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| What
is fibromyalgia? | What fibromyalgia is | What
fibromyalgia is not |
| Common sites of pain/tenderness | What causes . . . ? | What can be done for . . . ? |
| Treatment
Options | Medications | Exercise |
Relaxation Techniques |
| Educational Resources | Guaifenesin
| Pain Glossary |
|
|
| Fibromyalgia
(aka
- FMS) originally named fibrositis, is a mysteriously debilitating syndrome that attacks
women more often than men. It is not physically damaging to the body in any way, but is
characterized by the constant presence of widespread pain that often moves about the
body.
Fibromyalgia can be so severe that it is often incapacitating. Fibromyalgia is a condition that causes pain in muscles, joints,
ligaments and tendons. The dots in the picture at the right represent tender points found
in Fibromyalgia patients. These points are often the foundation of the doctors diagnosis. |
Fibromyalgia
Pain/Tenderness Points
 |
What is
Fibromyalgia?
Fibromyalgia, is a mysteriously debilitating syndrome. It is not
physically damaging to the body in any way, but is characterized by the constant presence
of widespread pain so severe that it is often incapacitating. Other symptoms include, but
are not limited to; chronic muscle pain, aching, stiffness, disturbed sleep, depression,
and fatigue. It is estimated that three to six million people are afflicted in the United
States alone.
The condition mainly affects women aged 25 to 50 years and bears a striking resemblance to
Chronic Fatigue Syndrome. Unfortunately, no one laboratory test or X-ray can diagnose
fibromyalgia, however, research has revealed that upon a physical examination: the
presence of 18 specific points in muscles, tendons or bones are tender and painful to the
touch. These tender points can be used to distinguish fibromyalgia from other painful
joint and muscle conditions. The identifying criteria for diagnosing fibromyalgia is pain
or tenderness experienced in at least 11 of the 18 points. These tender points can range
from mildly irritating to completely debilitating. Roughly 75% of CFS-diagnosed patients
will meet the FMS criteria. As a person who suffers from FMS, you may have some degree of
constant pain but the severity may vary. You may have a deep ache or a burning pain,
muscle tightening or spasms. Most people with fibromyalgia feel tired or out of energy.
They are sensitive to odors, bright lights, loud noises and even medicines. Headaches and
jaw pain are also common.
|
What
FMS IS!
 | In the brain
|
| A
neurosomatic disorder
|
| A
dysfunctional spectrum syndrome
|
| A
pain modulation disorder
|
| A
chronic (often) debilitating condition of unknown etiology
|
| Most
probably caused by different factors |
|
What
FMS is NOT!!
| A
(non inflammatory) rheumatic disease
|
| A
Musculoskeletal disorder
|
| A
psychiatric disorder
|
| A
psychosomatic disorder
|
| A
form of depression
|
| An
accident neurosis
|
| A
malingering behavior |
|
|
What Causes
Fibromyalgia?
The exact cause of Fibromyalgia is
unknown. Many different factors, alone or in combination may trigger this disorder. In
recent years, studies have shown that in FMS, the muscle is especially vulnerable to
decreased circulation and minor injury. Research has also looked at the role of certain
hormones or body chemicals that may alter pain, sleep, and mood.
What Can
be done?
One of the most effective treatments is low-impact aerobic
exercises. (Swimming, water exercise, stationary bicycling) You will probably want to
start out at a very low level of exercise (even five minutes a day every other day is
helpful) continue until you can increase the time to 20 or 30 minutes at least four times
a week. Avoid alcohol and caffeine as they can cause poor sleep quality.
|
|
|
PAIN
Pain becomes a part of your daily existence for patients of
Fibromyalgia. The Pain of Fibromyalgia (FMS) runs throughout the body. Patients describe
the pain as deep muscular burning, throbbing, shooting and stabbing. In a majority of
cases, the pain and stiffness are more severe in the mornings. To meet the diagnostic
criteria, patients must have widespread pain in all four quadrants of their body for a
minimum duration of three (3) months and at least 11 of the 18 specified tender points. These 18 sites cluster around the neck, shoulder, chest, hip,
knee and elbow regions. Also, check the Pain
Glossary for related terms. |
|
SLEEP
DISORDERS
Most FMS patients have an associated sleep disorder called the
alpha-EEG anomaly. Research has found that people with FMS could fall asleep without much
trouble, but their deep level (or stage 4) Sleep was constantly interrupted by bursts of
awake-like brain activity. Some FMS-diagnosed patients have been found to have other sleep
disorders, such as sleep apnea,, restless leg syndrome and teeth grinding. |
|
FATIGUE
Fatigue can be mild in some patients yet incapacitating in others.
