What you need to know about Fibromyalgia

What is Fibromyalgia?

Fibromyalgia is characterized by muscloskeletal pain accompanied with fatigue, sleep disorder, memory and mood discrepancies. Symptoms can begin after physical/emotional traumas, surgeries, infection or psychological stress. Sometimes individuals see symptoms with no single triggering event. Statistically, more women develop fibromyalgia at higher rates than men. It is also commonly associated with tension headaches, TMJ (temporomandibular joint) disorders, IBS (irritable bowel disorder), anxiety and depression.

Fibromyalgia (FM) affects about 2-4% of the population. FM mainly affects women between ages 25-55 years. It does change daily functioning of human being in a profound way. The medical community has been struggling to understand this condition in a clear and organized fashion. It is not considered a disease and is generally called a disorder. It can be called a medical condition with predictable signs and symptoms and hence a clinical diagnosis of FM can be made. The goal of this newsletter is to give you a review of this condition because as the knowledge and understanding of this disease would change so that the diagnostic and treatment tools could also change in the hopes of helping more people.

Over time the researchers have studied FM from gross clinical presentations to biochemistry. The understanding of genes, genetic expressions, and intra-cellular enzyme/protein synthesis and biochemical reactions is increasing. The current awareness of the intracellular functions has helped develop and promote some thoughtful therapeutics. Hormones, vitamins and minerals have been the focus of co-existing medical conditions and therapeutics.

The environmental causes may be related to the types of foods we consume these days such as bleached flour or soft drinks. The genetic disposition for FM and environmental factors interact through the neuro-immuno-endocrine axis to eventually cause fibromyalgia. In simple terms, a genetic predisposition and environmental factors can produce neurological, immune and hormonal symptoms. The immune response to the processed foods in the digestive tract is thought to be a triggering mechanism which in predisposed individuals causes neuro-immuno-endocrine activation and perpetuation.

A detailed laboratory testing of the micronutrients helps with the specific micronutrient assessment and treatment is the best approach to treatment of this ailment. The micro nutritional therapy is generally very effective especially due to lack of any serious side effects. Some patients with FM have low levels of Magnesium and they show improvement in FM when 400-1200 mg of magnesium is added for a while based upon their medical condition. Others have low vitamin D which helps restore immune endocrine and nervous system and hence can be very effective in FM. The dose of vitamin-D is highly variable. Other micronutrients important in FM include Malic acid, Manganese and B-complex vitamins. The treatment can vary greatly between person to person based of the deficiencies in their diet, there genetic make up and where they live.

The proper utilization of alternative and complimentary therapeutics should be under the guidance of a professional. There are home remedies that can help manage daily symptoms effectively. The knowledge of the condition and recognition of its individual pattern by both, the patient and the treatment provider, is important. The patient should be invited to be an active participant in the treatment plan. The degree of the sense of empowerment in the patient determines the ultimate effectiveness of the treatment.

What are the symptoms of Fibromyalgia?

The onset of FM may be gradual or sudden. The symptoms may appear after some seemingly minor illness or after a known or unknown traumatic/stressful life situation. The person may not be aware of the psychological stress. The human body can react with stress hormones independent of the awareness of the physical or psychological symptoms of stress such as palpitations, headaches, insomnia, fear, panic or difficulty breathing. Clinical or highnormal levels of anxiety/stress as well as clinical depression are almost always associated with FM.

Symptoms include:

✦ Widespread and generalized muscle and joint pain and a decreased threshold for pain.

✦ Pain is aggravated by weather changes, cold, humidity, lack of sleep and increased stress.

✦ Heat, rest and mild aerobic exercise is helpful in alleviating the intensity of the symptoms.

✦ Multiple, localized tender points are present along the upper and lower back as well as in all the four limbs and the front of torso.

✦ Sleep disturbances include broken or non-refreshing sleep and increased daytime somnolence.

✦ No laboratory findings can be applied to everyone with FM. However, the general/specific metabolic assessment as revealed by the individual and family medical/psychiatric history can help individualize the metabolic findings and treatment options. Eventually an integrated treatment can be customized.

✦ Persistent fatigue and low energy level.

✦ Cognitive dysfunction includes impaired attention and sustained concentration, poor new learning and impaired recall of information.

✦ Many patients experience cognitive dysfunction called "brain fog" or "fibro fog”.

