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What Is It? -- The
Basics
Below is a description of fibromyalgia syndrome
(FMS), but because of its substantial symptom
overlap with chronic fatigue syndrome (CFS), it
can be viewed as applying to chronic fatigue
syndrome patients as well.
WHAT IS
FIBROMYALGIA SYNDROME?
FMS
(fibromyalgia syndrome) is a widespread
musculoskeletal pain and fatigue disorder for
which the cause is still unknown. Fibromyalgia
means pain in the muscles, ligaments and
tendons--the fibrous tissues in the body. FMS
used to be called fibrositis, implying that there
was inflammation in the muscles, but research
later proved that inflammation did not exist.
Most
patients with fibromyalgia say that they ache all
over. Their muscles may feel like they have been
pulled or overworked. Sometimes the muscles
twitch and at other times they burn. More women
than men are afflicted with fibromyalgia, but it
shows up in people of all ages.
To
help your family and friends relate to your
condition, have them think back to the last time
they had a bad flu. Every muscle in their body
shouted out in pain. In addition, they felt
devoid of energy as though someone had unplugged
their power supply. While the severity of
symptoms fluctuate from person to person, FMS may
resemble a post-viral state and this is why
several experts in the field of FMS and CFS
believe that these two syndromes are one and the
same.
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SYMPTOMS AND
ASSOCIATED SYNDROMES
Pain - The pain of fibromyalgia has no
boundaries. People describe the pain as deep
muscular aching, burning, throbbing, shooting and
stabbing. Quite often, the pain and stiffness are
worse in the morning and you may hurt more in
muscle groups that are used repetitively.
Fatigue - This symptom can be mild in some
patients and yet incapacitating in others. The
fatigue has been described as "brain fatigue" in
which patients feel totally drained of energy.
Many patients depict this situation by saying
that they feel as though their arms and legs are
tied to concrete blocks, and they have difficulty
concentrating.
Sleep disorder - Most fibromyalgia patients
have an associated sleep disorder called the
alpha-EEG anomaly. This condition was uncovered
in a sleep lab with the aid of a machine which
recorded the brain waves of patients during
sleep. Researchers found that fibromyalgia
syndrome patients could fall asleep without much
trouble, but their deep level (or stage 4) sleep
was constantly interrupted by bursts of
awake-like brain activity. Patients appeared to
spend the night with one foot in sleep and the
other one out of it. In most cases, a physician
doesn't have to order expensive sleep lab tests
to determine if you have disturbed sleep. If you
wake up feeling as though you have just been run
over by a Mack truck--what doctors refer to as
unrefreshed sleep--it is reasonable for your
physician to assume that you have a sleep
disorder. It should be noted that most patients
diagnosed with chronic fatigue syndrome have the
same alpha-EEG sleep pattern and some
fibromyalgia-diagnosed patients have been found
to have other sleep disorders, such as sleep
myoclonus or PLMS (nighttime jerking of the arms
and legs), restless leg syndrome and bruxism
(teeth grinding). The sleep pattern for
clinically depressed patients is distinctly
different from that found in FMS or CFS.
Irritable Bowel Syndrome - Constipation,
diarrhea, frequent abdominal pain, abdominal gas
and nausea represent symptoms frequently found in
roughly 40% to 70% of fibromyalgia patients.
Chronic headaches - Recurrent migraine or
tension-type headaches are seen in about 50% of
fibromyalgia patients and can pose as a major
problem in coping for this patient group.
Temporomandibular Joint Dysfunction Syndrome
- This syndrome, sometimes referred to as TMJD,
causes tremendous face and head pain in one
quarter of FMS patients. However, a 1997 report
indicates that as many as 90% of fibromyalgia
patients may have jaw and facial tenderness that
could produce, at least intermittently, symptoms
of TMJD. Most of the problems associated with
this condition are thought to be related to the
muscles and ligaments surrounding the joint and
not necessarily the joint itself.
Multiple Chemical Sensitivity Syndrome -
Sensitivities to odors, noise, bright lights,
medications and various foods is common in
roughly 50% of FMS or CFS patients.
Other common symptoms - Painful menstrual
periods (dysmenorrhea), chest pain, morning
stiffness, cognitive or memory impairment,
numbness and tingling sensations, muscle
twitching, irritable bladder, the feeling of
swollen extremities, skin sensitivities, dry eyes
and mouth, frequent changes in eye prescription,
dizziness, and impaired coordination can occur.
Aggravating factors - Changes in weather,
cold or drafty environments, hormonal
fluctuations (premenstrual and menopausal
states), stress, depression, anxiety and
over-exertion can all contribute to symptom
flare-ups.