The fatigue has often been described as "brain fatigue" in which patients feel
totally drained of energy. Many patients depict this situation by saying that they feel as
thought their arms and legs are tied to concrete blocks, and they have difficulty
concentrating. |
|
Educational
Resources |
CHRONIC
HEADACHES
Recurrent migraine or tension type headaches are seen in about 50%
of FMS patients. |
|
IRRITABLE BOWEL SYNDROME
Constipation, diarrhea, frequent abdominal pain, abdominal gas and
nausea represent symptoms frequently found in roughly 40 to 70% of FMS patients. |
|
TMJ
Tempromandibular Joint Dysfunction Syndrome causes tremendous face
and head pain in one quarter of FMS patients. Most of the problems associated with this
condition are thought to be related to the muscles and ligaments surrounding the joint and
not necessarily the joint itself. |
|
Treatment
Options for people who suffer from Fibromyalgia
Generally, treatment is geared towards
improving the quality of sleep, as well as reducing pain. Why sleep? Because stage 4 sleep
(the deepest level of sleep) is so critical for many body functions such as tissue repair,
antibody production, and the production of many hormones, neurotransmitters, and immune
system chemicals, the sleep disorders that frequently occur in FMS patients are thought to
be a major contributing factor to the symptoms of fibromyalgia. If you suffer from
fibromyalgia, you probably can't remember the last time that you slept through the entire
night, and woke up totally refreshed the next day.
|
|
Medications — (This information is presented for your
information only. It is not intended to replace advice from a qualified healthcare
professional.)
Medicines that boost your body's level
of serotonin—a neurotransmitter that modulates sleep, pain, and immune system
function—are often prescribed in low doses. Examples of drugs in this category would
include Elavil, Prozac, Flexeril, Sinequan, Paxil, Xanax and Klonopin. in addition,
Nonsteroidal, anti-inflammatory drugs (NSAIDS) like Ibuprofen may also be helpful.
Many patients also use other treatments such
as trigger point injections with lidocaine, physical therapy, acupuncture, acupressure,
relaxation and mind/body techniques, osteopathic or chiropractic manipulation, therapeutic
massage or a gentle exercise program.
Exercise— (This information is presented for your information only. It is not
intended to replace advice from a qualified healthcare professional.)
Daily gentle aerobic exercise is very
important. While patients who try to do too much exercise too soon or of the wrong type
will make themselves temporarily worse, most patients who don't begin a daily aerobic
exercise regimen will never notice much improvement in their fibromyalgia. Aerobic
exercise is defined as exercise that increases your heart rate for the duration of the
exercise period.
How To Tell If Exercise Intensity Is
Too Hard
There are a number of guidelines to help you exercise safely and conservatively. Here are
some good ones for you to follow:
| Exercise should not make you
huff and puff. You should be able to breathe comfortably AND carry on a conversation
without gasping for breath. This is called "The Talk Test." |
| Normal, easy breathing is
what should occur. There is a difference between "normal, exertional breathing"
and "shortness of breath." It is normal to breath a little harder while you are
exercising (walking, aerobic dance, etc.) than you do when you are sitting or lying—this is called
"Normal, exertional breathing." Normal, exertional breathing is simply that—breathing a little
harder than you do at rest because your body is doing something. However, it is NOT having
to gasp for breath! Huffing and puffing, having to gasp for breath, having difficulty
getting enough breath is called "Shortness of breath" and is a reason for you to
slow down or stop your activity until you can once again breathe normally. |
| Monitor discomfort or pain
throughout your body, and especially in your chest, neck, throat, arms, particularly the
left arm or jaw—all of the signs that signal angina, or heart pain. At the slightest hint
of angina, slow down—reduce the demand for oxygen to the heart muscle—and if the discomfort or
pain goes away within 30 seconds or so, you may continue at this slower speed. If it does
not go away, stop and allow yourself to recover. You may want to consider seeing your
physician to have your heart evaluated for Coronary Artery Disease. |
| If you can take your pulse,
or have a heart rate monitor, notice what your resting heart rate is prior to exercise.
During exercise your goal is to increase your heart rate 20 or 30 beats above that resting
rate. |
|
| For example: |
Resting
Heart Rate = 70 beats per minute. |
Add 20 to 30 beats
per minute to that for an exercise rate. |
In this example,
the Exercise Heart Rate would be 90 to 100 beats per minute. |
Your Exercise
Heart Rate will vary depending upon your Resting Heart Rate. |
|
|
Monitoring heart rate is not essential if
you will stay in touch with your body as suggested in the previous items. However, if you
find yourself to be one of those people whom must push harder and harder every day, if you
grew up with the "No Pain—No Gain" ethic, this heart rate method of
monitoring exercise intensity is more mechanical and less subjective than other methods
and may help slow you down to an appropriate activity level for someone who is interested
in a gentle aerobic exercise program.
| Remember—Do Less Than You
Think You Can. Have something left at the end of your exercise so you will feel
like coming back and doing it again tomorrow. This is not what your high school coach or
gym teacher told you. But you are probably not 18 anymore either—AND you have fibromyalgia.
