Fibromyalgia

Fibromyalgia Symptoms

Pain is the most prominent symptom of fibromyalgia. It is generally felt all over, although it may start in one region, such as the neck and shoulders, and seems to spread over a period of time. Fibromyalgia pain has been described in a variety of ways including: burning, radiating, gnawing, sore, stiff, and aching. It often varies according to time of the day, activity level, weather, sleep patterns, and stress. Most people with fibromyalgia say that some degree of pain is always present. They sense that the pain is mainly in their muscles and often note that fibromyalgia feels like a persistent flu. For some people with fibromyalgia the pain may be quite severe.

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Although the general physical examination is usually normal, and individuals may look well, a careful examination of their muscles will demonstrate tender areas at specific locations.

Fatigue and Sleep Disturbances

About 90 percent of people with fibromyalgia describe moderate or severe fatigue with lack of energy, decreased exercise endurance, or the kind of exhaustion felt with the flu or with lack of sleep. Often the fatigue is more of a problem and more troubling than the pain. Generally, people with fibromyalgia wake up feeling tired, even after sleeping throughout the night. They may be aware that their sleep has become lighter and that they wake up during the night. Scientific studies have demonstrated that most people with fibromyalgia have an abnormal sleep pattern, especially an interruption in their deep sleep.

The fatigue in fibromyalgia is similar to that in another condition called chronic fatigue syndrome (CFS). Some people with fibromyalgia have symptoms of CFS, and vice versa. For example, many people with CFS have the tender points and symptoms considered to be diagnostic of fibromyalgia. Because there is an overlap in these two common syndromes, it may not be possible to separate these two conditions, and one doctor may give a diagnosis of fibromyalgia whereas another may call the same condition chronic fatigue syndrome.

Nervous System Symptoms

Changes in mood and thinking are common in fibromyalgia. Many individuals feel “blue” or “down,” although only about 25 percent are truly depressed. Some people also feel very anxious. Generally, the depression and anxiety seem to follow the onset of fibromyalgia symptoms and may be the result of the fibromyalgia rather than a cause of it.

As with other chronic illnesses, people with fibromyalgia may report difficulty concentrating or performing simple mental tasks. There is no evidence that these problems become more serious. Similar problems have been noted in many people with sleep disturbances of all kinds or with mood changes.

People with fibromyalgia may have feelings of numbness and tingling in their hands, arms, feet, legs, or sometimes in their face. These feelings can suggest other disorders such as carpal tunnel syndrome, neuritis, or even multiple sclerosis. Therefore, people with fibromyalgia often undergo numerous tests for such conditions, only to find that the test results are normal.

Other Problems

Headaches, especially muscular (tension) and migraine headaches, are common in fibromyalgia. Abdominal pain, bloating, and alternating constipation and diarrhea are also common. This may resemble irritable bowel syndrome or “spastic colon.” Similar bladder spasms and irritability may cause urinary urgency or frequency. The skin and circulation are often sensitive to temperature and moisture changes, resulting in temporary changes in skin color.

Other conditions, such as low thyroid hormone (hypothyroidism), may mimic the symptoms of fibromyalgia. Because the complaints of fibromyalgia are so general and often bring to mind other medical disorders, many people undergo complicated and often repeated evaluations before the condition is diagnosed.

Fibromyalgia may be triggered by a variety of stresses-such as an illness, physical trauma, emotional trauma, or hormonal changes. These stresses may precipitate the generalized pain, fatigue, sleep, and mood problems that characterize fibromyalgia. Physical or emotional trauma could precipitate fibromyalgia in a number of ways. For example, a physical trauma such as having an infection or flu could lead to certain hormonal or chemical changes that promote pain and worsen sleep. In addition, people with fibromyalgia may become inactive, depressed, and anxious about their health, further aggravating the disorder. Smoking and inappropriate exercise or poor posture may aggravate fibromyalgia.

