heightened alertness, relief from depression and anxiety, increased immune function, lower levels of the stress hormone cortisol, and reduced difficulty in getting to sleep. Massage increases circulation in the body, gives relief from musculoskeletal pain, and helps to increase flexibility and mobility—all important for FMS patients.
When to Call the Doctor
It’s important to know that some internal organ problems can cause chronic pain that may mimic the overall aching and pain of fibromyalgia. If the pain is caused by kidney disease, stomach disease, or other internal organ abnormality, treating the problem will resolve the pain. Cancer and other serious diseases can cause the symptoms of fatigue and weakness. In most cases early treatment can eliminate the problem and the symptoms. That’s why an accurate diagnosis is so important. After you have been diagnosed with fibromyalgia, should any of the symptoms worsen with prescribed treatment or alternative therapies, call your doctor. You may need a different medication or medical therapy, or you may have a new or coexisting problem that needs to be
diagnosed and resolved.