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Excerpt from The Fibromyalgia Relief Handbook
By Chet Cunningham
What is Fibromyalgia?
Fibromyalgia is a serious medical problem that involves some or all of the following symptoms: intense chronic muscle pain, fatigue, headaches, sleeping problems, joint pain, numbness and tingling, irritable bowel syndrome, problems with memory and concentration, sensitivity to cold, bladder complications, depression, and a swelling sensation of the hands.
Doctors don't know what causes it: therefore it is difficult to figure out how to cure it. They do have a short name though. They call it FibroMyalgia Syndrome, or FMS. We'll use the term as well.
These aches and pains can come almost anywhere in the body, and can include one or two or ten or twelve different areas. The pain is often what brings on other problems, especially the mental ones, and depression.
For many years, doctors had no idea what this group of problems actually was. Often FMS was passed off as a patient's imagination or just feeling "out of sorts." People who have X-rays and blood tests and other physical exams do not show any sign of what is causing the pain. It's there - and even ten years ago, doctors had no idea what was going on.
Today, some doctors still don't, so if you have fibromyalgia, be sure to find a doctor who knows about it and how to treat it.
This problem is not fatal, and most people are relieved to know what they have and that it isn't some serious bone cancer or other fatal ailment. Fibromyalgia is not consistent. You may hurt one place one day and not the next. Your symptoms may be excruciating for a few months and then almost vanish in certain parts of your body.
The problem with FMS is that it will not go away. Quite simply put, there is no cure for fibromyalgia. In many cases the symptoms will interfere with your work, your pleasure, even your sleeping. Research is continuing to find a cause. Much work must be done before effective treatment is found to go after the cause and not just to reduce the symptoms.
FMS is most common in middle-aged women from 30 to 50 years of age. Seven to ten million Americans suffer to some degree with FMS. Some young children have it, and some elderly, but most of the cases are in the 30-50 year range of women. Some experts say that more than fifty women have the problem to every case of a man with it. That still means that 20,000 men will have fibromyalgia. Others in the field say they are now finding that twenty-five percent of their patients with FMS are men. They say this may be due to better diagnosis of men patients.
One point here to understand. FMS is not the same as arthritis. Arthritis is a problem with the immune system attacking the joints rather than protecting them. The joints themselves are the victims, and not the muscles or tendons around the joints. It may seem like your joints hurt with FMS, but in reality it is the soft muscles and tissues around the joint that are causing the pain.
The hurt can feel much the same, and in many cases the patient limits the use of the arm of leg, or cuts down on physical activity so the leg won't hurt as much. We'll discuss this later when we get into exercise. For right now, exercise will help, rather than hurt your FMS.
How Can You Tell If You Have Fibromyalgia?
The best diagnostic tool the doctors have so far is the palpation test. This simply means the doctor will press with his fingers on various parts of your body. Over the years, doctors have learned where to find these tender points. They pinpoint tender areas in specific locations.
Generally your doctor will take a complete personal and family history to rule out other health problems. The pressure tests are done on eighteen tender points on the body. If the pain has been there for three months, and the doctor finds sensitivity in eleven of the eighteen points, it's probable that the patient has fibromyalgia.
Where are these tender points? They always come in pairs. There are two on the throat about where the carotid arteries are situated. Two more are located below the clavicle about two inches and about four inches apart. Two more are found on the inside of the front of the leg and just above the knee.
On the back, there are two tender points on the upper neck, two more about half way down from the neck to the shoulder, and two more about four inches below the shoulder points in the back.
The back of the elbows finds another point on each arm. Two more are located in the lower back about four inches below the waist, and the last two are on the back of the outside of the hips.
What are the Symptoms of FMS?
Pain in soft tissue is a primary symptom. This pain might be burning, gnawing, radiating, shooting, or just a dull ache. These pains can be severe or mild, but they are felt deep inside the muscle, ligament and tendons. Joint pain may also be present.
When you hurt, the pain might be in your hips, thighs, knees, legs, buttocks, neck, elbows, wrists, arms, shoulders, back, chest, feet, or ankles. You might hurt in one or all of these places.
You doctor will ask you about other symptoms. These are the primary ailments that FMS can produce:
Fatigue: This is one of the most common problems associated with FMS. You might get over your bad night's sleep by noon, but by afternoon you will get so tired and slow and even sleepy that it will be hard to do your work. The problem worsens as the afternoon wears on. Fatigue all day can lead to total exhaustion at quitting time, but then chances are a real restful sleep will not be possible.
