What is FM?

The main features of FM are severe and wide-spread pains in the muscles, most prominent in the neck and shoulders, strong fatigue and, in most cases, difficulty sleeping. Fibromyalgia may give up an impression of joint pain, but the pain actually appears in adjacent muscles connected by ligaments and tendons. The FM-caused pains and other symptoms may last from years - even a whole lifetime - however, their intensity may vary from day to day. Both the lack of, and unadjusted physical activity may worsen the symptoms, and so can insomnia, a higher degree of moisture in the atmosphere and stress. Alongside widespread persistent pain, fatigue and lack of sleep, people suffering from FM also complain about may other problems including:

• irritable bowel syndrome (appears in up to 50 percent of cases)
• tension-type headache
• problems with concentrating and memory
• feeling of swollen hands, without the examination confirming it
• heart palpitations
• depression

What causes FM?

One of the most frustrating aspects of FM to patients, their families and doctors is the non-existence of any apparent cause or groups of causes of the condition. FM can in fact be a result of complex interaction of a large number of different physiological and psychological factors. Experts have suggested several theoretical causes of FM:

Hereditary factors or the appearance of the condition in the family

- Research has shown that family members of patients suffering from FM suffer from pain, depression or alcoholism more often than other people. Also, FM appears more often in relatives of the patient's than in other people, which is not surprising.

The factor of stress

Most scientists agree that stress is a key factor in FM. Research shows that patients suffering from FM complain of high levels of stress, which are higher than in, for example, patients suffering from rheumatoid arthritis or the rest of the population not suffering from FM. A recent research including patients suffering from FM has proven that they are under much heavier psychological pressure, are more sensitive to pain and complain more on physical difficulties. What is still unclear is whether stress causes FM or if it is merely a consequence of a life with a difficult and crippling disease.

A real problem

Even if stress does cause FM, the condition is in no case just "in the head", as some skeptics claim it to be, but it is an actual medical problem. Holistic research during the last decade show that emotional stress may cause big changes which unfavorably affect the nervous and immune system and hormone levels in the body.

High levels of substance P

It has been found that substance P, which is chemically responsible of alerting the nervous system in the case of a painful tissue injury, is found in higher levels in the cerebrospinal fluid of people suffering from fibromyalgia. In some people suffering from FM, the levels of substance P persistently show values 2 o 3 times higher than normal. In others, its levels gradually grow as the symptoms become more severe. Heightened levels of substance P, possibly caused by stress, may help with explaining the recent discovery that patients suffering from FM have a lower pain threshold (are more sensitive to pain) than people not suffering from the condition.

Injuries, accidents and traumas

Some people can determine their FM starting after relatively mild accidents such as a car crash where nothing besides the bumper was hurt. However, most experts believe that a small trauma may lead to a long-lasting effect on the muscles and other soft tissues in the body, which is what characterizes FM.

The delicate diagnosis of FM

Eighteen sensitive points are represented by nine pairs of points (eg. the inner side of both elbows) on the front and back side of the body, between the knees and neck. Firmly pressing the sensitive points will cause pain in anyone, but in people suffering from FM even mild pressure, just so that the nail becomes pale, can trigger excruciating pain. To make a diagnosis of fibromyalgia, the person must be painfully sensitive to at least 11 points. However, in practice experts believe that people with bone-muscle pains, who alongside that suffer from sleep disturbances which gives them no rest can be diagnosed for FM even when they painfully react to the stimulation of less than 11 sensitivity points.

How is FM diagnosed?

The unusual characteristic of FM is that the results of standard diagnostic tests such as, for example, blood tests or X-rays, look completely normal. That is why the diagnosis of FM must be made on the basis of a clinical examination. In 1190, after comparing patients suffering from FM with a control group of patients, the American College of Rheumatology gave doctors criteria to diagnose FM for use. Those criteria are also widely accepted in the UK. To be diagnosed for FM, patients must suffer from:

• wide-spread muscle pain present for at least three months
• pains present at applying pressure to at least 11 of the 18 "sensitivity points

What to do?

If you are like most people, maybe the diagnosis of Fm will actually be a relief. Some people spend years in search for an explanation for their symptoms, during which many doctor try to convince them that the problem is "in their head".

