Fibromyalgia is a chronic or long-term condition causing pain, stiffness, and tenderness of the muscles, tendons, and joints. The condition also causes restless sleep, constant tiredness, anxiety, depression, and disturbances in bowel function.
It is not unusual to wake up every day unrefreshed from the night’s sleep. Whilst fibromyalgia is one of the most common diseases affecting the muscles, its cause is currently unknown to orthodox medicine. Fibromyalgia is different from many other rheumatic conditions such as rheumatoid arthritis, lupus etc. In those diseases, the tissue inflammation is the major cause of pain, stiffness, and tenderness of the joints, tendons and muscles, and it can lead to joint deformity and damage to the internal organs or muscles, whereas fibromyalgia does not have that outcome.
What causes fibromyalgia?
The cause of fibromyalgia is not known by orthodox medicine. Those affected feel pain in response to stimuli that are not normally perceived as painful. Researchers have found elevated levels of a nerve chemical signal, called substance P, and nerve growth factor in the spinal fluid of fibromyalgia patients. Levels of the brain chemical serotonin are also relatively low in patients with fibromyalgia. Studies of pain in fibromyalgia have suggested that the central nervous system (brain) may be somehow supersensitive. Scientists note that there seems to be a diffuse disturbance of pain perception in patients with fibromyalgia.
Patients with this condition have an impaired non-Rapid-Eye-Movement, or non-REM, sleep phase (which likely, at least in part, explains the common feature of waking up fatigued and unrefreshed in these patients). The onset of fibromyalgia has been associated with psychological distress, trauma, and infection.
Who does fibromyalgia affect?
Fibromyalgia affects predominantly women (over 80% of those affected are women) between the ages of 35 and 55. Rarely fibromyalgia can also affect men, children, and the elderly. It can occur independently or can be associated with another disease, such as systemic lupus or rheumatoid arthritis. The prevalence of fibromyalgia varies in different countries. In Sweden and Britain, 1% of the population is affected by fibromyalgia. In the United States, approximately 2% of the population has fibromyalgia.
What are symptoms of fibromyalgia?
The universal symptom of fibromyalgia is pain as mentioned earlier. 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. "Tender points" are localized tender areas of the body that can bring on widespread pain and muscle spasm when touched. Fibromyalgia tender points, or pressure points, are commonly found around the elbows, shoulders, knees, hips, back of the head, and the sides of the breastbone.
Fatigue occurs in 90% of patients. Fatigue may be related to the abnormal sleep patterns. Normally, there are several levels of depth of sleep. Getting enough of the deeper levels of sleep may be more important in refreshing a person than the total number of hours of sleep. Patients with fibromyalgia lack the deep, restorative level of sleep, called "non-rapid-eye-movement" (non-REM) sleep. Consequently, patients with fibromyalgia often awaken in the morning without feeling fully rested. Some patients awaken with muscle aches or a sensation of muscle fatigue.
Over 50% of people with fibromyalgia can experience symptoms including poor concentration, forgetfulness, mood changes, irritability, depression, and anxiety. Since a firm diagnosis of fibromyalgia is difficult, and no confirmatory laboratory tests are 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. Each patient with fibromyalgia is unique. Any of the above symptoms can occur intermittently and in different combinations.
How is fibromyalgia diagnosed?
There are no blood tests or X-ray tests that help the doctor determine whether someone has fibromyalgia. These tests are done to exclude other possible diagnoses. Therefore, the diagnosis of fibromyalgia is made purely on clinical grounds based on the doctor's history and physical examination. In patients with widespread body pain, the diagnosis of fibromyalgia can be made by identifying point tenderness areas (typically, patients will have at least 11 of the 18 classic fibromyalgia tender points), by finding no accompanying tissue swelling or inflammation, and by excluding other medical conditions that can mimic fibromyalgia.
Again, even though there is no blood test for fibromyalgia, blood tests are important to exclude other medical conditions. Therefore, thyroid hormone and calcium blood levels are obtained to exclude hypercalcemia, hyperparathyroidism, and hypothyroidism. The blood alkaline phosphatase (a bone enzyme) level is often raised in patients with Paget's disease of the bone. The CPK (a muscle enzyme) level is often elevated in patients with polymyositis, a disease with diffuse muscle inflammation. Therefore, obtaining alkaline phosphatase and CPK blood levels can help the doctor decide whether Paget's disease and polymyositis are the causes of bone and muscle pains. A complete blood count (CBC) and liver tests help in the diagnosis of hepatitis and other infections.