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POSSIBLE
CAUSES
The
cause of fibromyalgia and chronic fatigue
syndrome remains elusive, but there are many
triggering events thought to precipitate its
onset. A few examples would be an infection
(viral or bacterial), an automobile accident or
the development of another disorder, such as
rheumatoid arthritis, lupus, or hypothyroidism.
These triggering events probably don't cause FMS,
but rather, they may awaken an underlying
physiological abnormality that's already present
in the form of genetic predisposition.
What
could this abnormality be? Theories pertaining to
alterations in neurotransmitter regulation
(particularly serotonin and norepinephrine, and
substance P), immune system function, sleep
physiology, and hormonal control are under
investigation. Substance P is a pain
neurotransmitter that has been found by repeat
studies to be elevated threefold in the spinal
fluid of fibromyalgia patients. Two hormones that
have been shown to be abnormal are cortisol and
growth hormone. In addition, modern brain imaging
techniques are being used to explore various
aspects of brain function--while the structure
may be intact, there is likely a dysregulation in
the way the brain operates. The body's response
to exercise, stress and simple alterations in
position (vertical versus horizontal) are also
being evaluated to determine if the autonomic
nervous system is not working properly. Your body
uses many neurotransmitters, such as
norepinephrine and epinephrine, to regulate your
heart, lungs and other vital organs that you
don't have to consciously think about.
Ironically, many of the drugs prescribed for FMS/CFS
may have a favorable impact on these transmitters
as well.
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COMMON
TREATMENTS
Traditional treatments are geared toward
improving the quality of sleep, as well as
reducing pain. Because deep level (stage 4) sleep
is so crucial for many body functions, such as
tissue repair, antibody production, and perhaps
even the regulation of various neurotransmitters,
hormones and immune system chemicals, the sleep
disorders that frequently occur in fibromyalgia
and chronic fatigue patients are thought to be a
major contributing factor to the symptoms of this
condition. Medicines that boost your body's level
of serotonin and norepinephrine--neurotransmitters
that modulate sleep, pain and immune system
function--are commonly prescribed. Examples of
drugs in this category would include Elavil,
Flexeril, Sinequan, Paxil, Serzone, Xanax and
Klonopin. A low dose of one of these medications
may be of help. In addition, nonsteroidal,
anti-inflammatory drugs (NSAIDs) like ibuprofen
may also be beneficial. Most patients will
probably need to use other treatment methods as
well, such as trigger point injections with
lidocaine, physical therapy, acupuncture,
acupressure, relaxation techniques, osteopathic
manipulation, chiropractic care, therapeutic
massage, or a gentle exercise program.
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[Karl Note:
It is fascinating to see how many new diseases
are invented where the cause is bad diet, or
something very much within the control of the
patient, but where the recommended treatment is a
psychiatric drug. There are several drugs
mentioned above as possible treatments for
fibromyalgia. Interestingly, all of them
are outright psychiatric drugs or like
psychiatric drugs that cause a great deal of
harm, become addictive, and guarantee that even
as pain may recede other health problems
increase.
Elavil
-- this is a psychiatric drug -- an
anti-depressant
Amitriptyline is
a
heterocyclic drug used to treat spontaneous
endogenous depression and is extremely
sedating. This drug may also be helpful in the
treatment of agitation, anorexia, adjunctive
treatment of neurogenic pain, bulimia
associated with depression, chronic
hiccups, insomnia, major depression, or in a
patient with chronic pain and other pain
syndromes including: Ciguatera, posttherpetic
neuralgia, neuropathic, and vulvodynia.
Flexeril --
this is claimed to NOT be a psychiatric drug, but
it basically works the same many of them.
- Cyclobenzaprine (Flexeril). This medication
can be used on a longer-term basis and actually
has a chemical structure related to some
antidepressant medications, although it is not
an antidepressant. Usually it is prescribed as
10mg every six hours as needed to relieve low
back pain associated with muscle spasm, or it
can also be prescribed as 10mg at night as
needed to help with difficulty sleeping.
Flexeril can impair mental and physical
function, and may lead to urinary retention in
males with large prostates.
Sinequan
-- this is a psychiatric drug
Doxepin is a psychotropic agent with
antidepressant and anxiolytic properties. It
also has sedative and anticholinergic effects,
and, in the higher dosage range, it produces
peripheral adrenergic blocking effects. Studies
of electroencephalograms in humans have shown
decreases in amplitude, and amplitude
variability, also, the delta, theta and 24-35
CPS activities increased.
Paxil --
this is a psychiatric drug
In
just a few years, Paxil® (paroxetine HCl) has
become one of the leading treatments for
depression and anxiety disorders in the
country. Paxil is a member of a class of
prescription drugs called selective serotonin
reuptake inhibitors (SSRIs) that has proven in
clinical trials to be both safe and effective
with fewer side effects than other types of
antidepressant medications.(17)
Serzone --
this is a psychiatric drug
Nefazodone is a synthetically derived
analogue of the phenylpiperazine series which
is metabolized in vivo to compounds which
likewise exhibit pharmacological activity.
