FIBROMYALGIA
Fibromyalgia is a type of rheumatism which affects the muscles and ligaments
but not the joints. It is not a crippling ailment, but because there are no
outward signs, other people cannot see the pain and tiredness you are
suffering.
It is a common condition, sometimes so severe that it interferes with
personal and family life. In fibromyalgia the fibrous tissues (hence
"fibro") and muscles ("my") are affected by pain
("algia") and tenderness. The pain may often feel as though it
affects the whole body.
However, tender points are usually present in certain areas of the body
which help the doctor make the diagnosis. If pressure is applied to these
tender places, most of us will find it uncomfortable (they may give rise to a
localised condition such as tennis elbow) but in fibromyalgia there is a change
in the threshold at which pressure causes pain and many of these points can be
extremely tender.
In the past fibromyalgia was diagnosed as muscular rheumatism or fibrositis.
Or else it was misdiagnosed as degenerative disease of the joints (since x-rays
of the neck, for example, eventually show wear and tear in most of us whether
we have fibromyalgia or not). However, research in the past few years has led
to a much clearer picture of fibromyalgia, and the diagnosis is being made more
often by rheumatologists and general practitioners.
Symptoms
Pain, tiredness and other less frequent symptoms occur in fibromyalgia. Most
people feel the pain of fibromyalgia as aching, stiffness and tiredness in
muscles, and in tendons and ligaments around joints. It may feel worse first
thing in the morning or as the day goes on. One part of the body or several
different areas such as limbs, neck or back may be affected.
Fatigue may be the most severe aspect of fibromyalgia. There may be overall
tiredness and lack of energy, or muscular fatigue and lack of endurance. Either
way, it can be difficult to climb the stairs, do the household chores, or go
shopping, let alone go to work. Losing fitness may make matters worse.
Less frequent but still troublesome symptoms include: tingling, numbness,
poor circulation, or swelling of the hands and feet; headache; irritability;
feeling low or weepy; forgetfulness and poor concentration; needing to pass
water; irritable bowels; waking up feeling unrefreshed.
Of course symptoms like these can have other causes, and your doctor can
help decide whether any further tests or advice are required.
Fibromyalgia and ME (Myalgic Encephalomyelitis)
The symptoms described in ME are often very similar to those in
fibromyalgia. except that ME sufferers can often recall a viral infection
before symptoms appeared. For this reason many doctors prefer the term
post-viral fatigue syndrome rather than ME. More needs to be known about these
conditions before we are able to understand whether there may be a relationship
between them.
Causes of Fibromyalgia
Much recent research into fibromyalgia was stimulated by the finding of
specific tender points and the discovery of sleep disturbance. Brain wave
studies (EEG) during sleep have revealed that people with fibromyalgia lose
deep sleep. Deep and non-dreaming sleep is repeatedly and excessively disturbed
by lighter, dreaming sleep. Even healthy volunteers who are woken up in each
period of deep sleep suffer the typical symptoms and tender points of
fibromyalgia.
The lack of deep sleep that can produce fibromyalgia may have several
causes, and more than one cause may be affecting any particular individual.
Pain or stiffness in the neck may disturb sleep. There may be the pain and
stress of an injury, or of another disease (e.g. arthritis). Emotional pain and
strain, anxiety, or depression brought on by events or relationships at home or
work, may also be a factor.
Once fibromyalgia sets in there is a vicious cycle producing more pain and
more sleep disturbance. This can be enough to cause depression even if this was
not present initially. When fibromyalgia is obviously associated with another
condition like arthritis or depression, it is sometimes called
"secondary". When it seems to be occurring alone, it may be called
"primary".
Treatment
Fibromyalgia cannot be cured but it can be helped a great deal through team
work involving yourself, your doctor, and your family. Your doctor can help
first by making the diagnosis of fibromyalgia and reassuring you that despite
all the pain, you do not have a crippling condition. You are no more likely to
develop arthritis later on than anyone else. Your doctor can also prescribe
medication, but you will learn for yourself whether this helps enough to be
worth continuing.
The medication available to help your pain includes painkillers like
paracetamol and non-steroidal anti-inflammatory drugs (of which there are
many). These may help a little. Similarly, a steroid injection in the affected
area may help if one or two places are particularly painful. But injections are
not a long-term answer.
