Fibromyalgia Syndrome and Its Treatment

Fibromyalgia (often abbreviated to FM) is a common condition (affecting 3.4% of women and 0.5% of men).  Fibromyalgia literally means “muscle fibre pain”.

The main symptoms of fibromyalgia are aches all over the body, fatigue and poor sleep.

Fibromyalgia patients have pain or tenderness in specific tender points.  Eighteen tender points are defined by the American College of Rheumatology.  These points are generally located near tendons.  Pain (to light pressure) in at least 11 of the eighteen points is generally considered diagnostic for fibromyalgia.

Fibromyalgia Tender Points

Muscle tenderness, soreness and spasms are common in fibromyalgia as are neck tension headaches and migraines.  Temperomandibular joint (TMJ) disorder, a painful condition involving the jaw, affects about a quarter of fibromyalgia patients.

More than half of fibromyalgia patients also suffer from irritable bowel syndrome (IBS) which causes diarrhoea and abdominal cramps.

The majority of fibromyalgia patients have difficulty sleeping, with the quality of sleep being poor and the patient feeling tired and achy in the morning.  Many fibromyalgia patients report problems with memory and reasoning skills, along with lowered mood.

In spite of a more standardised approach to diagnosis in recent years, fibromyalgia can still be difficult for doctors to diagnose.  Although there is pain in joints and muscles, laboratory tests generally come back negative, and rarely is physical damage or inflammation detected in affected tissues.  There is an overlap of symptoms with fibromyalgia, chronic fatigue syndrome, depression, sleep disorder and digestive problems, so that the patient often endures a frustrating series of tests and medical visits without much apparent progress.

Yet extensive recent research has improved our understanding of fibromyalgia and there are many practical steps now recognised to assist fibromyalgia sufferers.

What is the Current Understanding on the Cause of Fibromyalgia?
Current research indicates a central pain sensitisation mechanism for fibromyalgia.  This means that nerves processing pain signals become super sensitive and “amplify” the signals to an excessive degree.  A recent study (Petzke, University of Cologne) showed that fibromyalgia patients were more sensitive to both pressure and heat stimuli than non sufferers.  This mechanism also explains why pain without inflammation or obvious tissue damage occurs.

Sleep problems also appear to have a major link with fibromyalgia.  The deepest phase of sleep, known as delta phase, also corresponds with the secretion of growth hormone from the pituitary gland in the brain.  Along with normal growth in children, growth hormone is necessary for the repair of muscle damage, including the microscopic damage done to muscles on a daily basis.  Sleep studies done on fibromyalgia patients have shown that in 90% of cases the delta phase of sleep does not occur properly.  This means that the deepest phase of sleep is not achieved, and very little growth hormone is released.  The result is aching, unrepaired muscles and a light, non refreshing sleep.

Additionally, in a recent study by Groneman, it was shown that fibromyalgia patients had significantly less collagen within their muscles than non-fibromyalgia patients.  This lack of collagen many expose muscle to micro-injury.  Note that muscle micro-injury would not be detectable during a routine medical examination.

It appears that the digestive system also has important involvement with fibromyalgia.  The pain sensitisation mechanism mentioned previously, which involves an imbalance of neurotransmitters (the chemical messengers between nerve cells) may in part be caused by a lack of absorption of certain nutrients.  For example, fibromyalgics have been shown to be deficient in the amino acid tryptophan.  Tryptophan is converted in the body to serotonin, a neurotransmitter important in producing sleep and in decreasing pain signals.  Other amino acids such as alanine, histidine and lysine have also been found in lower than normal levels in the blood supply of fibromyalgics.

It appears that fibromyalgia patients do not absorb amino acids well.  Vitamins may also not be well absorbed.

There are many other theories being put forward regarding possible causes for fibromyalgia, including altered phosphate metabolism, resistance to thyroid hormone, a viral cause, etc., but the key points on the cause of fibromyalgia appear to be:

     1.      Genetic link.  Fibromyalgia is well known to run in families.  Low levels
              of serotonin can explain many of the problems of fibromyalgia.

     2.      Poor sleep/microscopic muscle damage.

     3.      Nerves processing pain signals become over sensitive.

Digestive problems may reduce the absorption of key nutrients.  In a study by Aaron (University of Washington) 77% of fibromyalgics reported also suffering from Irritable Bowel Syndrome.