THE DIFFICULTIES IN DIAGNOSING AND TREATING FIBROMYALGIA
Fibromyalgia is a chronic disorder characterized by muscle pain, fatigue, stiffness and tenderness of the muscles, tendons and joints. Formerly known as fibrositis, fibromyalgia is marked by an extremely low pain threshold. And while it is not caused by the inflammation of surrounding tissue, fibromyalgia can be affected by outside factors, including emotional stress, noise and even the weather.
Those suffering from the disorder experience increased sensitivity to numerous sensory stimuli that may not be painful to others. Their pain occurs in what is known as "tender points," which are specific spots that hurt when pressure is applied to them. These spots are normally at the back of the head and front of the neck, the shoulders, hips and knees, the sides of the breatbone and around the elbows. But while the primary effect of fibromyalgia is pain, it can also produce other symptons, including anxiety, depression, faulty memory or thought processes, poor concentration, irritability, mood changes, restless sleep or tiredness after awakening, migraine and tension headaches, painful menstrual periods, tingling or numbness in the hands and feet, and disturbances in bowel functioning.
The causes of fibromyalgia are unclear. What is known is that humans are constantly exposed to many elements that can have adverse affects on the endocrine system, including chemicals, toxic substances and allergens. Some researchers believe that increased liver toxicity related to such exposure may cause fibromyalgia. As a dysfunctional liver will not properly remove from the body fat-soluble substances, those with such a condition are more susceptible to the accumulation of chemicals in their fatty tissue, leading to other ailments. Researchers have speculated on many other possible causes of fibromyalgia, including bacterial overgrowth, the contracting of certain illnesses or diseases, genetic predisposition, abnormalities in the immune system, accidental injury or trauma to the muscle or repetitive injuries, or other types of stressful or traumatic events. Other possible precipitating factors are sleep disorders, especially when considering that sufferers of fibromyalgia were found to have lower amounts of the brain nerve chemical serotonin, and improper functioning of their autonomic nervous system, which is important to controlling bodily processes such as digestion and stress reaction, and their metabolism, which includes the functioning of hormones and neurotransmitters.
It has been estimated that fibromyalgia affects as many one out of 50 Americans, or two percent of the U.S. population. Approximately 80 to 90 percent of the sufferers are women, and they are normally diagnosed with the disorder between the ages of 20 and 25. But fibromyalgia can also develop in elderly women and even men who are older. Statistics indicate that as many as 30 percent of those suffering from the disease lupus also have fibromyalgia, as do between 10 and 15 percent of those with osteoarthritis. Fibromyalgia is also found to be more prevalent among those who suffer from spinal and rheumatoid arthritis. Various risk factors are believed to be related to the onset of fibromyalgia, including certain medical conditions.
As blood tests or X-rays do not detect fibromyalgia, and biopsies of muscles taken from the affected areas have also not proven to be useful, diagnosis of the disease must be made on information gathered from physical examination and through a careful study of the patient's history. Diagnosis also involves the elimination of other disorders as a cause of the pain, including hypothyroidism, hypercalcemia, parathyroid disease, polymyositis, Paget's disease, cancer and such infectious diseases as AIDS, hepatitis and Epstein Barr virus. Significantly, fibromyalgia normally results in pain in 11 out of 18 classic tender points. Another tell-tale indication of the disease is the absence of swelling or inflammation accompanying the pain.
The treatment of fibromyalgia should include input from the family doctor as well as a general internist, physical therapist, rheumatologist and other health care providers. A change in the patient's lifestyle, which will normally involve diet, exercise and taking steps to assure adequate sleep, will also be recommended. It is equally important for patients to reduce their stress levels. Specific medications used in the treatment of the disease include analgesics to reduce pain and stiffness; such Nonsteroidal anti-inflammatory drugs as aspirin, Ibuprofen and naproxen; muscle relaxants; anti-seizure medication; tricyclic antidepressants, which can treat depression often associated with fibromyalgia, and newer classes of antidepressants that can reduce pain by regulating brain chemicals. Pregabalin is the first drug approved by the Food and Drug Administration for the treatment of fibromyalgia.
Alternative medical treatments have also been effective in dealing with the disease, including acupuncture and biofeedback. Colon cleansing(colonic irrigation) has been advocated by some afflicted with the diease, as it can remove toxins in the body that may be associated with fibromyalgia. But no matter what it is, any treatment should ideally use a "team" approach involving not only medical experts but also community hospital support groups and local chapters of the Arthritis Foundation.