What is fibromyalgia?
Fibromyalgia is a common and disabling disorder affecting 2-4% of the population, women more often than men. Despite the condition's frequency, the diagnosis is often missed. Patients with fibromyalgia usually ache all over, sleep poorly, are stiff on waking, and are tired all day. They are prone to headaches, memory and concentration problems, dizziness, numbness and tingling, itching, fluid retention, crampy abdominal or pelvic pain and diarrhea, and several other symptoms.
There are no diagnostic lab or x-ray abnormalities, but a physician can confirm the diagnosis by finding tender points in characteristic locations. Fibromyalgia often runs in families, suggesting an inherited predisposition. It may lie dormant until triggered by an infection, injury, stress, or sleep disturbance. It is closely related to the chronic fatigue and irritable bowel syndromes and to migraines. Some have suggested that these are all just different facets of the same underlying disorder.
What causes it?
Fibromyalgia was once thought to be an inflammatory condition and later a psychiatric one, but neither of these causes now appears likely. No good evidence of inflammation or arthritis has been found. When depression and anxiety occur they are more often the result than the cause of fibromyalgia. Patients with fibromyalgia are no more likely to be depressed than patients with other chronic painful disorders such as rheumatoid arthritis. Spinal fluid levels four times normal of the main pain neurotransmitter substance P suggest that the pain is not imaginary.
We still do not know exactly what causes fibromyalgia, but we know much more than we did a few years ago. Several good theories have been proposed and much scientific data gathered. One leading theory links fibromyalgia with an abnormality of deep sleep. Fibromyalgia patients often note that not getting enough sleep or even just staying up an hour late makes their fibromyalgia symptoms worse the next day. Abnormal brain waveforms have been found in deep sleep in many patients with fibromyalgia. Fibromyalgia-like symptoms and tender points can be produced in normal volunteers by depriving them of deep sleep for a few days. Low levels of growth hormone, important in maintaining good muscle and other soft tissue health, have been found in patients with fibromyalgia. This hormone is produced almost exclusively in deep sleep, and its production is increased by exercise. Daily exercise has been found to be an important part of treatment of fibromyalgia along with steps taken to improve sleep.
Fibromyalgia is also associated with certain immune system changes. These do not appear to be of the auto immune kind seen in some unrelated disorders like multiple sclerosis or rheumatoid arthritis, but rather the immune system appears as if fighting a virus. No virus has been convincingly demonstrated, and the fact that fibromyalgia does not appear to be contagious (for example, it is no more common in spouses of affected patients than in the general population) argues against an infectious cause.
Experimental disturbance of deep sleep in normal volunteers causes similar immune system changes, suggesting that the immune system changes may be secondary to the sleep disorder. Levels of certain cytokines, a class of immune system hormones, are elevated in fibromyalgia. When these same cytokines are given to patients to treat other disorders, fibromyalgia-like side effects are common. Putting this all together, this suggests that fibromyalgia symptoms may be caused by elevated levels of certain cytokines produced by an immune system which is not functioning normally because of a chronic sleep disorder. This explanation is by no means proven, and several other good theories exist.
Neurotransmitter and endocrine changes occur in fibromyalgia, particularly involving serotonin and the pituitary-adrenal axis, but as these same changes can also be produced by experimental deep sleep deprivation, they are probably secondary rather than primary. They may account for some fibromyalgia symptoms, however. Depression and migraine headaches are associated with low serotonin levels, for example, and often respond to medications that boost serotonin.
How is it treated?
With:
1) Medication to improve deep sleep.
2) Regular sleep hours and an adequate amount of sleep.
3) Daily gentle aerobic exercise and stretching.
4) Avoidance of over exertion and stress.
5) Treatment of any coexisting sleep disorders.
6) Patient education.
Medication by itself is of little value in treating fibromyalgia. Successful treatment demands the patient's active involvement in treatment as well as lifestyle changes. Each of the six parts of treatment above is important. If any one is omitted, the chance of significant improvement is considerably reduced.
- Post to:
del.icio.us
Digg
Newsvine
Nowpublic
Reddit