Your doctor can also try to help the sleep disturbance. Sleeping in a soft
collar may help you sleep better, particularly if your neck is uncomfortable.
However, there is no harm in anyone trying this for a week or so, providing
they do not get into the habit of wearing it during the day. Ordinary sleeping
tablets are best avoided because they are often habit-forming and eventually
lose their effect. However, many patients may be helped by an anti-depressant
drug, even if there is no depression, as they not only help improve the sleep
pattern, but may also raise the pain threshold. They may also help some
patients who have depression associated with the fibromyalgia, but this is not
usually the main reason they are prescribed. The benefit may not be immediate,
so it is worth trying for at least a couple of months before deciding if they
are helpful.
Your doctor may also refer you to a physiotherapist for further advice and
education about fibromyalgia. But by far the most effective therapist will be
you, yourself.
It is worth facing up the fact that fibromyalgia can be severe, and may last
for several years. The good news is that many people have learnt to control
their condition so that it becomes part of life without ruining life. The
advice that follows does work and will help if you persevere. Gradually you can
help yourself, so your aim should be to do a little to start with and a little
bit more each day. You must be prepared for setbacks, and for the fact that
treatment may hurt. Remember too that what helps one person with fibromyalgia,
may not give the same benefit to another.
Self-help
- Learn about fibromyalgia (further information is available from the support
group mentioned later); sharing the frustration of having this condition, and
knowing that other people out there have similar problems, can help enormously
- Educate your family, to engage their sympathy and help, otherwise they will
just share your frustration
- Try the medication your doctor has to offer
- Avoid drugs such as nasal decongestants, and do not drink alcohol, tea or
coffee late at night, because these may disturb your sleep
- Learn to take time out for yourself; reduce muscle tension and stress;
learn to relax your mind and your muscles (e.g. by yoga), or by playing an
audio tape on relaxation
- Identify the stresses and strains in your life so that you can learn to
face them or cope with them
- Eat healthily and lose the flab
- Exercise and strengthen your body
Research has confirmed that aerobic exercise improves fitness and reduces
pain and fatigue in people with fibromyalgia. Aerobic exercise means doing
enough to get you breathing heavily and your heart beating faster.
Swimming is one of the best forms of exercise for fibromyalgia. Many people
who have not learned to swim find the effort to do so is well worthwhile.
Do not be over-ambitious about your progress, take it slowly and steadily.
If you feel that walking down the road is more than you can manage, start by
counting the houses you pass each day and after some time you will find that
you are counting the streets. If you go swimming (and warmer water is more
soothing), start just by standing and moving your arms and legs against the
resistance of the water, then go on to widths, and eventually you will be doing
lengths.
You must expect exercise to be painful initially, and it may leave you in
greater pain and fatigue later that day or the next. So build up your exercise
at a rate you can cope with, a little each day. You should build up to at least
three hours of exercise each week, but it is often better to do ten minutes and
have a break than to do an hour all in one go. Gradually, your muscles will
become stronger and there will be more muscle fibres to move your limbs
smoothly and avoid jarring of tendons and ligaments. Exercise also promotes
sleep and improves your sense of well-being.
Other Treatment
No particular diet has been shown to help fibromyalgia, but it is sensible
to shed unnecessary fat from your body and to avoid drinking too much coffee
and tea. Controlling your diet helps you feel in control of your body.
Treatments like massage, acupuncture, physiotherapy, and manipulation from a
chiropractor or osteopath, can all soothe pain and improve morale, but the
benefits may not be long-lasting. Only you can decide whether the benefits are
worth the time and expense.
Your aim is self reliance. Exercise, sound sleep, and dealing with physical
or mental stress, are the keys to releasing the pain and fatigue of
fibromyalgia, until research provides us with better answers.
Useful Publications
Coping with Fibromyalgia (Fibrositis) by Beth Ediger, foreword by D L
Goldberg, MD
38 pages
Fibromyalgia: Fighting Back by Bev Spencer, foreword by Dr G McCain
40 pages
These booklets are produced by LRH Publications, Toronto, Canada. They can
be obtained, together with further information, from:
Fibromyalgia Support Group
8 Rochester Grove
Hazel Grove
Stockport
Cheshire
SK7 4JD
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