Fibromyalgia: No longer a catchall diagnosis.
Fibromyalgia: No longer a catchall diagnosis.
Emma Christensen I first developed an interest in fibromyalgia syndrome through my mother. About ten years ago, she began complaining of achiness, sharp pain in various parts of her body-specifically the neck, and constant fatigue and insomnia. Being treated for clinical depression, however, my mother put these annoyances off as simply more symptoms of her depression and the results of extreme stress and tension. It was only very recently, within the past year while receiving massage therapy, that her masseuse happened to mention that my mother might have fibromyalgia, a relatively recent syndrome to enter into medical circles. Since then, my mother has been diagnosed as having fibromyalgia. This information does little good outside of peace of mind, as both the causes and the cures of these syndromes are not certain.
Fibromyalgia is characterized most prominently, of course, by pain. Pain can be experienced both as widespread and general 'achiness' felt throughout the body and also at specific 'trigger points,' which are areas that radiate intense pain in the muscle fiber. To meet the medical definition of 'fybromyalgia' the patient must respond to eleven out of the eighteen most common trigger points, the patient must have trigger points in all four quadrants of the body, and the patient must have experienced continuous pain for at least three months. I will discuss these 'trigger points' in more depth later in this paper. There are multitudinous other symptoms which are also known to be associated with fibromyalgia. A few of the most significant among these are difficulty sleeping, intense fatigue, weight gain and loss, muscle spasms and loss of muscular control, mood swings and other neurological disorders, and headaches. What causes fibromyalgia is still very ambiguous to medical science. In general fibromyalgia is known to follow severe physical injury such as a car accident or intense emotional or psychological trauma like that associated with intense depression or following the loss of a loved one. Other times, fibromyalgia can appear for no obvious reason or could be the result of multiple microtraumas to the nervous system.
Although the cause of fibromyalgia is unknown, there are many explanations for what occurs in the nervous system of people afflicted with fibromyalgia. Specific to this are the various reasons for the intense perception of pain. A change to the myofascia surrounding the muscles has been found to be one of the leading causes of pain and other muscular symptoms of fibromyalgia in the majority of cases. Myofascia is the thin, whitish membrane comprised of a material called 'ground substance' that envelopes and protects the muscle like a sack and which is responsible for supporting and connecting all of the body's muscles together. Normally, neurotransmitters pass easily from the interneurons on one side of the myofascia to create action potentials in the motor neurons attached to the muscles. In the case of people with fibromyalgia, however, often the myofascia has lost its elastic properties and hardened. The ground substance within the myofascia, which is usual in a fluid state, has become more like a solid gel. This change in the myofascia hinders or entirely prevents the neurotransmitters from reaching the motor neurons and creating action potentials.
In other terms, there is a discrepancy between what the brain expects to happen and what actually happens in the nervous system. Through corollary discharge between the motor neurons and the sensory neurons, the brain(and nervous system) is expecting the muscle to behave normally-to flex and contract as directed. However, because the final step, the activation of the motor neurons, was hampered by the cohesion of the ground substance in myofascia, the muscle with either act in a belated manner to the original signal, will act differently than intended, or will not act at all. One physical and easily observable result of this is lack of muscle control; i.e. staggered walking, shaking hands, and poor reflexes. The above mentioned trigger points, or tender points, are also intrinsically involved in the experience of pain. Traumas to the skin tissue, ligaments, or myofascia create a 'pain-response' in the nervous system. The muscles will contract around the area of the perceived pain forming a sort of bubble or cushion for the injured area while it heals. The muscle tissue in this region will remain contracted in a state of 'sustained tension ' even after the surrounding muscle tissue has ceased to work and is in a period of relaxation. The area of the muscle that continues to work is gradually expending more food and oxygen in the form of toxic waste than it is receiving, and so the region becomes not only starved for nourishment but also polluted with toxins-a trigger point which is painfully sensitive to pressure from surrounding muscle tissue as well as to the pressure of the doctor's fingers.
The secondary manifestations of fibromyalgia associated with sleep deprivation are quite possibly a result of a combination of these primary manifestations of pain resulting from the hardening of the myofascia and the formation of trigger points. Dr. Devin Starlanyl notes, "People with FMS[fibromyalgia syndrome] often have the alpha-delta sleep anomaly". The continuous pain, in combination with the hypertension of many of the muscles in the body, makes it difficult for people with fibromyalgia to relax into delta sleep. Often, once delta sleep has been achieved, alpha waves(normal, 'awake' brain activity) will disrupt delta sleep, jarring the person awake or into a lighter level of sleep. Delta sleep is the level at which the body is relaxed enough to heal itself and revive its depleted stores of neurotransmitters and energy. It is also during delta sleep in which large amounts of the neurotransmitter serotonin is released , a neurotransmitter that regulates depressed moods.
A final point I wish to mention involves an interesting side effect of fibromyalgia-hypersensitivity. Due to the intense role of pain in this syndrome, sensory neurons are extremely active and receptive to any changes or abnormalities in sensory input. In effect, these neurons become hypersensitive to the point at which almost any sensory stimulus will ignite a fury of neuronal activity that transmits to the brain a message of pain. A fluorescent light, rough clothing, certain perfumes or other scents, and even slight changes in temperature and air pressure can all be interpreted as pain to the sensitive nervous system. Further disorder and confusion is created in the nervous system when, much like the myofascia situation, there is discord between what the nervous system thinks is happening to the body and what is actually happening. The nervous system, because it has received pain signals which indicate that there is some sort of trauma occurring to the body, activates various its various defense mechanisms to deal with the trauma (namely the release of endogenous endorphins and opioid peptides, the tightening of muscle tissue around the affected area and the activation of the immune system).
There is no effectively proven cure for fibromyalgia. Apparently, one of the most effective cures remains sleep, pure and simple. Often finding a solution to insomnia and helping patients to achieve deeper sleep is all that is needed to relax the suspended tension in the muscles, restore the biochemical balance and replenish the store of neurotransmitters. Various types of sedatives are sometimes used in conjunction with drugs such as amitriptyline, and the newly available drug, guaifenesin. Guaifenesin works to break up the toxins that have collected in the trigger points. Another alternative medicine source that has been prescribed with increasing frequency in the past decade is a pine bark extract patented as Pycnogenol® . This is an all natural antioxidant that prevents the breakdown of cells and tissues and enhancing the immune system. As a result of the relatively recent introduction of fibromyalgia as a valid medical syndrome and diagnosis, much is known about what occurs inside the body and the nervous system with fibromyalgia, but very little is known about the exact cause or causes or, most unfortunately, an effective cure. Many people with fibromyalgia remain undiagnosed or improperly diagnosed, as the symptoms of fibromyalgia can resemble those of other conditions like simple sleep deprivation if the doctor is not alert to the specific symphony of symptoms associated with fibromyalgia. Particularly in the past few years as knowledge of fibromyalgia has become increasingly integrated into the scientific community, there has been a greater push towards the development of possible treatments-the two major possibilities being guaifeneson and Pycnogenol®.
1. CFS Days
2. Fibromyalgia and Chronic Fatigue Syndrome by Dr. Starlanyla and J. Nickson
Comments made prior to 2007
thought this document over fibromyalgia was very interesting. I
am now twenty one years old and was diagnosed with this disease almost
eleven yrs ago. I would be interested in any updates you
may find on fibromyalgia ... Kathleen White, 10 February 2006