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Fibromyalgia: New Insights Into a Misunderstood Ailment

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SATURDAY, Jan. 1 (HealthDay News) -- Fibromyalgia was once dismissed by many traditional medical practitioners as a phantom illness.

But that view is changing rapidly. Not only is fibromyalgia accepted as a diagnosable illness, it is also a syndrome that researchers are finding more complicated as new information emerges.

As recently as a year ago, many physicians still associated some of fibromyalgia's symptoms with emotional problems, but that's no longer the case.

A simple description of fibromyalgia is that it is a chronic syndrome characterized by widespread muscle pain and fatigue.

For still unknown reasons, people with fibromyalgia have increased sensitivity to pain that occurs in areas called their "tender points." Common ones are the front of the knees, the elbows, the hip joints, the neck and spine. People may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety and other symptoms.

According to the American College of Rheumatology, fibromyalgia affects 3 million to 6 million Americans, 80 percent to 90 percent of whom are women. The condition is most often diagnosed during middle age, but at least one of its symptoms appears earlier in life.

But is there a psychological tie-in strong enough to differentiate fibromyalgia from other similar diseases and conditions? Apparently not.

"Fibromyalgia patients are such a diverse group of patients, they cannot all be the same," said Dr. Thorsten Giesecke, a University of Michigan research fellow.

Giesecke and his colleagues evaluated 97 fibromyalgia patients, including 85 women and 12 men. The patients underwent a two-day series of tests, answering questions about their coping strategies and personality traits -- particularly their emotional well-being. They were also tested for sensitivity to pressure and pain.

"It's generally been thought that fibromyalgia patients who have higher distress have higher pain sensitivities," Giesecke said.

In other words, it was believed that those with fibromyalgia who were prone to emotional difficulties such as depression and anxiety were more likely to experience greater physical pain.

But his study didn't bear that out. In fact, patients in one of the three groups in the study who had the highest pain levels had the lowest anxiety.

The term fibromyalgia comes from the Latin word for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Tender points are specific locations on the body -- 18 points on the neck, shoulders, back, hips and upper and lower extremities -- where individuals with fibromyalgia feel pain in response to relatively slight pressure.

The U.S. government's National Institute of Arthritis and Musculoskeletal and Skin Diseases says fibromyalgia patients often experience combinations of many other chronic and frustrating symptoms, including:

  • sleep disturbances,
  • morning stiffness,
  • headaches,
  • irritable bowel syndrome,
  • painful menstrual periods,
  • numbness or tingling of the extremities,
  • restless leg syndrome,
  • temperature sensitivity,
  • cognitive and memory problems, sometimes referred to as "fibro fog."

Latest research indicates that fibromyalgia is the result of internal biochemical imbalances that cause physical symptoms such as pain, weakness and mental impairment. Because it is a syndrome -- a collection of signs and symptoms -- rather than a disease, fibromyalgia can't be diagnosed by an invariable set of specific symptoms or reproducible laboratory findings.

Even with the findings about relatively small psychological influence, practical experience seems to indicate that stress may play a role. Roger H. Murphree, a Birmingham, Ala., chiropractor who specializes in treating patients with fibromyalgia and chronic fatigue syndrome, said he has seen a link between stress and the intensity of fibromyalgia.

"Most of us live in a world of stress," Murphree said. "Something has to give, and it's usually sleep. Meanwhile, we subsist on junk food, caffeine, alcohol and prescription medications. Such a lifestyle isn't good for anyone. But for an unlucky few, the toll is severe."

Dr. Jacob Teitelbaum, whose practice in Annapolis, Md., led him to do research into fibromyalgia and the closely related chronic fatigue syndrome, concluded that the body's endocrine system could hold the clue to treatment. It's a matter of how the body's energy is marshaled, he said.

"Fibromyalgia is like the body blowing a fuse," he explained. "The hypothalamus serves as humans' internal fuse box. When the demands of living build up, stress increases and the hypothalamus shuts down. Because the circuit is overtaxed and the fuse is blown, the body simply can't generate enough energy."

"That causes muscles to cease functioning in a shortened position, resulting in pain all over the body and a general feeling of fatigue or weariness," Teitelbaum said.

Murphree's experience with hundreds of patients confirms Teitelbaum's analogy. Most, he said, are either "Type A" perfectionists or "Type B" caregivers.

"Type A fibromyalgia patients work and work and work until they burn out," said Murphree. "Type B patients give and give and give -- nurturing their spouses, children, family and friends -- until they break down. Anyone whose lifestyle includes very little downtime is at risk."

Teitelbaum recommends a four-pronged approach to repair the "blown fuse" and turn the body's current back on:

  • Restoration of sleep -- at a minimum, eight to nine hours every night, using appropriate medications, as needed;
  • Restoration of a normal hormone balance, including thyroid, adrenal and reproductive hormones;
  • Appropriate treatment for infections that may be present as a consequence of the body's depleted immune function;
  • Nutritional support, particularly with B complex vitamins, magnesium, zinc and malic acid.

Teitelbaum uses the acronym SHIN to summarize his treatment regimen. "S is for sleep, H for hormone balance, I for infection control, and N for nutrition," he explained. "The important thing is that all four should be implemented in concert with one another for maximum therapeutic effect."

More information

The National Institute of Arthritis and Musculoskeletal and Skin Diseases offers more information on fibromyalgia.

SOURCES: Thorsten Giesecke, M.D., research fellow, University of Michigan, Ann Arbor, Mich.; Roger H. Murphree, chiropractor, Birmingham, Ala.; Jacob Teitelbaum, M.D., director, Center for Effective CFIDS/Fibromyalgia Therapies, Annapolis, Md.; National Institute of Arthritis and Musculoskeletal and Skin Diseases; October 2003 Arthritis & Rheumatism
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