About Fibromyalgia Syndrome
Fibromyalgia syndrome (FMS) is an illness characterized by diffuse muscle pain, poor sleep, and unrelenting fatigue. Individuals with fibromyalgia may also experience headaches, anxiety, depression, poor memory, numbness and tingling in the extremities, cold hands and feet, irritable bowel syndrome, lowered immune function, and chemical sensitivities. Over 10 million Americans suffer with fibromyalgia; ninety percent of them are women between 25 and 45 years old.
Diagnostic tests are currently unavailable to confirm fibromyalgia. The diagnosis is usually reached after ruling out other conditions including neurological, autoimmune, endocrine, musculoskeletal, immunological, and mental disorders. Patients have typically had the illness at least 7 years and have been seen by a dozen different doctors before they’re diagnosed with fibromyalgia.
In 1990 The American College of Rheumatology (ACR) first proposed the current criteria for defining fibromyalgia syndrome. The criteria include a history of widespread pain lasting more than 3 months and the presence of at least 11, out of a possible 18, tender points. Pain is considered to be widespread when it affects all four quadrants of the body; that is, you must have pain in both your right and left sides as well as above and below the waist to be diagnosed with fibromyalgia.
The American College of Rheumatology first proposed the current criteria for defining FMS. The diagnosis requires that all three of the major criteria, and four or more of the minor criteria, be present:
1. Generalized aches or stiffness of at least three anatomical sites for at least three months
2. Six or more typical, reproducible tender points
3. Exclusion of other disorders that can cause similar symptoms
1. Generalized fatigue
2. Chronic headache
3. Sleep disturbance
4. Neurological and psychological complaints
5. Numbing or tingling sensations
6. Irritable bowel syndrome
7. Variation of symptoms in relation to activity, stress, and weather changes
It's reported that only 2% of the population meet all he criteria of the American College of Rheumatology. This estimate is much too low. There are some problems with the ACR criteria. The biggest being many individuals with FMS meet some of the criteria but not all of it. Most of these individuals have other symptoms associated with FMS not explicitly outlined in the ACR criteria. They may have insomnia, irritable bowel, fatigue, mental confusion, and only 4 of the 18 trigger points. Or they may have insomnia, fatigue and 5 reproducible tender points. Although the minor criteria represent the most frequent and usual symptoms associated with FMS, it doesn't account for all of the various conditions seen in FMS patients.
The following is a more detailed list of potential symptoms that patients may experience:
Sufferers may not feel refreshed, despite getting adequate amounts of sleep. They may also have difficulty falling asleep or staying asleep.
Body stiffness is present in most patients. Weather changes and remaining in one position for a long period of time contributes to the problem. Stiffness may also be present upon awakening.
Headaches and facial pain:
Headaches may be caused by associated tenderness in the neck and shoulder area or soft tissue around the temporomandibular joint (TMJ).
Irritable bowel syndrome including such symptoms as digestive disturbances, abdominal pain and bloating, constipation, and diarrhea may be present.
Irritable Bladder: An increase in urinary frequency and a greater urgency to urinate may be present.
Numbness or tingling: Known as parathesia, symptoms include a prickling or burning sensation in the extremities.
Chest Pain: Muscular pain at the point where the ribs meet the chest bone may occur.
The symptoms of cognitive disorders may vary from day to day. They can include "spaciness," memory lapses, difficulty concentrating, word mix-ups when speaking or writing, and clumsiness.
Sensitivities to light noise, odors, and weather are often present, as are allergic reactions to a variety of substances.
Difficulties in orientation may occur when standing, driving, or reading. Dizziness and balance problems may also be present.
What Causes Fibromyalgia?
Research suggests fibromyalgia may be the result of:
• Trauma, especially whiplash injuries. • Hypothalamus-pituitary-adrenal axis (HPA) dysfunction.
• Emotional/physical/mental stress. • Low thyroid function. • Low serotonin states.
• Adrenal dysfunction. • Chronic viral, mycoplasma, and or bacterial infections.
• Endocrine disorders. • Sleep disorders.
The truth is we really don’t know for sure what causes fibromyalgia.