Poor Sleep Syndrome: All but ten percent of FMS sufferers have some type of sleep problem. It could be difficulty falling asleep, waking up several times each night, tossing all night without sleep, waking up several times each night, tossing all night without sleep, waking up early in the morning and not being able to get back to sleep. Or it could be insomnia without the ability to get back to sleep.
Some FMS patients get to sleep and think they are getting restful sleep, but in reality they are not. Their sleep is disturbed, and not the deep restorative type needed. Nobody knows why this happens. Some experts say that sleep problems may be part of the cause of muscle pain. The muscles don't get their usual regenerative rest period and react the next day with pain.
Headaches: Surveys show that about forty percent of those with FMS have headaches at least once a day. Many of these are severe. Patients report that tension headaches usually start with strain or tightness in the upper neck, often from muscle tightness. Migraine headaches happen, but usually at no higher rate than for people without FMS.
Joint Pain: FMS can lead to pain in hands, elbows, neck, wrists, feet, ankles, knees, hips, and the chest wall. We call this joint pain, but the pain is usually felt over the joint area and is not associated with the joint. Doctors tell us that this pain often happens where the tendon attaches to the bone. If you think you have tendinitis after some strenuous activity, use the normal tendinitis treatments of ice, rest, aspirin or cortisone. If the problem does not respond to those treatments, it could be FMS and not tendinitis.
Tingling and Numbness: These neurological symptoms show up in arms and legs of only a quarter of the people who have FMS. Those who have it say it makes their hands feel swollen and clumsy. We don't know what causes these problems and there is no special treatment.
Irritable Bowel Syndrome: About a third of FMS patients have some of the problems associated with an irritable bowel. These include bloating, gas, abdominal pain, diarrhea, constipation, and various other digestive disorders. Correct diet, prescriptions and over-the-counter remedies can usually handle these problems. Consult your doctor or a gastroenterologist.
Possible Swelling: Some FMS patients say they feel swelling of their ankles, feet, and hands. The problem is that usually there is no actual swelling, only the feeling of swelling. If there is actual swelling, it may be the result of some other problem such as arthritis, phlebitis, or a hormonal imbalance.
Chest Wall Pain: Pain in the chest wall is important for FMS patients because it could be a heart problem. A third of FMS patients report this type of pain. Most who are tested show no heart problems. Another indication that this pain is in the chest wall is when the patient reports tenderness when the chest is palpated. This fibromyalgia symptom can be treated with therapy and medication to control the pain. Your doctor will prescribe.
Sensitive to Cold: Some forty percent of people with FMS have trouble with cold hands. Small vessels in the hands over-react to cold temperatures and begin to spasm. The result can be the fingers and hand changing colors from white to blue and then red. Along with it can come stinging, pain, numbness, and tingling. See your doctor. Warming the affected hand can produce temporary relief.
Concentration and Memory: A quarter of the people with FMS report memory and concentration problems. A person may go to a room and forget why he or she went there. Sometimes the right words to complete a sentence won't come. Others say they sometimes have trouble completing a project or reading.
Other symptoms of fibromyalgia include:
- Chronic aching
- Stiffness
- Anxiety
- Depression
- Dizziness, palpations
- Irritable bladder
- Muscular twitching
- Sensitive Skin
- Dry eyes and mouth
- Frequent changes in eye prescriptions
- Impaired coordination
- Urinary frequency
- Restless Legs Syndrome
- Painful menstrual cramps
What Causes Fibromyalgia?
For every action, there is a reaction. For every cause there is an effect. For every disease or clinical disorder, there is a cause.
Yes, but finding that cause of a disease or clinical disorder is a huge task, and one not easily satisfied. Usually there must be concrete proof, something that will show on an X-ray or a CAT scan or an MRI, or in an overwhelming statistical report of double-blind clinical tests.
Right now, there is no proof of what causes fibromyalgia. There are a batch of theories and speculations, and half-proven treatments that could indicate a cause. We don't even know if there is one cause, or a variety of causes that produce the variety of bodily problems created in the fibromyalgia syndrome.
So where does that leave us? We take a long hard look at the evidence that the best in the field have turned up, reported, and promoted. We let the experts in this area evaluate them and take what shakes down.