Fibromyalgia can occur alone or in association with other systemic rheumatic conditions. Systemic rheumatic conditions refer to diseases that can cause inflammation and damage to numerous different tissues and organs in the body. Systemic rheumatic conditions associated with fibromyalgia include systemic lupus erythematosus, rheumatoid arthritis, polymyositis, and polymyalgia rheumatica. Blood tests which are helpful in evaluating these diseases include erythrocyte sedimentation rate (ESR), serum protein electrophoresis (SPEP), antinuclear antibody (ANA), and rheumatoid factor (RF). In patients with fibromyalgia without associated systemic illnesses, the ESR, SPEP, ANA, and RF blood tests are usually normal.
What is the orthodox medical treatment for fibromyalgia?
The most effective medications in the treatment of fibromyalgia have been the tricyclic antidepressants. In treating fibromyalgia, tricyclic antidepressants are taken at bedtime in doses that are a fraction of those used for treating depression. Tricyclic antidepressants appear to reduce fatigue, relieve muscle pain and spasm, and promote deep, restorative sleep in patients with fibromyalgia. Scientists believe that tricyclics work by interfering with a nerve transmitter chemical in the brain called serotonin. Examples of tricyclic antidepressants commonly used in treating fibromyalgia include amitriptyline (Elavil) and doxepin (Sinequan).
Studies have shown that adding fluoxetine (Prozac), or related medications, to low-dose amitriptyline further reduces muscle pain, anxiety, and depression in patients with fibromyalgia. The combination is also more effective in promoting restful sleep and improving an overall sense of well-being. These two medications also tend to cancel out certain side effects each can have. Tricyclic medications can cause tiredness and fatigue, while Prozac can make patients more cheerful and awake. Even more recently, study of patients with resistant fibromyalgia found that lorazepam (Ativan) was helpful in relieving symptoms. Prozac has also been shown to be effective when used alone for some patients with fibromyalgia.
In 2007, pregabalin (Lyrica) became the first medication approved specifically for treating fibromyalgia. Lyrica may be work by blocking nerve pain in patients with fibromyalgia. Lyrica has advantages of flexible dosing that can be adjusted according to persisting symptoms.
More recently, drugs that simultaneously increase the amount of two brain nerve transmitters, serotonin and norepinephrine, have been approved to treat fibromyalgia in adults. These drugs include duloxetine (Cymbalta) and milnacipran (Savella). Research studies have shown significant effectiveness in decreasing pain and improving function in patients with fibromyalgia with these drugs. Cymbalta has been effective in treating depression and relieving pain in people with depression and is also used to treat anxiety.
Local injections of analgesics and/or cortisone medication into the tender point areas can also be helpful in relieving painful soft tissues, while breaking cycles of pain and muscle spasm. Some studies indicate that the pain reliever tramadol (Ultram) and tramadol/acetaminophen (Ultracet) may be helpful for the treatment of fibromyalgia pains. The muscle relaxant cyclobenzaprine (Flexeril) has been helpful for reducing pain symptoms and improving sleep.
The nonsteroidal antiinflammatory drugs (NSAIDs), while very helpful in treating other rheumatic conditions, have only a limited value in treating fibromyalgia pain. Narcotic pain relievers and cortisone medications have not been shown to be beneficial in this condition. Narcotics and cortisone medications are avoided because they have not been shown to be beneficial and they have potential adverse side effects, including dependency, when used long term.
Both biofeedback and electro-acupuncture have been used for relief of symptoms with some success. Standard acupuncture has also been reported to be effective in treating some patients with fibromyalgia.
The Herbal Treatment of Fibromyalgia
Herbal Medicine believes that fibromyalgia is a complex condition involving several body systems. Patients are treated holistically by looking at their whole body and lifestyle. This in-depth approach to treatment gets to the root of the problem and thereby enables the underlying problems to be addressed and treated as well as the symptoms. Patients usually come to Herbal Medicine after doing the rounds, often spending a small fortune yet still in pain. They are very pleasantly surprised and delighted to discover that Herbal Medicine usually makes a difference within the first six weeks of treatment. Every patient’s presentation of fibromyalgia is different and so each patient has a prescription to meet their own unique needs. This approach gains the best results as treatment is tailored to the individual. The treatment is in stages and prescriptions change as progress is made and the patient goes on to the next stage of treatment. Patients are seen monthly to discuss progress. Treatment usually take up to a year, depending on the individual case. However, some cases may be resolved earlier, particularly when patients adhere to the diet specified for the duration of the treatment.
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If you have been diagnosed with fibromyalgia and would prefer a safe, natural approach to treating it, call for an appointment.