Your body will not like you if you push to "Work through the pain," or "Go
for the burn." If you are in pain or discomfort you are doing too much and need to
slow down or quit until you have recovered. It is more important to do something regularly
for a longer period of time almost every day than it is to do something harder. If
you get to choose (You do!), do your activity longer instead of
harder. |
| Here
is something interesting for fibromyalgia patients. Exercise seems not to work
through conditioning of muscles but rather through a direct, possibly hormonal effect on
pain and sleep, which explains why you don't need to exercise painful muscles for the pain
in them to decrease. Daily exercise is essential. Patients who have been exercising
regularly and then miss a day usually find that their fibromyalgia symptoms are
significantly worse for the next day or two. |
| The kind
of exercise is unimportant. Just make sure to pick something that doesn't make you hurt
worse. It may take trying several different kinds before finding one or more types that
agree with you. Popular kinds include walking, a water exercise program, regular or
exercise bicycles, other exercise equipment, and "gentle" aerobic
dance. Jogging, vigorous aerobic dance, and weight lifting tend not to very good choices.
If your pain is mainly in your legs or back, exercise just your arms or try exercising in
the water. |
| While
many patients insist that they get plenty of exercise at work, doing housework, or in
their yard, it is rarely the right kind. Effective exercise must result in a sustained
elevation of the heart rate, and these incidental kinds of exercise are usually stop and
go and may instead increase your pain. You need to set aside a time specifically for daily
exercise. |
|
Particularly if you are out of shape, start out with just 3-5 minutes of exercise and
gradually increase as tolerated, shooting for twenty to thirty minutes. Take a few minutes
to stretch your muscles, then start out slowly, increasing to full speed after a minute or
two. Slow down again for the last minute or two and repeat the stretches. There are five
recommended stretches, each done for 20 seconds a side. They should be gentle and
painless. Hold onto a tree or post for support for #s 3-5: |
1. Shrug your shoulders in a circular
motion.
2. Reach your arm over your head and bend to the opposite side.
3. Bend forward with your legs straight.
4. Pull your foot towards your buttock while standing on the other leg.
5. With your feet flat on the ground and one foot ahead of the other, lean
forward,
bending just the front knee
| Exercise
is most effective if done in the late afternoon or early evening. If you absolutely can't
do it then, exercising earlier in the day is better than not exercising at all, but you
will probably need to exercise longer for the same effect. Don't exercise just before bed
as this may interfere with sleep. Some patients find that exercise provides an immediate
benefit, making them feel more alert and comfortable for several hours. If you experience
this effect, you may want to try exercising on awakening and at noon as well. Some
patients for whom this works may not need medication. AEROBICS CAN CONQUER FATIGUE! Aerobic
exercise can help patients suffering from chronic fatigue syndrome regain their energy,
researchers have claimed. |
| Dr Peter
White and colleagues at St. Bartholomew's Hospital in London said experiments on 66
volunteers showed aerobics helped sufferers reduce fatigue and feel better overall.
Exercise Summary
|
| Regular, almost
every day.
|
|
Comfortable intensity, not hard.
|
| Follow
the "Talk Test." You should be able to walk and talk without huffing and
puffing.
|
| Warm Up
AND Cool Down—you'll feel better and you'll be safer.
|
| Longer
is better than harder. |
Relaxation
Techniques - Mind/Body Applications— (This
information is presented for your information only. It is not intended to replace advice
from a qualified healthcare professional.)
Relaxation and stress management techniques are
effective for many people with fibromyalgia. These include:
| Eliciting the Relaxation
Response
|
| Yoga (gentle stretches
and breathing)
|
| Meditation
|
| Guided Imagery and
Progressive Muscular Relaxation
|
| Cognitive Restructuring |
Acute Pain is limited in duration, and the cause is usually
known. Chronic pain lasts longer than three months, and the cause is ill defined or
unknown. Think of Chronic Pain as a form of Chronic Stress. These techniques help reduce
the amount of stress the individual experiences, and therefore help in the management of
the chronic pain associated with fibromyalgia.
Chronic
Fatigue Syndrome
The term chronic fatigue syndrome (CFS) is used to classify a
variety of symptoms whose causes are not entirely clear. Once derided as 'yuppie flu', it
is now becoming accepted and recognized by many doctors as a physical disorder.
Diet And
Fibromyalgia— (This information is presented for your
information only. It is not intended to replace advice from a qualified healthcare
professional.)