Right now, there is no proven cure for FMS. However there is progress in trying to find the “why” behind this serious group of symptoms. Here are some of the theories about what causes FMS. Some of these are based on psychological reasons, other delve into chemical and biological potential causes. We'll look at these one at a time:
Stress
There is strong support for the idea that FMS is basically a psychological disorder. That it is partly the result of our fast-paced and highly competitive lifestyle. The idea is that stress alters some element in the brain that results in some or all of the various symptoms of fibromyalgia.
These supporters point out that FMS is more prevalent in our highly competitive Western society than in under-developed countries. Most developed countries report FMS, while most of the third world countries don't report any FMS. This does not mean that it is not present in some form.
Frustration may be an important factor. People with FMS show a much higher rate of frustration than those with other medical problems. This may be a result of the FMS and not the cause, since people who can't sleep properly, have aches and pains all over their bodies and feel tired all of the time, naturally would be more frustrated at life's little problems than individuals who are feeling good.
Some say that the body simply can't function normally when it's under intense stress. There is a chance that the automatic nervous system does not work properly under continued stress. Over long periods of stress, the body seems to interrupt the natural physiological process of energy production. This and other factors could weaken the body's immune system until the body reacts with some of the various problems of fibromyalgia.
Depression
Most researchers working on the cause of FMS now say that depression probably isn't a contributing factor in the cause of FMS. They say that only about thirty percent of FMS individuals are seriously depressed. The theory now is that this depression may be the result of the FMS and not the cause. The depression often comes after the onset of FMS and not before.
Traumatic Experiences
There is a growing belief that long lasting emotional traumatic experiences may have a direct bearing on FMS. One doctor reports that almost one hundred percent of his fibromyalgia patients have gone through a long period of emotional trauma. This might have been a divorce, a car accident, some long debilitating illness, child abuse, or growing up in a dysfunctional family environment.
The theory here is that the traumatic events in themselves did not cause the FMS, but they may have triggered the attacks. The trauma may have provoked some deep-seated physiological abnormality that had been latent in the individual. Now with all this prodding, the FMS rears up and the symptoms appear.
Once the FMS shows itself, it can affect the patient to launch other FMS problems. Pain may cause a person to cut down on activity, and that can result in anxiety and stress and even depression.
Chronic Fatigue:
Fatigue is the most common symptom of people with FMS. Many describe the feeling as the same as when they have the flu. A total drain of energy and the desire to do absolutely nothing but rest. The severity of fatigue varies with different individuals. For some it is mild, while in others it is so severe that they are totally incapacitated. For these severe cases, fatigue becomes the worst problem of FMS, even more than the pain in various parts of the body.
Those persons with serious chronic fatigue are often beset by the problem of not getting enough or the right kind of sleep, which only makes the fatigue factor worse.
Disruption of Deep Sleep
Almost all who suffer from some symptoms of FMS have some type of sleep disorder. This often is a disruption of deep sleep – where the most restorative benefits of sleep come. Studies in sleep labs have shown that the tested FMS patients had little trouble falling asleep, but were interrupted numerous times by sudden burst of brain activity. Researchers said these brain activities were much the same as awake-brain functioning.
With reduced deep sleep, the patient also produces less growth hormone, which is vital in healthy muscles and soft tissue. So the lack of deep sleep can be the cause of additional FMS problems.
Many of those with FMS wake up in the morning feeling like they didn't get a minute of good sleep. They are tired and not refreshed. This is sometimes called nonrestorative sleep. Such a problem will mean that muscles that were hurting the day before did not get enough rest and rejuvenation, and they will also hurt again the next day.
Some fibromyalgia patients have a sleep disorder called Alpha-EEG. Other problems with sleeping include nighttime jerking of arms and legs, sleep apnea, restless legs syndrome, and teeth grinding.
While sleep disorders may not be a basic cause of FMS, they can certainly contribute to the problem and beget new symptoms.
Growth Hormone Deficiency
As noted in the material above, the disruption of deep sleep impairs the production of growth hormone. This hormone has a lot to do with restoring damaged and fatigued muscles. If these fibers can't be refreshed during sleep, as they normally would be, it creates a continuing problem for pain in any of the eighteen tender points.