Currently, treatment of fibromyalgia includes:

  • non-narcotic medications that diminish pain and improve sleep
  • exercise programs that involve muscle stretching and improve cardiovascular fitness
  • relaxation techniques and other measures to help you relax tense muscles
  • educational programs to help you cope with fibromyalgia

As with most chronic illnesses, the treatment should be tailored to meet your individual needs. Some people with fibromyalgia have mild symptoms and need very little treatment once they understand what fibromyalgia is and what worsens their condition. Most people do benefit from a comprehensive care program.

Medications

The anti-inflammatory medications used to treat arthritis and many rheumatic conditions do not have a major effect in fibromyalgia. However, modest doses of aspirin, ibuprofen, or acetaminophen may help to provide some pain relief and lessen stiffness. Narcotic pain relievers, tranquilizers, and cortisone derivatives have been shown to be ineffective and should be avoided because of their potential side effects.

Medications that promote deeper sleep and also relax muscles help many people with fibromyalgia. These include amitriptyline (Elavil), doxepin (Sinequan), cyclobenzaprine (Flexeril), and related medications. Although these medications are also used to treat depression, in people with fibromyalgia they are generally used in very low doses and only at bedtime. Thus, they are not specifically used as antidepressants or tranquilizers in the treatment of fibromyalgia but may relieve pain and improve sleep.

Although many people sleep better and have less discomfort when they take these medications, the improvement varies greatly from person to person. In addition, the medications may have side effects such as daytime drowsiness, constipation, dry mouth, and increased appetite. These side effects are rarely severe, but can be disturbing and may limit the use of these drugs. Therefore, a number of different medicines may need to be tried and doses adjusted in consultation with a doctor.

Two principles of treating fibromyalgia are to increase cardiovascular (aerobic) fitness and to stretch and mobilize tight, sore muscles. You may be reluctant to exercise if you are already in pain and feel tired. Low or non-impact aerobic exercises such as brisk walking, biking, swimming, or water aerobics are generally the best way to start such a program. Exercise on a regular basis, such as every other day, and gradually increase to reach a better level of fitness.

Gently stretch your muscles and move your joints through an adequate range of motion daily and before and after aerobic exercise. Physical therapy may be helpful and could include techniques such as: heat, ice, massage, whirlpool, ultrasound, and electrical stimulation to help control pain. Physical therapists may also be consulted to design a specific exercise program to improve posture, flexibility, and fitness.

Often people with fibromyalgia have undergone many tests and have seen many different specialists while in search of an answer. This leads to fear and frustration, which may increase the pain. People with fibromyalgia are often told that since they look well and their tests are normal, they are not suffering from a real disorder. Their family and friends, as well as physicians, may doubt the reality of their complaints, increasing their feelings of isolation, guilt, and anger.

You and your family should understand that fibromyalgia is definitely associated with chronic pain and fatigue and must be dealt with as with any chronic illness. Yet, fibromyalgia is not life-threatening and causes no deformity. Although symptoms may vary, the overall condition rarely worsens over time.

Often just knowing fibromyalgia is not a progressive, crippling disease allows people to stop additional expensive testing and develop a more positive attitude toward their condition. Relaxation techniques, such as meditation, visual imagery, progressive muscle relaxation, yoga, or biofeedback may also be helpful. You should examine your own sleep patterns and avoid aggravating factors such as excess caffeine and alcohol. If you feel depressed or very anxious, it is important to get help from a mental health professional. The more you learn about your condition, and the more you take an active role in finding the best means to lessen your symptoms, the better the outcome.

Support groups and educational classes organized by the Arthritis Foundation have been a source of help for many people with fibromyalgia. Just knowing that you are not alone can be a source of support.

Some people with fibromyalgia have such severe symptoms that they are unable to function well at work or socially. These individuals may require greater attention in a program that employs physical or occupational therapists, medical social workers, specially trained nurses, mental health professionals, rehabilitation counselors, and sleep specialists.

Adapted from the pamphlet originally prepared for the Arthritis Foundation by Don L. Goldenberg, M.D. This material is protected by copyright.

