Fibromyalgia
What Causes fibromyalgia?
Most researchers agree that FM is a disorder of central processing with neuroendocrine/ neurotransmitter dysregulation. The FM patient experiences pain amplification due to abnormal sensory processing in the central nervous system. An increasing number of scientific studies now show multiple physiological abnormalities in the FM patient, including: increased levels of substance P in the spinal cord, low levels of blood flow to the thalamus region of the brain, HPA axis hypofunction, low levels of serotonin and tryptophan and abnormalities in cytokine function. Recent studies show that genetic factors may predispose individuals to a genetic susceptibility to FM.
For some, the onset of FM is slow; however, in a large percentage of patients the onset is triggered by an illness or injury that causes trauma to the body. These events may act to incite an undetected physiological problem already present. Exciting new research has also begun in the areas of brain imaging and neurosurgery. Ongoing research will test the hypothesis that FM is caused by an interpretative defect in the central nervous system that brings about abnormal pain perception. Medical researchers have just begun to untangle the truths about this life-altering disease.
Symptoms of fibromyalgia
The defining symptoms of fibromyalgia are chronic, widespread pain and tenderness to light touch, and usually moderate to severe fatigue. Those affected may also experience heightened sensitivity of the skin (also called allodynia) thankfully in my case not very often, tingling of the skin (often needle-like), achiness in the muscle tissues, prolonged muscle spasms, weakness in the limbs, and nerve pain. Chronic sleep disturbances are also characteristic of fibromyalgia -- and not just from discomfort: some studies suggest that these sleep disturbances are the result of a sleep disorder called alpha-delta sleep, a condition in which deep sleep (associated with delta EEG waves) is frequently interrupted by bursts of brain activity similar to wakefulness (i.e. alpha waves).
Deeper stages of sleep (stages 3 & 4) are often dramatically reduced. In addition, many patients experience cognitive dysfunction (known as "brain fog" or "fibrofog"), which may be characterized by impaired concentration and short-term memory consolidation, impaired speed of performance, inability to multi-task, and cognitive overload. Many experts suspect that "brain fog" is directly related to the sleep disturbances experienced by sufferers of fibromyalgia. However, the relationship has not been strictly established.
Commonly associated symptoms of fibromyalgia include:
- Fatigue
- Irritable bowel syndrome Sleep disorders
- Chronic headaches
- Jaw pain
- Cognitive or memory impairment
- Muscle pain or morning stiffness
- Painful menstruation
- Numbness and tingling in the extremities
- Dizziness or light headedness
- Skin and chemical sensitivities
Other symptoms often attributed to fibromyalgia (possibly due to another comorbid disorder) may include myofascial pain syndrome, chronic paresthesia, physical fatigue, irritable bowel syndrome, genitourinary symptoms (such as those associated with the chronic bladder condition interstitial cystitis), dermatological disorders, headaches, myoclonic twitches, and symptomatic hypoglycemia. Although it is common in people with fibromyalgia for pain to be widespread, it may also be localized in areas such as the shoulders, neck, back, hips, or other areas. Many sufferers also experience varying degrees of temporomandibular joint disorder. Not all patients have all symptoms.
How is it diagnosed?
Currently there are no laboratory tests available for diagnosing fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination. This exam is based on the standardized American College of Rheumatology (ACR) criteria. Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.It is estimated that it takes an average of 5 yrs for an FM patient to get an accurate diagnosis. Many doctors are still not adequately informed or educated about Fibromyalgia! Laboratory tests often prove negative and many FM symptoms overlap with those of other conditions, thus leading to extensive investigative costs and frustration for both the doctor and patient. Another essential point that must be considered is that the presence of other diseases, such as rheumatoid arthritis or lupus, does not rule out an FM diagnosis. Fibromyalgia is not a diagnosis of exclusion and must be diagnosed by its own characteristic features.
Fibromyalgia is characterized by the presence of multiple tender points and a constellation of symptoms:
FM Pain
The pain of FM is profound, widespread and chronic. It knows no boundaries, migrating to all parts of the body and varying in intensity. FM pain has been described as stabbing and shooting pain and deep muscular aching, throbbing, and twitching. Neurological complaints such as numbness, tingling, and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors that affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.
Fatigue - In today's world many people complain of fatigue; however, the fatigue of FM is much more than being tired. It is an all-encompassing exhaustion that interferes with even the simplest daily activities. It feels like every drop of energy has been drained from the body, which at times can leave the patient with a limited ability to function both mentally and physically.
Sleep problems - Many fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep. Medical researchers have documented specific and distinctive abnormalities in the Stage 4 deep sleep of FM patients. During sleep, individuals with FM are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep.
Other symptoms - Additional symptoms may include: irritable bowel and bladder, headaches and migraines, restless legs syndrome (periodic limb movement disorder), impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, Raynaud's Syndrome, neurological symptoms, and impaired coordination.
Diagnostic Criteria - The difficulty with diagnosing fibromyalgia lies in the fact that, in most cases, laboratory testing appears normal and that many of the symptoms mimic those of other disorders. A definite diagnosis of fibromyalgia syndrome should only be made when no other medical disease can explain the symptoms. This is to say, fibromyalgia is a diagnosis of exclusion.
A proper history and physical exam coupled with blood work and/or x-rays may be done to rule out:
- Hormonal imbalance
- Anemia
- Infection
- Muscle disease
- Bone disease
- Nerve disease
- Joint disease
- Cancer
- Rheumatoid arthritis
- Hypothyroidism (including primary hypothyroidism, secondary hypothyroidism, Hashimoto';s thyroiditis, iodine deficiency goiter, and genetic thyroid enzyme defects). Thyroid-stimulating hormone levels should be checked routinely because this condition can mimic many of the symptoms of fibromyalgia
- Polymyalgia rheumatica
- Electrical nerve and muscle testing, known as electromyography (EMG) or nerve conduction velocity (NCV), may also be done to check the muscles and nerves.