What We Do Know
Fibromyalgia is now thought to arise from a miscommunication between the nerve impulses of the central nervous system. The neurons, which supply the brain, become more excitable, exaggerating the pain sensation. This over-amplification of pain is referred to as "central sensitization." Fibromyalgia patients have a reduction in their pain threshold (allodynia),
an increased response to painful stimuli (hyperalgesia) and an increase in the duration of pain after nociceptor stimulation (persistent pain). Individuals with fibromyalgia syndrome have low levels of serotonin, a 4-fold increase in nerve growth factor, and elevated levels of substance P. Nerve growth factor (NGF) is a member of a family of peptides known as the neurotrophins. The exposure of nociceptive sensory neurons to NGF leads to up-regulation of substance P in sensory neurons. Substance P, the neuropeptide in spinal fluid, is a neurotransmitter that is released when axons are stimulated. Increased levels of substance P increase the sensitivity of nerves to pain or heighten awareness of pain. Although it’s not fully understood, fibromyalgia patients have an imbalance of the hypothalamus-pituitary-adrenal (HPA) axis. This imbalance creates hormonal inconsistencies, which disrupt the body’s ability to maintain homeostasis.
Many of the most common fibromyalgia symptoms including widespread muscle pain, fatigue, poor sleep, gastrointestinal problems, and depression regularly occur in people with various neuroendocrine disorders, including those manifested by HPA dysfunction. Researchers believe suppression of the HPA (quite likely from chronic stress), which results in lowering human growth hormone (HGH), dehydroepiandrosterone (DHEA), cortisol, and other hormones, is aggravated by the chronic pain and poor sleep associated with fibromyalgia.
Hypothalamus-Pituitary-Adrenal Axis (HPA) Dysfunction
The main function of the hypothalamus is homeostasis, or maintaining the body's status quo. The hypothalamus receives and transmits messages from the nervous system and hormonally through the circulatory system. Because of its broad sphere of influence, the hypothalamus could be considered the body’s master computer. The hypothalamus receives continuous input about the state of the body and must be able to initiate compensatory changes if anything drifts out of line.
The Hypothalamus regulates such bodily functions as:
1. Blood pressure - is often low in those with fibromyalgia.
2. Digestion - bloating, gas, indigestion, and reflux are common in FMS patients.
4. Circadian rhythms (sleep/wake cycle) - which is consistently disrupted in FMS.
6. Sex drive - loss of libido is a common complaint for FMS patients.
7. Body temperature - is often low in FMS patients.
8. Balance and coordination- FMS patients have balance and coordination problems.
9. Heart rate - mitral valve prolapse (MVP) and heart arrhythmias are a common finding in FMS patients.
10. Sweating - it’s not unusual for FMS patients to experience excessive sweating.
11. Adrenal hormones - are consistently low in FMS patients.
12. Thyroid hormones and metabolism-hypothyroid is a common finding in FMS patients.
Recent studies show that over 43% of FMS patients have low thyroid function. It's estimated that those with FMS are 10 to 250,000 times more likely to suffer from thyroid dysfunction.
A Vicious Cycle
1. Chronic stress disrupts HPA homeostasis, leading to allodynia.
2. Chronic pain disrupts the circadian rhythm.
3. Dysfunction in the circadian rhythm results in poor sleep.
4. Poor sleep reduces growth hormone production, leading to poor repair of damaged muscle fibers, poor memory, fatigue, suppressed immune function, and more pain.
5. Increased pain further disrupts sleep and leads to depletion of stress coping chemicals including serotonin.
6. A reduction in serotonin causes an increase in the neurotransmitter, substance P.
Substance P enhances pain receptors, creating even more pain.
7. Poor sleep and ongoing stress lead to fatigue, mood disorders, IBS and may cause thyroid
8. Chronic stress contributes to adrenal fatigue, decreased DHEA, and lowered resistance to stress. Decreased stress coping abilities then lead to lowered immune function.
9. Lowered blood volume from adrenal dysfunction (and resultant hypo-tension) leads to further fatigue.
Stress and Fibromyalgia
A survey by The Fibromyalgia Network reports that 62% of their respondents list physical or emotional stress as the initiating factor in their acquiring fibromyalgia. I believe chronic stress is the underlying catalyst for the onset of HPA dysfunction and fibromyalgia. Several studies have demonstrated how chronic stress undermines the normal hypothalamic-pituitary-adrenal axis (HPA) function.
The Importance of a Good Night’s Sleep
Studies have shown that individuals who were prevented from going into deep sleep for a period of a week develop the same symptoms associated with FMS and CFS; diffuse pain, fatigue, depression, anxiety, irritability, stomach disturbances, and headaches. Sleep deprivation markedly increases inflammatory cytokines (pain causing chemicals)—by a whopping 40%.
Therefore, restoring deep restorative sleep is one of the most important steps in beating fibromyalgia, if not the most important step of all.
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