Schuylkill County: Do you hurt all over, frequently feel exhausted, can’t seem to ever feel “rested” after a night’s sleep?  Do you feel like your brain is in a fog, and you failed to respond to any of the recommended medications from your family physician and no test seems to uncover anything specific?  If this sounds like you, it is possible that you are suffering from fibromyalgia (FM). 

FM can begin with a physical or an emotional event but does not have to; FM can seem to come out of nowhere, as well.  In the US, FM. affects about 2% of the population, mostly women (3.4%) and especially with increasing age. 

A Review of the Diagnosis and Symptoms of Fibromyalgia

When we consider the wide spectrum of signs and symptoms associated with Fibromyalgia Syndrome, it is important to understand that not everyone has all of these symptoms.  However, the first four symptoms must be present in order to have a diagnosis of Fibromyalgia Syndrome.

• Generalized body pain of three or more month’s duration.
• Widespread pain on both sides of the body, in areas above and below the waist
• Pain at 11 out of 18 predictable “tender points”  
• Sleep disturbance

Other symptoms may include:

• “Restless Leg” Syndrome
• Diffuse muscle and joint pain which increases with activity
• Fatigue often accompanied by a “hazy” or “foggy” sensation
• Inability to concentrate often leading to anxiety and frustration
• Numbness in various body regions (often transient).  
• Irritable bowel can be part of the syndrome as well as digestive problems.  
• Tension headaches and/or migraine headaches
• Temporomandibular joint (TMJ) syndrome

The 18 predictable “Tender Points” associated with Fibromyalgia are illustrated below.  These tender points are verified using approximately 4 kg of pressure.  There must be at least 11 out of 18 tender points present; otherwise, the patient does not have true FMS, according to the American College of Rheumatology guidelines.

• Back of the head
• Between shoulder blades
• Top of shoulders
• Front sides of neck
• Upper chest
• Outer elbows
• Upper hips
• Sides of hips
• Inner knees

Poor sleep quality is a serious attribute to FM, and one that has been in the spotlight of investigation when it comes to finding the cause.  In the past, medical treatment has been heavily focused on the problem of sleep disturbance, and therefore one of the treatments of choice thus far has been administration of sleeping medication to enhance quality of sleep.  Results have been somewhat favorable, but less than desirable in most cases.

New Reasearch Insights

Over the past few years, it is well accepted that generalized hypersensitivity is common in FM suffers.  It is as if they just cannot turn off their brain.  Their pain centers are stimulated too easily.

Central pain processing (activity in the brain and spinal cord) has been shown to differ in patients with FM compared to those without FM.  This is very complicated to explain but how the nervous system process painful or typical non-painful stimuli changes with FM.  It is almost that the brain and spinal cord of FM suffers amplify a painful and sub-painful stimulus so that the pain is felt more intensely.  The brain of FM suffers also fails to modulate or reduce pain signals. 

In a study using Functional Brain MRIs of FM patients, it was found that there was increased brain activity to low threshold stimulus.  This means that a stimulus that would not be considered painful by a normal functioning brain and spinal cord is very painful to a FM suffer.  Additionally, in this study when the painful stimulus was applied in the normal group there was increased activity in the brain at different areas that was not found with FM patients.  This additional activity is thought to be the activation of what is called the Descending Inhibitory Pathway, a built-in pain regulator/depressor.

In another study, a group of 168 FM patients, various tests were performed including an auditory brainstem response (ABR) which tests the cranial nerve that is responsible for our hearing and balance; a test that measures for eye movements primarily when sleeping; and, a third test that measures balance functions.  The following is a list of the results from the 168 patient study:

• 78% of the FM patients complained of dizziness or vertigo.  Most of these cases were mild, but 4% complained of constant, severe dizziness.
• Sensorineural hearing loss (hearing loss that comes from the inner ear) was found in 15% of the FM patients.
• 51 of the subjects (30%) had abnormal ABR test findings.
• 58% had abnormal eye movement tests, and
• 45% had abnormal findings on the balance test.

Some studies also report that similar symptoms are associated with whiplash-associated disorders and up to 22% of whiplash suffers develop FM.

FM patients were found to have low serum ferritin, magnesium, and zinc.  Serum IL-8 (a pro-inflammatory factor) was elevated but did return to normal in 6 months after multidisciplinary pain treatment.  This was interesting because anti-inflammatory meds, including steroids are not helpful for FM.

Oxidative stress also has a role to play.  A decreased level of a coenzyme was also found.  This coenzyme becomes depleted by the lipid lowering Statin drugs, the ones that can give you muscle pains.

Several studies failed to demonstrate any abnormalities in the muscles of FM patients.  There is some evidence that fascia (connective tissue between muscle) is the source of the abnormal pain stimulus.  It has been found that FM suffers have increased levels of inflammatory mediators in the fascia surrounding the muscle cells.  Under the microscope, the fascia looks similar to chronic plantar fasciitis and tennis elbow.  The appearance has been described as a dysfunctional healing response.

Current Treatment Recommedations

There have been several drugs approved for FM.  Some have shown long-term responses to pain, sleep, and quality of life.  All have reported significant side effects.  There is also evidence of a mixed opiate with acetaminophen being helpful.

There is strong evidence for mild cardiovascular exercise and cognitive behavioral therapy, stress reduction.  At Doctors’ Choice, we use gentle Cranial Electrical Stimulation (CES) to treat all the main symptoms of Fibromyalgia – widespread pain, insomnia, brain fog, anxiety, and depression that sometimes are present.  In medical studies, this treatment has been 90% effective.

CES works on the Central Nervous System helping regulate the neurological mechanisms that carry pain signaling.  It also reduces the production of stress hormones, which further reduces the pain experience.

There is moderate evidence supporting massage, muscle strength training, and acupuncture.

There is good antidotal evidence for certain nutritional/herbal supplements but not when used by themselves.

The best responses to FM treatment have been noted when combinations of therapies have been used.

At Doctors’ Choice Physical Medicine and Rehabilitation, we have a FM program that is unique in addressing the recommended therapies.  We are committed to help you or a loved one that is suffering with FM, and sharing this information may be one of most evident acts of kindness you can give.