Low Levels of Magnesium, Phosphate, and Oxygen Substrate
Researchers in various areas are now reporting that FMS patients are showing deficiencies in at least three substances. These three are magnesium, phosphate, and oxygen substrate. All are essential for the body to produce energy. High levels of these three mean that the body can continue healthy cell respiration and the production of biological energy.
Withdraw these elements and there is an inability of the body to utilize oxygen for muscle energy. The result? In many FMS people it will produce fatigue – and soon depression.
Serotonin Level
Serotonin is a chemical in the brain. Anxiety, depression and anger all cause stress. That stress helps to deplete the brain chemical serotonin. When that happens, it elevates the substance called P. When this substance P is too high it makes the pain you feel much more intense. The increased pain causes anxiety, depression, and anger, which produces stress. That stress helps to deplete the brain chemical serotonin.
Which just cycles around again, regenerating the pain and the anxiety and the stress all over again.
Serotonin can't yet be measured in the brain, so it is checked in the spinal fluid where its metabolic by-product 5-HIAA collects.
People with FMS have less of the serotonin by-product than normal individuals. This lack may be because the emotional response of the person to stress uses up some of it. Control the stress and you control the level of serotonin.
The Inheritance Factor
More and ore researchers today feel that the tendency to develop FMS is inherited. An Ohio State study says that this inheritance will affect only half the children of a fibromyalgia patient.
Exercise is Vital
You say your muscles hurt and you don't want to even take a walk? Exercise is the last thing you want to hear about, let alone do? Mistake. Wrong. No way, Jose. Not a chance. Give it up.
Experts on FMS now say that the correct type of exercise program is one of the best medications you can take to recover and maintain good health. True. Even five years ago, exercise was not thought to be good for aching muscles.
Now the reverse is true. Why? Regular exercise activates your whole body, gets more blood circulating and is generally good for whole body health. Exercise helps prevent other problems not associated with FMS such as heart disease, diabetes, obesity, and high blood pressure.
You say your legs hurt, so how can you a half-mile walk?
Give it a try. Believing you can take that walk is half the battle.
How does exercise help your FMS? It promotes blood circulation - getting blood to nourish your bodily tissues. Exercise increases your flexibility, helps produce more healing endorphins in your immune system, helps promote the secretion of serotonin and growth hormones, and increases the production of T-cells in you autoimmune system.
Exercise of the right kind and in the right amount is also important in weight control, increasing mobility, and reducing pain. It also helps your joints and supportive structures such as ligaments and tendons - vital for FMS patients.
Fibromyalgia victims, who stop all kinds of exercise, even walking around the house, soon find out that they have made a mistake. When muscles are not used, they tend to shrink and weaken. The lack of exercise will further increase the pain and other problems from FMS. It's a cycle that soon deteriorates the body - which makes the FMS symptoms worse than before.
Activity and planned exercises have exactly the opposite effect of the body and on FMS symptoms.
Let's take a look at how exercise fights the painful effects of fibromyalgia:
- Exercise helps strengthen tendons and ligaments, and promotes muscle tone.
- When your body is well-toned, and has strong muscles, tendons and ligaments, they will do their regular work of supporting the body, and help lessen pain.
- Blood flow to muscles increases with exercise.
- More blood flowing to your muscles means more oxygen and nutrients get to the muscles and fibers. This helps to restore depleted muscles and re-supplies the muscle tissue. Most FMS patients have a lower blood flow than normal. Anything we can do to increase that – such as exercise - will help reduce pain.
- The growth of T-cells is helped by exercise.
- After exercise, the thymus gland produces a large number of the killer T-cells than it does normally. This is vitally important to the FMS person. T-cells enhance the autoimmune system. The T-cells are the body's fighters, attacking most disease cells. Both of these increases help the body work itself back toward normal.
Exercise Helps Flexibility and Range of Motion
Flexible and pliable muscles simply work better and will help you to avoid muscle tears, strains, or pulls. Exercise helps your muscles be more flexible. The more flexible your muscles are, the easier it is to do normal actions such as walking, stooping, reaching, and even sitting.
Exercise can prevent muscle stiffness, which is one of the early morning problems for FMS patients. You can probably reduce or eliminate that morning stiffness with execise. The more and better you exercise, the better your whole body will functions - including overall muscle and joint working. This can result in less pain and less tension - which can work on lowering your stress.
Endorphin Production Increases
Endorphins in your body help with healing, are a natural pain reliever, and help you to get better deep sleep. When you exercise, the action increases the production of endorphins and their release into your body to help you feel better.
