Fibromyalgia
From Wikipedia, the free encyclopedia
Fibromyalgia (FM or FMS) is a chronic syndrome (constellation of signs and symptoms) characterized by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. It is not contagious, and recent studies suggest that people with fibromyalgia may be genetically predisposed[1]. It affects more females than males, with a ratio of 9:1 by ACR (American College of Rheumatology) criteria[2]. Fibromyalgia is seen in 3% to 6% of the general population, and is most commonly diagnosed in individuals between the ages of 20 and 50. The nature of fibromyalgia is not well understood; some physicians believe that it may be psychosomatic or malingering. However, a new study reported in the National Fibromyalgia Association Newsletter [5], suggests a strong dopamine link. There are few, if any, treatments available. Although there is no cure, the disease itself is neither life-threatening nor progressive, though the degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission.
History
Fibromyalgia has been studied since the early 1800s and referred to by a variety of former names, including muscular rheumatism and fibrositis[3]. The term fibromyalgia was coined in 1976 to more accurately describe the symptoms, from the Latin word fibra, meaning fiber, myo, meaning muscle, and the Greek word algos, meaning pain.
Fibromyalgia was first recognized by the American Medical Association as a "true" illness and the cause of disability in 1987. In an article the same year, in the Journal of the American Medical Association, a physician named Goldenberg called the syndrome Fibromyalgia.
Symptoms
The primary symptom of fibromyalgia is widespread, diffuse pain, often including heightened sensitivity of the skin (Allodynia), tingling of the skin (often needlelike), achiness in the muscle tissues, prolonged muscle spasms, weakness in the limbs, and nerve pain. Chronic sleep disturbances are also characteristic of fibromyalgia, and some studies suggest that these sleep disturbances are the result of a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. REM sleep is seldom reached.
Many patients experience "brain fog", also known as "fibrofog", exhibiting abnormally slow brain waves and cognitive deficits[4]. Many experts suspect that "brain fog" is directly related to the sleep disturbances experienced by sufferers of fibromyalgia. It is not unusual for patients to experience extended periods (two hours or more) of sleep inertia.
Other symptoms often attributed to fibromyalgia (possibly due to another comorbid disorder) are 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.
Fibromyalgia can start as a result of some trauma (such as a traffic accident) or major surgery (usually hysterectomy), but there is currently no known strong correlation between any specific type of trigger and the subsequent initiation of fibromyalgia. Symptoms can have a slow onset, and many patients have mild symptoms beginning in childhood, such as growing pains. Symptoms are often aggravated by unrelated illness or changes in the weather. They can become more tolerable or less tolerable throughout daily or yearly cycles; however, many people with fibromyalgia find that, at least some of the time, the condition prevents them from performing normal activities such as driving a car or walking up stairs. The syndrome does not cause inflammation as is presented in arthritis, but anti-inflammatory treatments, such as Ibuprofen and Iontophoresis, are known to temporarily reduce pain symptoms in some people.
Variability of Symptoms
The following factors are said to temporarily increase the suffering of patients:
§ Cold weather, especially when damp
§ Changes in atmospheric pressure (such as with the onset of a cold front)
§ Malnutrition, hunger, or starvation
§ Physical activity
§ Lack of deep (REM) sleep
§ Increase of stress
Diagnosis
When making a diagnosis of fibromyalgia, a practitioner would take into consideration the patient's case history and the exclusion of other conditions such as endocrine disorders, arthritis, and polymyalgia rheumatica. There are also two criteria established by The American College of Rheumatology for diagnosis:
§ A history of widespread pain lasting more than three months — widespread as in all four quadrants of the body, i.e., both sides, and above and below the waist.
§ Tender points — there are 18 designated possible tender points (although a person with the syndrome may feel pain in other areas as well). During diagnosis, four kilograms-force (40 newtons) of force[6] is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered. Four kilograms of force is about the amount of pressure required to turn fingernails white or to feel pain sensations on the forehead. This technique was developed by the American College of Rheumatology as a means of confirming the diagnosis for clinical studies. It is also used in the United Kingdom. Pressure on nearby areas rarely elicits any reaction.
Fibromyalgia patients also have elevated levels of Substance P in the body, which increases the levels of pain and intensity.
However, it should be remembered that this diagnostic criteria was originally established as an inclusion criteria for a research study and was not then intended for general diagnosis. The number of tender points that invoke a response can vary as the condition flares and eases. Patients have also been known to start off having Fibromyalgic symptoms in only one half of their body. The tender point test also depends on a good medical practitioner and good communication between doctor and patient: if the doctor misses the tender point site, then a false negative reponse could be noted; the doctor might not apply the right level of pressure to the tender point; if the patient has some tender points that hurt less than other points they might not mention them even if they do hurt; and some doctors do the test without telling the patient to say when it hurts, so if the patient conceals when some points hurts then a false negative response could be noted.
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Topic: Fibromyalgia (Read 5095 times)
September 23, 2010, 01:48:07 PM