Emphasize the positive side

The good news for people suffering from fibromyalgia is that it does not cause damage to the joints. Even though you may experience pain all over your body and alongside that be fatigued, FM will not cripple you. On the other side, FM is often long-lasting, sometimes it can last your whole life, although the strength of the pain and fatigue may rise and fall during the years. One of the key components helping to cope with FM easier is overpowering the sleep disturbances which attribute to the fatigue caused by FM, and which is sometimes crippling.

How is FM treated?

Since the cause of FM is not known, treatment is focused on alleviating its symptoms, which is not at all an easy task. For example, the drugs that are successful in reducing pain connected to many types of arthritis-related problems (ibuprofen and other NSAR drugs) are especially inefficient against pain caused by fibromyalgia. Difficulties in finding an efficient treatment often only strengthen the frustration whose victim are many patients suffering from the condition.

Physical exercise

Even though no method of treatment has proven to be fully efficient against FM, it seems that doctors who had treated many FM patients agree that aerobic exercise should be a component part of all treatment programs. Aerobic exercise improves the quality of sleep, which is almost always of poor quality in patients suffering from FM, and better sleep helps reduce severe fatigue which is a companion of FM. Research subsequently shows that aerobic exercise helps relieve muscle pain and sensitivity among patients suffering from FM. Many fibromyalgia patients have come to a conclusion that the best way to relieve the symptoms is a combination of different methods of treatment. Some research from the US have, for example, shown that combinations of magnesium and malic acid, L-carnitine and the co-enzyme Q-10, when taken together with a strong preparation of multivitamins and antioxidants, may help patients suffering from FM. Other methods of treating FM include:

Low doses of antidepressants

These tricyclic drugs like amitryptiline and SIPPS, like fluoxetine hydrochloride, are given mostly to improve sleep quality and to relax the muscles, not for depression. It seems that both types of drugs have a physiological influence on the nervous system which can explain the reduced fatigue and more refreshing sleep in people suffering from FM. It has generally been proven for drugs that improve sleep quality to be the most useful in treating fibromyalgia.

NSAR drugs

These anti-pain medication have not usually shown satisfying results in clinical trials including patients suffering from FM. However, it is possible for some people suffering from the condition to have some benefits from their use.

Products for local application

It seems that the application of cremes which contain capsaicin, a compound extracted from chili peppers, helps some people suffering from FM in painful places, because capsaicin lowers the levels of substance P in sensitive nerve endings. The levels of substance P are often heightened in patients suffering from fibromyalgia and are connected to their lowered pain threshold. However, it is possible that two or three weeks are needed for the development of these favorable results. In the meantime the patient may be affected by temporary side effects, such as skin redness and irritability.

Acupuncture

This ancient method of treatment is promising at treating several bone-muscle problems, including FM. In one research, published in 1992 in the British Medical Journal magazine, 70 patients suffering from FM were randomly succumbed to 6 treatments of electroacupuncture (the current passing through the needles), or surface "pricking". At the end of the treatment program, patients treated by real acupuncture had felt significantly more pain relief than patients given "false" acupuncture.

A tactical guide to fight fibromyalgia: what else you can do

- Eat several smaller meals during the day as to keep the body's supply of proteins and carbohydrates, needed for normal muscle activity, balanced.

- Give yourself hot baths or have hot water showers, especially in the morning. In that way you will relieve the pains, improve circulation and alleviate stiffness.

- Find a massage therapist familiar with fibromyalgia. The "trigger-point" technique many significantly help with reducing the pain.

- Reduce your caffeine, alcohol and sugar intake, which often cause fatigue. Try to get at least 8 hours of sleep every night - aerobic exercise and certain antidepressants can improve sleep quality.

Living with fibromyalgia

Sometimes it is easier to suffer from a condition which has specific features than from a condition like FM, which is usually followed by very subjective symptoms, pains and fatigue. People suffering from FM must often fight suspicious doctors and family members who have doubts about the truthfulness of the difficulties.

Practical gain

Due to those and other reasons, including the non-existence of a completely successful method of treatment, FM is sometimes especially difficult to deal with, but it is also a condition which can largely be helped by the approach of co-living which is exposed in this book. Research consistently shows that by taking responsibility for one's own life - believing in one's own ability to keep the condition under control and overcoming the symptoms - the patients suffering from FM can improve their mood, reduce the pain and more easily bear the pain that keeps troubling them.

Source: Excerpt from book "Living with Arthritis"