Old Friend Serotonin
Yes, it's back. Serotonin production is increased with exercise. You've heard this before. Remember it this time. Serotonin and its growth hormone enhancement are two of the agents that most FMS patients lack. They are pain reducers and muscle-repair materials that can help you to feel better.
Synovial Fluid A Household Term
Synovial fluid moves in and out of your joints as they function. With exercise, the joints work more, and more of this fluid washes out of the cartilage, lubricates it and brings in nourishment to keep the joints healthy - and so they will hurt a lot less for an FMS patient.
Stretching
You see runners do it before a race. You see ballet dancers do it before a show. You see football and baseball players do it before every game. It's called stretching and in effect it helps the body get ready for the exercising that is to come.
Stretching is not warming up. Many experts say you should warm up before you stretch. This might include a brief walk, some side straddle hops, or body twists and another walk. When you feel warmed up, then is the time to do some serious stretching.
For people with FMS, stretching is a vital part of any type of exercise program. No matter what you do for your exercise workout, do a warm-up and stretching first.
Many people with fibromyalgia sit around all day, don't get up and move or be active. The pain is less that way. The only problem is the pain is never going to lessen by sitting around. Lack of motion, let alone exercise, lets the muscles and ligaments lose their flexibility, tone, and strength. Flexibility more most FMS patients tends to be impaired in the lower back and neck, shoulders, hips, and thighs.
Stretching usually works best if done after your aerobic workout. It's a good way to cool down. Stretching is most effective if you do it every day. If you exercise six days a week, be sure to do your stretching cool down every day.
Special Stretches for FMS Patients
These stretching procedures are especially designed to help those with fibromyalgia. We stretch the muscles that hurt the most: that includes those in the upper neck, upper back, shoulders, arms, lower back, hips, and the hamstrings in the back of the thighs. Utilize these stretches:
1. For your Lower Back and Hips: Lie on your back with your arms extended level with your shoulders. Lift your leg as high as you can, vertical if possible, and then turn your body and bring down your left foot and put it on your right hand. If it won't go all the way, bring your hand up to meet the foot. Now, stretch your foot toward your hand for five seconds, relax for a few seconds and then stretch your foot downward again. You should get a little farther this time. Repeat three times. Then return the leg to the floor and do the same stretch with the right foot to the left hand. Do three times.
2. For your Lower Back and Buttocks: Lie on your back on the floor keeping your hands beside your body, legs out straight and feet together. Bring both knees toward your chest slowly. This will stretch your lower back and buttocks. Hold for ten seconds and return to starting position. Repeat the stretch four times.
3. For your Shoulders, Upper Back Muscles, and the Trunk Rotators: Sit on the floor and cross your legs, pulling your feet as close to your buttocks as possible. Now twist to the right with your trunk and both arms. Go as far as you can, then grab the left arm with your right hand and pull it even farther to the right. This will stretch your upper arm, back and shoulder. Hold this for ten seconds, then release gently and return facing the front. Repeat this stretch three times to the right, then do it three times to the left.
4. For your Lower Back Muscles, Hip Flexors, and Hamstrings: Lie on your back with your legs fully extended and feet together, your hands by your sides. Pull up your right knee to your chest, and keep the other leg extended. Put both hands under the right knee and pull the leg toward your chest for a gentle stretch. Hold the position for ten seconds and return the leg to the floor. Do this three times, then repeat with the other leg.
5. For your Hamstrings, Lower Back, and Buttocks: While sitting on the floor with your legs straight in front of you, extend your arms forward and reach toward your toes as far as you can without pain. This will put a gentle stretch on your hamstrings, your lower back, and your buttocks. When you have reached as far as possible in a gentle move, hold it for ten seconds. After ten seconds, return to the position you started. Do this four or five times, trying to stretch a little farther each time. Don't over do it, and don't lunge or bounce.
6. For your Neck, your Upper Back, and your Chest: For this one, stand behind a kitchen type chair. Place both your hands on the back of the chair. Now move back until your hands are still on the chair and your upper torso is parallel with the floor. Now bend your torso lower toward the floor letting your head come between your arms. After ten seconds in this position, lower your head even more so you can look back at your legs. This will give a gentle stretch to your neck muscles. After ten seconds here, move easily back to the starting position. Work this stretch five times.
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