Tender Points - Upon physical examination, the fibromyalgia patient will be sensitive to pressure in certain areas of the body called tender points. To meet the diagnostic criteria, patients must have: Widespread pain in all four quadrants of their body for a minimum of three months. Pain is considered widespread when all of the following are present:
- Pain in the left side of the body
- Pain in the right side of the body
- Pain above the waist
- Pain below the waist
- Pain in the neck, front of your chest, mid-back, or low back
At least 11 of the 18 specified tender points of fibromyalgia. These are areas of pain on touch but without signs of redness, swelling or heat in the surrounding joints or muscles. For a tender point to be considered "positive" you must feel pain when someone pushes with their finger with an approximate force of 4kg (roughly the amount of pressure needed to change the colour of the skin). Some health care providers may use an instrument called an algometer during the examination of the patient to ensure that only a 4kg load is being placed. The location of the 18 tender points are:
- (1 & 2) Occiput: on both sides (bilateral), at the sub-occipital muscle insertions.
- (3 & 4) Low Cervical: bilateral, at the anterior aspects of the inter-transverse spaces.
- (5 & 6) Lateral Epicondyle: bilateral, 2 cm distal to the epicondyles
- (7 & 8) Knee: bilateral, at the medial fat pad proximal to the joint line.
- (9 & 10) Second Rib: bilateral, at the second costochondral junction, just lateral to the junctions on upper surfaces.
- (11 & 12) Trapezius: bilateral, at the midpoint of the upper border of the muscle.
- (13 & 14) Supraspinatus: bilateral, at origins, above the spine of the scapula (shoulder blade) near the medial border
- (15 & 16) Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
- (17 & 18) Greater Trochanter: bilateral, posterior to the trochanteric prominence.
Why Eleven Points? Some experts believe that a person does not need to have the required 11 tender points to be diagnosed and treated for fibromyalgia. This criterion was originally intended for research purposes. A diagnosis of fibromyalgia may still be made if a person has less than the 11 of the required tender points so long as they have widespread pain and many of the common symptoms and associated syndromes connected to fibromyalgia, such as sleep disorders and irritable bowel syndrome. If a patient has some symptoms but does not meet the tender point criterion, a diagnosis of "possible fibromyalgia syndrome" may be assigned. You should also remember that self-diagnosis is not advised and that you should consult a skilled medical professional to conduct a thorough examination.
Limitations of the Diagnostic Criteria -
Since fibromyalgia sufferers have typically normal laboratory or x-ray tests the above listed criteria are important for diagnosing and studying the syndrome. However, the criteria are not without their drawbacks. First, the tender point paradigm assumes that fibromyalgia sufferers only experience pain in the 18 anatomical sites of the body. Recent research has made it evident that individuals with fibromyalgia are sensitive to painful stimuli throughout the body, not merely at the identified locations. Second, many patients with fibromyalgia will often find that on a given day they will have less than the diagnostic 11 tender points in their body. Does this mean that some days you have fibromyalgia others you don';t? Obviously this is not the case. Patient tenderness varies from day to day and, as a result, tender point counts on some days can be below the required 11 while on other days it may surpass it. Furthermore, some patients will not always have pain in all four quadrants of the body. Some experience pain only on one side or on the upper or lower half of the body. That being said, in the absence of a foolproof laboratory marker for fibromyalgia, the criteria explained above remains the best diagnostic tool for this condition.
New study poses the question of whether fibromyalgia can be diagnosed with simply a Blood Pressure Test
While such fibromyalgia tests as a tender point count physical exam have been useful in the diagnosis of fibromyalgia syndrome, a new fibromyalgia test is being used to identify whether an individual experiencing fibromyalgia symptoms such as fatigue and cognitive impairment truly has fibromyalgia. The test is based in part on the most common of the symptoms of fibromyalgia: pain. A recent study that tested blood pressure (BP) discovered that participants with fibromyalgia were 69% more likely to experience pain during a routine BP test than those who did not have fibromyalgia.
The study found that while fibromyalgia patients experienced discomfort while undergoing a blood pressure test (or a sphygmomanometry), only 20% of the study participants that did not have the condition did so. Therefore, experts believe that a blood pressure test can be a useful tool in fibromyalgia diagnosis. Allodynia is the term given to the condition in which an individual experiences pain and discomfort in reaction to a stimulus that typically does not result in such responses. The study participants with fms experienced pains at levels less than 210 Hg. Pressure was sustained for a maximum time of 30 seconds or less.
Participants were tested on their dominant arm, although participants reported that pain was experienced on both arms. In addition, findings have shown that a BP test is more reliable than a tender point count that is part of a typical physical exam in the diagnosis of fibromyalgia. In such a test, a variety of areas sensitive to pain (known as fibromyalgia tender points or fibromyalgia pressure points) are examined for their response to pain.
Blood pressure tests are typically used to evaluate cardiovascular health. A blood pressure test includes wrapping a cuff around the arm. The cuff is then inflated, causing a large artery in the arm to compress and blood in the arm to stop flowing. When the cuff is released, blood flows once more, producing sound. Your doctor listens to this sound in order to check that your blood pressure is healthy. These findings suggest a new ray of hope for fibromyalgia sufferers. Because of the believed accuracy of a blood pressure test in fibromyalgia diagnosis, those whose lives are being affected by common fibromyalgia symptoms, such as chest discomfort, anxiety and vision problems, can be directed to fibromyalgia treatment sooner by their health care providers.
Medical source: http://www.fibromyalgia-symptoms.org/
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