Nutritional supplements

The combination of magnesium and malic acid helps to increase energy. These nutrients are precursors to the Krebs cycle, a series of enzyme reactions that are a key part of the production of energy on the cellular level. Take 100 to 200 milligrams of magnesium and 400 to 800 milligrams of malic acid three times a day, twenty minutes before each meal. (Some professional recommend up to 500 milligrams of magnesium and 2,000 milligrams of malic acid.) With the extra malic acid and magnesium, fibromyalgia sufferers can handle exercise and still get out and about the next day. The combination magnesium and malic acid may also be helping the bodies handle physiologic stress better. (Caution: People with heart or kidney problems should check with their doctors before taking supplemental magnesium.)

Antioxidants help reduce free-radical damage and fight inflammation. Take a good antioxidant formula that provides daily:

  • 5,000 to 10,000 International Units of vitamin A
  • Up to 10,000 milligrams of buffered vitamin C
  • 400 to 800 international units of vitamin E
  • 200 micrograms of selenium.

This is called ACES therapy and is a very good combination of vitamins and nutrients. Vitamins A, C and E are called antioxidants. They are useful to combat free- radical damage at the cellular level. Vitamin E, in particular, improves circulation and reduces muscle pain.

Note: If you are pregnant, or intend to get pregnant, or if you have liver disease, consult your doctor before taking supplemental vitamin A. If you have high blood pressure, limit your intake of supplemental vitamin E to a total of 400 International Units daily, and if you are taking an anticoagulant (blood thinner), consult your physician before taking supplemental vitamin E.

S-adenosylmethionine (SAM or SAM-e) is an amino acid derivative that has been shown in clinical trials to reduce the number of trigger points and areas of pain, lessen pain and fatigue, and improve mood. Take 400 milligrams two or three times daily. Be patient. It can take up to six weeks to see results.

Evening primrose oil is an excellent source of essential fatty acids, which act as natural anti-inflammatories in the body. By dealing with the inflammation, pain is reduced.

If emotional or physical stress is a source of problems, taking extra B vitamins will help the nerves and improve energy.

If fatigue is a problem, bee pollen or royal jelly supplements are safe and effective sources of energy which will not deplete the adrenal glands, but are building and supporting.

Calcium and magnesium are relaxing and improve muscle and nerve function.

Intramuscular injections of vitamin B12 and magnesium sulphate have been helpful against pain, insomnia and the low energy of fibromyalgia. Treatment is usually long-term, three to six months or more to stabilize, and often there are relapses.

DHEA has been used successfully in the treatment of many autoimmune disorders including multiple sclerosis, lupus and fibromyalgia. DHEA regulates the immune system and maintains the metabolic and structural integrity of the nervous system. DHEA has been shown to be antiviral and has benefited conditions as serious as HIV infection and AIDS.

Thymus glandular supports the immune system with grape seed extract and quercetin. Green foods should be added for optimal nutrition. Whey protein and creatine monohydrate support the musculoskeletal system in its repair process.

Bromelain helps reduce inflammation. Take 400 milligrams three times daily, between meals.

Coenzyme Q10 is also an antioxidant and helps deliver oxygen to cells. Take 60 milligrams twice daily, between meals.

Lipoic acid is very useful for enhancing the body’s utilization of carbohydrates and enhancing energy. Take 100 milligrams three times daily.

Nicotinamide adenine dinucleotide hydrogen (NADH) is an antioxidant enzyme that occurs in all living cells. It facilitates the production of neurotransmitters such as dopamine and noradrenaline. Low levels of neurotransmitters are often associated with fibromyalgia. Taking 15 milligrams one-half hour before breakfast and dinner often improves concentration, stamina, and energy.

Phosphatidylserine, a type of lipid, can be helpful if memory problems accompany fibromyalgia. It often yields rapid and impressive improvement in memory and mental alertness. Unfortunately, it is relatively expensive. Take 75 to 100 milligrams three times daily. (Gingko Biloba is a cheaper alternative.)

Nutrient Recommendations

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Important