Fibromyalgia (also mistakenly referred to as fibrositis) is a musculo-skeletal condition causing pain, stiffness and tenderness of the muscles, tendons and joints. Other symptoms associated with this condition include restless sleep, fatigue, anxiety, depression and disturbances in bowel function.
While fibromyalgia is one of the most common diseases affecting the muscles, its cause is currently unknown. It predominantly affects women between the ages of 35 and 55 and can occur independently or associated with another disease, such as systemic lupus or rheumatoid arthritis.
What causes the symptoms?
• The universal symptom of fibromyalgia is pain. However, the pain associated with this condition is different from many other arthritic conditions (such as osteoarthritis, rheumatoid arthritis and systemic lupus). In those diseases, tissue inflammation is the major cause of pain, stiffness and tenderness of the joints, tendons and muscles leading to joint deformity and damage to the internal organs or muscles.
In fibromyalgia, the painful tissues involved are not accompanied by tissue inflammation, therefore, despite disabling body pain, patients with fibromyalgia do not develop body damage or deformity.
Part of the problem appears to be a failure of the muscles to relax, in addition to an increased sensitivity to many different sensory stimuli and an unusually low pain threshold.
Minor sensory stimuli that ordinarily would not cause pain in individuals can cause disabling pain in patients with fibromyalgia. The body pain of patients with fibromyalgia can be aggravated by noise, weather changes, and emotional stress.
The pain of fibromyalgia is generally widespread, involving both sides of the body. Pain usually affects the neck, buttocks, shoulders, arms, the upper back and the chest, with trigger points (localised tender areas of the body that can bring on widespread pain and muscle spasm when touched) commonly found around the elbows, shoulders, knees, hips, back of the head and sides of the breast bone.
• The fatigue experienced by many patients with fibromyalgia can generally be related to abnormal sleep patterns. Normally, there are several levels of sleep. Getting enough of the deeper levels of sleep can be more important in refreshing a person than the total number of hours slept.
Patients with fibromyalgia lack the deep, restorative level of sleep, called ‘non-rapid-eye-movement’ (non-REM) sleep, causing them to awaken in the morning without feeling fully rested. Many will also awaken with muscle aches or a sensation of muscle fatigue as if they had been ‘working out’ all night.
• Mental and/or emotional disturbances occur in over half of fibromyalgia patients. These symptoms include poor concentration, forgetfulness, mood changes, irritability, depression and anxiety.
Similar to the fatigue experienced, such emotional disturbances are most likely to be related to poor sleep patterns in addition to the constant pain suffered. Because firm diagnosis of fibromyalgia is difficult with no confirmatory laboratory tests available, patients with fibromyalgia are often misdiagnosed as having depression as their primary underlying problem.
• Other symptoms of fibromyalgia include 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.
How is fibromyalgia diagnosed?
There are no blood or x-ray tests to help the doctor determine whether a patient has fibromyalgia, therefore the diagnosis is made on the basis of symptoms.
Because many other conditions can cause pain in different areas of the body, mimicking fibromyalgia, blood tests are important to exclude other medical conditions such as low thyroid hormone level (hypothyroidism), parathyroid disease (causing elevated blood calcium level), muscle diseases causing muscle pain (such as polymyositis), elevated blood calcium (hypercalcemia) and cancer.
Because fibromyalgia can occur alone, or in association with other inflammatory conditions such as systemic lupus, rheumatoid arthritis, polymyositis and polymyalgia rheumatica, blood tests to evaluate these diseases are also helpful.
With so many variables to consider it is not unusual for a patient to go from doctor to doctor for years without obtaining a correct diagnosis of their symptoms.
Dietary and lifestyle factors
Each patient with fibromyalgia is unique, with symptoms that can occur intermittently and in different combinations. Treatment programmes should, therefore, be individualised involving patient education, stress reduction, regular exercise, dietary changes and supplementation.
Although there is no known cause, it is useful to assess fibromyalgia patients for food allergy, intestinal yeast overgrowth, nutritional deficiencies (especially magnesium status) and adrenal exhaustion. If weight is a problem, this should also be considered and addressed. Having a consultation with a qualified nutritionist is the best way to assess these factors.
Stress management skills should be employed and tailored to the individual. This may include simple stress modification at home or work, relaxation tapes, yoga, tai chi, counselling, and support among family members and friends. Changes in environmental factors such as noise, temperature and weather exposure can exacerbate the symptoms of fibromyalgia, therefore these factors should be modified.
Low-impact aerobic exercises, such as swimming, cycling and walking can help to reduce the pain of fibromyalgia. Initially, such exercise may not always seem to provide relief. In the long-term, however, sufferers who exercise on a regular basis should see benefits as their muscles become more conditioned. In addition, sufferers following a regular exercise programme also report increased energy and mood. It is thought that such exercise may exert its beneficial effect by promoting a deep level of sleep (non-REM sleep).
Other measures to improve sleep are also very important including the avoidance of caffeinated beverages especially before bedtime, maintaining a stable blood sugar level through the night by having a small carbohydrate snack before retiring and carrying out a relaxation technique before bed such as yoga or meditation. Massage, heat treatment and gentle stretching also help to improve muscle function and reduce pain.
By: Elizabeth Hartland
|| features@algarveresident.com
Elizabeth Hartland has a Bachelor of Science Degree in nutrition, together with a Diploma from the Institute of Nutritional Therapy. She is married with two young children and has a passion for good nutrition and helping others to find better health. 282 427 652