-- From FIBROMYALGIA—NUTRITION
RESOURCE CENTER 1-800-229-3376
Fibromyalgia patients should eat a balanced, whole foods diet to
provide the body with the nutrients it needs to function well and to replace the nutrients
that are depleted on a daily basis. Many of those with Fibromyalgia are high sugar eaters,
and therefore every effort should be taken to minimize sugar intake as it an adversely
affects energy levels when taken excessively. Avoid acid-forming foods such as red meats,
caffeine and carbonated drinks. Saturated fats found in refined foods should be reduced.
Try eliminating common food allergens such as milk, corn, wheat, eggs, and nightshade
vegetables such as tomatoes, potatoes, pepper and eggplant.
Adequate protein is also important because it is used for tissue repair, in particular
ligaments and tendons which are largely protein. Protein deficiency occurs in the diet
when it is deficient in food containing the essential amino acids, or from an inability to
digest food properly.
Sufficient Essential Fatty Acid in the diet also appears to be important, especially if it
contains Gamma Linolenic Acid or GLA. In a study of 63 patients with post-viral fatigue,
and myalgia, Essential Fatty Acid supplementation resulted in improvement in 74% of
patients after 1 month and 85% after 3 months. ADRENAL SUPPORT FOR FATIGUE, PAIN, AND
STRESS. In a recent two year study of 12 Fibromyalgia patients, there was "remarkable
improvement" after DHEA (Dehydroepiandosterone) was added to their program. Prior to
this study plasma levels of DHEA were tested on the patients revealing low levels of DHEA.
DHEA is a steroid hormone that is produced naturally by the adrenal glands. Some
researchers call it "the mother hormone," because it is a metabolic precursor of
all other steroid hormones, including estrogen, testosterone, and cortisone. When DHEA
levels are low, the body is susceptible to disease and other age-related effects. When
DHEA levels are high, the body is at its youthful peak; vibrant, healthy, and able to
combat diseases effectively. Stress, anxiety, chronic pain and aging can cause the levels
of DHEA to drop dramatically.
Patients in the 2 year study were given between 25 and 50 mg of DHEA. All 12 patients
reported a decrease in pain and stiffness, and an increase in energy.
|
|
Educational
Resources
Education and self-care are your best bet in the treatment of fibromyalgia. There are a
number of fibromyalgia support groups around the country. They can be contacted through
your local branch of The Arthritis Foundation.
A number of resources are also
available on the Internet. Here is a place to get you started:
• Fibromyalgia and CFS Basics
• Fibromyalgia Network Article
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And here are several books that
may prove useful.
 |
• "Fibromyalgia & Chronic Myofascial
Pain Syndrome: A Survival Manual"
by Devin J. Starlanyl and Mary Ellen Copeland,
New Harbinger Pubns, 1996,
ISBN 1-572-24046-6
"My
Fibro patients all tell me this is the most helpful book they have ever
used."
Dr. Gary Flegal
|
• "Relax & Renew: Restful Yoga For
Stressful Times"
by Judith Lasater, Ph.D., P.T.,
Rodmell Press, Berkeley, California, 1995,
ISBN 0-9627138-4-8 |
 |
Ever heard of Guaifenesin?
Order the book here! |
• "What
Your Doctor May NOT Tell you about Fibromyalgia: The Revolutionary
Treatment that can Reverse the Disease"
by R. Paul St. Amand, M.D. and Claudia Craig Marek
Warner Books, 1999
ISBN 0-446-67512-1
Sources
for Guaifenesin by Dr. R. Paul St. Armand
This link is included strictly as informational, and is not intended
to suggest that patients should self-treat. Medication should be used only
under physician treatment. To find a physician who uses the Graifenesin
Protocol in your area, click
here.
|
• "Yoga Over 50: The Way to Vitality, Health and
Energy in the Prime of Life"
by Mary Stewart,
Simon & Schuster, Inc., New York, NY, 1994,
ISBN 0-671-88510-3 |
 |
 |
• "Managing Pain Before It Manages You"
by Margaret A. Caudill, M.D., Ph.D.,
The Guilford Press, New York,
NY, 1995,
ISBN 0-89862-224-7 |
• "Pain Erasure : The Bonnie Prudden Way"
by Bonnie Prudden,
Ballantine Books, 1980
ISBN 0-345-33102-8. |
 |
 |
• "The Wellness Book: The Comprehensive Guide to Maintaining Health and
Treating Stress-Related Illness"
by Herbert Benson,
M.D. and Eileen M. Stuart, R.N., C., M.S.,
Simon & Schuster, Inc., New York, NY, 1992,
ISBN 0-671-79750-6 |
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Click
Here to download a printable copy of the information on this Fibromyalgia
webpage -
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Reader to read or print this downloadable page. |
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