May 27, 2020 - Wednesday


By William H. Stager, DO, MS, MPH, FAAFP, FAAMA, FAAO, FACOFP dist.
FibromyalgiaFibromyalgia is a common pain syndrome affecting about two percent of Americans, more in women than in men. I call it a syndrome because it is a spectrum of conditions, whose predominant signs and symptoms include muscular pain, fatigue, and mood changes. Its’ cause is unknown, and there are no lab tests to diagnose it. Very often, blood tests or X-rays are normal. Your physician needs to rule out several conditions that look like it or can even occur concurrently with it. Then, the diagnosis is made by history and physical exam.
Some of the conditions that look like fibromyalgia or can occur with it are:
– Hormonal disorders, like hypothyroidism, hyperparathyroidism, Addison’s disease, and Cushing’s Syndrome
– Medications, especially the lipid lowering drugs (I see this a lot), and steroid use
– Polymyalgia rheumatica
​- Sleep apnea
– Viral infections, like hepatitis C and parvovirus
– Autoimmune disorders, like systemic lupus erythematosus and rheumatoid arthritis
– Lyme disease
– Eosinophilia-myalgia syndrome
– Malignancy
Fibromyalgia is a rheumatological disease, and rheumatologists are the medical specialists who diagnose and treat the over 100 rheumatological diseases. The American College of Rheumatology developed the definition of fibromyalgia in 1990: a history of pain in all four quadrants of the body for over 3 months, plus 11 of 18 tender points. New diagnostic criteria were developed in 2010, not using tender points but rather focusing upon widespread pain and allied symptoms such as problems with sleep, thinking clearly, and fatigue.
People with fibromyalgia have increased sensitivity to pain, and even that may come and go. The affected muscles usually have a decreased range of motion (they’re stiffer), can be weaker, and tire easily. Because the muscles are tight and tender most of the time, they cut off the blood circulation to them and their area, resulting in lack of oxygen and nutrients to the area. This releases neurotransmitters that then sensitize the nerves to the muscles, resulting in pain. This becomes a vicious cycle of pain, muscle tightness, nerve sensitization all the way back to the brain and spinal cord, an exaggerated pain response, hypersensitivity, and more pain. What was an acute problem becomes a chronic one, inducing referred pain, as well.
Fibromyalgia signs and symptoms include muscles that are tight, tender, and weak, plus a long list of physical and emotional problems. These include: chronic fatigue, sleep disturbance, anxiety, depression, inability to deal with stress, weight gain or loss, heat or cold intolerance, visceral pains and dysfunctions, headaches, allergies and hypersensitivities to almost anything, hearing and visual disturbances.
What causes fibromyalgia? There is no one answer to that. Officially, the answer is unknown. Research has come up with a variety of answers, such as infectious diseases, physical or emotional trauma, hormonal disorders, and a nervous system that is hypersensitive to stress responses. People can have fibromyalgia alone or with other conditions, which just confounds the picture.
Treatment: There are as many ways to treat people with fibromyalgia as there are symptoms. Understanding and education for you and your family probably comes first. A sympathetic physician, nurse or therapist is important. There are many support and information groups out there and you can find them in the phone book, newspaper, bookstore, and Internet. I have spoken about fibromyalgia at the local Palm Beach County Arthritis Foundation headquarters, and you will find the staff and resources there very helpful. They can be reached at: 561-833-1133, or by website:
Exercise that helps stretch and strengthen muscles, and relaxation techniques to ease depression and anxiety, including hypnosis, are all helpful. Diet is always a big question mark, as we have all heard of people who either added or deleted certain foods from their diets that helped their conditions. It boils down to what’s right for you, the individual. One way to explore whether foods are hurting or helping you is to carefully eliminate them, one at a time, for a few weeks, and see your results. I’m a firm believer in taking your vitamins, so: at least get a good multivitamin and take it with your diet.
Hands-on bodywork, gently and carefully done, can be a real blessing and lifesaver. I encourage everyone to explore osteopathic manipulation, acupuncture, and gentle massage techniques.
Good psychotherapy can be invaluable, too. I often spend a lot of time with my patients trying to discover the cause of their conditions, and it often includes discovering “who’s the pain in your neck”, not just “what’s the pain in your neck”. Understanding one’s past can be very liberating. Cognitive-behavioral therapy is one way to learn skills to cope. These include: relaxation training, activity pacing, visual imagery, cognitive restructuring, problem solving, and goal setting. Our attitude and behavior patterns are so important, and we can do a lot to control them and make them work positively for us.
There are a number of herbs, homeopathic and other natural remedies on the market that can help to varying degrees. I will mention one of my favorite groups here: the Bach Flower Remedies. There are 38 remedies, each corresponding to a different emotion. Rescue Remedy is the one I recommend the most, either as a liquid or to rub on as a cream. Again, bookstores, the Internet, etc., are all great resources for information.
Medications can often be a positive help. Pain meds, such as the NSAIDs (non-steroidal anti-inflammatory drugs) of which there are about twenty on the market, some presciption-only, and some over-the-counter, are usually the mainstay for pain. Anti-anxiety and anti-depressant meds can also be helpful. Sleep medicines can be helpful, as people with fibromyalgia often find that they don’t get restful sleep.

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