✦ In an acute flare-up there is lack of basic forces in the human body and mind which leads to poor functioning in all aspects of daily life. Some individuals may experience utter debilitation and total disability including basic self-care during flare-ups in the condition.

What can cause Fibromyalgia?

So far, there is not any clear causal relationship established for FM. However, there have been some associations found. Some factoids are as follows:

✦ It is believed that an increased level of muscle tissue breakdown may be a possible reason for aching, pain and muscle fatigue experienced commonly in fibromyalgia.

✦ Recent research has pointed out some changes in the brain that correlate with the symptoms and signs of FM. The involvement of the brain is clear. The brain areas are limbic system, hypothalamus, thalamus, pre-frontal cortex and parietal lobes.

✦ Increase in stress hormones in the body can occur due to chronic stress. The stressful stimuli trigger the adrenal glands and other endocrine glands via hypothalamic-pituitary axis. The secretion of stress hormones (glucocorticoids and catecholamines) typically lead to the stress related symptoms such as anxiety, panic, sleep disturbance, muscular tension and heightened autonomic changes. These changes over time may lead to loss of diurnal cortisol rhythm and absolute levels of cortisol throughout 24 hours. Hence a person may be in different phases of over or under production of cortisol hormone and may also experience different symptoms of over and under production of stress hormones. Fortunately the cortisol levels and its rhythm is a testable change in the laboratory to help guide proper treatment.

✦ Chronic stress is also known to alter sex hormones, glucose metabolism, thyroid hormones, distribution of body fat, and cardiovascular changes. There is altered utilization of different vitamins, minerals and micronutrients leading to altered metabolism presumably in every part of the body and brain (mind). The constitutional and environmental differences in individuals cause different patterns of metabolic insufficiencies or deficiencies.

✦ The neuro-chemical changes in the nervous system cause changes in the perception of pain and other sensations; and also changes in emotions, sleep, energy, cognition and motivational. The disturbances in stage 4 and REM parts of the sleep have been studied to be abnormal in FM in the sleep laboratory.

✦ A viral etiology has been proposed but has not been fully substantiated.

✦ The micronutrient deficiency is a newer concept that is gaining popularity. The understanding of genetics, genetic expressions and intracellular functions is increasing. The current awareness of the intracellular functions has helped develop and promote some hypotheses and postulates of FM. The FM patientsmay be deficient in certain compounds required for the synthesis of Adenosine Triphosphate (ATP). The ATP is a building block of energy in the human body. Magnesium is one of the crucial elements needed for ATP synthesis. Some patients with FM may have (relative or absolute) low levels of magnesium. Other important micronutrients in FM include Malic acid, Manganese and B-complex vitamins.

✦ The symptoms of sleep problems, depression and pain perception have overlapping neuroanatomy, neuro-hormones (melatonin, and cortisol) and neurochemicals (serotonin) in FM.

What are some treatment options?

Multimodal therapy: A combination of mild passive and active physical exercise, psychological strategies to manage stress, balanced nutrition, sleep hygiene and vitamin/micronutrient supplements.

Information: The effective treatment also requires getting educated about the condition and staying curious and well informed about it. As the knowledge about the condition increases so does the sense of empowerment to control the condition and life.

Psychological Treatments: Conventional therapies include behavior and cognitive therapies. They have the strongest evidential support for efficacy. The relaxation techniques are also helpful e.g. progressive muscle relaxation, visual imagery, self hypnosis, meditation, yoga, western Christian meditation or mindfulness. They can be learned from a psychologist, psychiatrist, or a clinical social worker. The local library may have educational material on these techniques. After the technique is learned, the practice can be done anywhere and everywhere.

Physical therapy: The key is to get involved in a light/low level aerobic exercise. You should start low and go slow to improve your chances at sustained success. Too aggressive a start generally makes the pain worse and may become a deterrent to the continuation of the program. The Aqua Therapy may be an attractive alternative. Warm water therapy is easier to tolerate as the water counters the gravitational forces and it is easier to move around. Light exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia.

Other Treatments:

✦ Applying heat to painful areas.

✦ Massage

✦ Acupuncture

✦ Electromagnetic field and Magneto therapy

✦ Transcranial magnetic stimulation

✦ Laser treatment

✦ Ultrasound heating and message

✦ TENS (Transcutaneous Electrical Nerve Stimulator)#

✦ Electromyographic biofeedback

✦ Infrared red light

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