Nefazodone (NEF) and one of its active
metabolites, hydroxy-nefazodone, exert dual
effects on serotonergic neurotransmission
through blockade of serotonin type 2 (5HT2)
receptors and inhibition of serotonin uptake.
The parent compound (NEF) and another active
metabolite, m-chlorophenylpiperazine (mCPP),
also exhibit affinity for the 5-HT1c
receptor. Nefazodone lacks anticholinergic or
antihistaminic effects but exhibits some
affinity for alpha1 adrenergic
receptors.
Xanax
-- this is a psychiatric drug
Alprazolam is an
antianxiety agent, benzodiazepines. Used
primarily for short-term relief of mild to
moderate anxiety and nervous tension. Alprazolam
is also effective in the treatment of activity
depression or panic attacks. It can be useful
in treating irritable bowel syndrome and
anxiety due to a neurosis as well. Alprazolam
may help the symptoms of PMS if extreme, some
cancers pains if given with various narcotics,
agoraphobia, essential tremor, and ringing
ears.
Klonopin
-- this is described as an anti-convulsive drug,
but is very similar to psychiatric drugs
Clonazepam's pharmacological profile is
similar to other anxiolytic/sedative
benzodiazepines. Its basic anticonvulsive
properties are also similar to those of other
diazepines. Clonazepam is capable of
suppressing the spike and wave discharge in
absence seizures (petit mal) and decreasing the
frequency, amplitude, duration and spread of
discharge in minor motor seizures.
WHAT IS THE
PROGNOSIS?
Long
term follow-up studies on fibromyalgia syndrome
have shown that it is chronic, but the symptoms
may wax and wane. The impact that FMS can have on
daily-living activities, including the ability to
work a full-time job, differs among patients.
Overall, studies have shown that fibromyalgia can
be equally as disabling as rheumatoid arthritis.
On the other hand, follow-up of people meeting
the chronic fatigue sydnrome criteria indicates
that as many as 40% may significantly improve but
few are thought to completely recover from this
syndrome. Longer term follow-up studies are not
available to indicate whether these "improved"
CFS patients later relapse with an increase in
symptoms. A preliminary follow-up study by the
CDC (Centers for Disease Control) reveals that
for those individuals with chronic fatigue
syndrome who do not recover or significantly
improve after five years duration, their most
prominent symptom changes from fatigue to muscle
pain with concentration problems (sounds a lot
like the permanent syndrome of fibromyalgia but
the CDC is not checking patients for tender
points).
According to a research study by Dedra Buchwald,
M.D., people who meet the criteria for both FMS
and CFS tend to be at the more severe end of the
spectrum of symptoms and are more likely to
become work-disabled. Buchwald says her findings
underscore the importance of recognizing
concurrent fibromyalgia and chronic fatigue
syndrome (Rheumatic Disease Clinics of North
America 22(2):219-243, 1996).
[Karl Note:
When they invent a new disease they realize that
the perfect disease is one that can never be
cured, but that will leave you alive while your
health insurance is still paying the bill.
Health Insurance, as I have written
elsewhere, is simply "Disease Assurance!"
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SELF-HELP
STRATEGIES
Lifestyle modifications may help you conserve
your energy and minimize your pain. Learn what
factors aggravate your symptoms and avoid them if
possible. Join your local support group and
become informed about your condition by
subscribing to Fibromyalgia Network
newsletter (click on red catalog button above).
In this newsletter, you will read about research
findings, new treatment options, and tips on
coping with fibromyalgia and chronic fatigue
syndrome. You may also contact Fibromyalgia
Network for a listing of patient contacts and
physician referrals. Our phone number is:
(800) 853-2929.
Other educational materials may be ordered from
Fibromyalgia Network as well. Just click on the
pink "Newletters/Resources"
side button above or select the "Store"
below for details. We also provide referral
sheets free with every order!
[Karl Note:
The philosophical evil which is "psychiatry"
suffers from a inherent and fatal flaw. Man
achieves greatness, particularly compared with
plants and animals, because he is able to change
his environment. He "takes charge" of
things and changes them to suit himself.
Animals and
plants ADAPT to their environment.
Psychiatry
has the philosophical foundation that man must
adapt to his stresses and problems in life.
Thus generally psychiatry is telling you that you
have to COPE with your problems, not "solve"
them. That, you see above, is the
recommendation for those who suffer with
fibromyalgia. You are encouraged to learn
how to "cope" with the malady. You are told
that you are likely to have this for the rest of
your life, and that it will get worse!
For the page
offered by the hidden psychiatric inventors of
this disease about COPING --
click here!]
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Monday June 10, 2002
