By Jack Gardner, M.D. –
Did you know that Fibromyalgia is one of the fastest growing disabling conditions in the United States?
Fibromyalgia is a complex chronic pain disorder where the patient has long-term, full body pain and tenderness in the joints, muscles, tendons,and other soft tissues. Many areas are hypersensitive to touch and may be in states of chronic spasm. Fibromyalgia is a not a disease that can be easily diagnosed but rather a syndrome, or possibly even a group of related syndromes. Due to the complex nature of this disorder and the fact there are no laboratory tests available to clearly diagnose fibromyalgia, it can prove difficult for patients to be diagnosed and treated effectively in a timely fashion.
Beyond just the chronic pain associated with Fibromyalgia, it has also been associated to other related syndromes, such as: chronic fatigue, sleep disorders, chronic headaches, depression, irritable bowel, and anxiety.
Fibromyalgia patients are predominantly women (upwards of 80%) and typically see the onset of symptoms between 20-50 years of age. Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no triggering event.
What Causes Fibromyalgia?
While the exact underlying cause(s) still remains unclear, there is a fair amount of agreement amongst researchers that the mechanism seems to be one of central sensitization. This means that people with fibromyalgia have a lower threshold for pain, because their central nervous system has an increased sensitivity to pain signals. It is known that in chronic pain conditions, repeated painful stimulation can cause changes in the central nervous system which sensitizes the nervous system to subsequent painful stimuli. In other words, the body turns up the volume of the pain. A similar process seems to be at work in patients with fibromyalgia. Metabolite levels for the monamine neurotransmitters which play a role in natural analgesia (pain control) have shown to be lower in patients studied with fibromyalgia. Also, CSF levels of substance P, which is a substance associated with increasing pain signals has been found to be elevated. Another significant finding in fibromyalgia patients is that their sympathetic nervous system is hyperactive at baseline compared to the average person.
The source of much debate is what initially causes this process to happen in patients with fibromyalgia. Some researchers believe that fibromyalgia is the result of gross inflammatory process, while others believe that the process is more purely neurologic, possibly with a genetic basis (a faulty gene which causes an imbalance of the nervous system). While there is evidence that inflammatory processes are associated with or related to fibromyalgia, there is little evidence of gross inflammation in the affected tissues. For example, if you looked at a patient’s muscles under a powerful microscope, there would be no white blood cells or autoimmune antibodies, etc. Also, anti-inflammatory drug therapies are only somewhat helpful in treating the pain of fibromyalgia, and have certainly not proved to be curative.
Beyond the Pain
The debilitating pain associated with Fibromyalgia also causes a number of other issues for suffers. Patients commonly report:
• Snapping at family, friends and co-workers because the pain makes them crabby.
• Being up in the middle of the night because the pain keeps them awake or has lead to insomnia.
• Extreme frustration with medications that do not work or have major side effects.
• Strained to focus on work because the pain was so distracting.
• Sadness and depression.
• Unable to do simple tasks at home that have always been easy for them.
Treatment Options for Fibromyalgia
There is no one right answer for treating Fibromyalgia and no known cure. It takes a combination of treatments to help many sufferers.
Usually, multiple modalities are involved with the management of fibromyalgia. The anti-seizure medications Lyrica and Neurontin have been shown reduce pain in some, but not all, patients with Fibromyalgia. Some classes of antidepressants have been used in many cases to treat the pain and associated symptoms of depression, fatigue, and sleep disturbances. NSAIDS have proved to be only marginally effective in the treatment of fibromyalgia, and long-term use can be associated with potential risks of GI complications of gastritis or peptic ulcer disease. Complementary therapies including massage, and acupuncture have been found to be helpful. Also, regular exercise is recommended and appears to be generally helpful; especially exercise focused on movement such as Pilates, yoga, tai chi, and the Feldenkrias method.
I am personally involved with an exciting new treatment for Fibromyalgia patients, called the P-STIM neurostimulator. The FDA-approved P-STIM® device stimulates small nerve endings in the ear, and has been shown to affect the balance of the autonomic nervous system, decreasing sympathetic nervous system tone. This seems to decrease much of the sensitization of the nervous system seen in chronic pain conditions such as fibromyalgia. The procedure is minimally-invasive procedure, and virtually pain free. No sedation or anesthesia is required.
Drug Free Pain Center
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