Fibromyalgia: The Definition, Symptoms, Effects and Treatments
What is Fibromyalgia? Who is affected? What are
the symptoms? How is it treated? These are a reflection my first questions
after learning that my mother was diagnosed with the condition. I now have a
better understanding of what my mother endures on a daily basis and will
share with you the information necessary for you to have a better understanding
Fibromyalgia (FM) is an increasingly recognized
chronic pain illness which is characterized by widespread musculoskeletal
aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep
disturbances. The most common sites of pain include the neck, back,
shoulders, pelvic girdle and hands, but any body part can be involved.
Fibromyalgia patients experience a range of symptoms of varying intensities
that wax and wane over time.
Fibromyalgia is a soft tissue musculoskeletal syndrome that in many respects
is similar to Chronic Fatigue Syndrome (it differs from Chronic Fatigue
Syndrome (CFS) in that the primary symptom of fatigue experienced by CFS
patients tends to be replaced more with musculoskeletal pain in fibromyalgia
The American College of Rheumatology established diagnostic criteria which
includes pain on both sides of the body, both above and below the waist, as
well as in an axial distribution (cervical, thoracic, or lumbar spine or
anterior chest); additionally there must be point tenderness in at least 11
of 18 specified sites. Stedman's Medical Dictionary describes the condition
as "A syndrome of chronic pain of musculoskeletal origin but uncertain
As early as the nineteenth century, physicians
documented a 'vague' condition involving fatigue, stiffness, aches, pains,
and disturbed sleep patterns 2.. The origin of this condition, now known as
fibromylagia syndrome (FMS), mystified physicians, and initially, some
attributed the condition to the stress of modern life 2.. Others attributed
it to inflammation in the body's fibrous tissue 3..
Currently, the aetiology of fibromyalgia syndrome (FMS) still remains elusive
and FMS cannot be regarded as a distinctive disease, in the sense of having a
uniform pathophysiogical basis, since its origin has yet to be determined 4.,
8. . "While there is still not a majority of FMS researchers who support
any one theory, significant progress is being made in identifying an
It has been noted that fibromyalgia often develops after physical trauma
(i.e. an accident, injury or severe illness) which appears to act as a
trigger in predisposed individuals. In 1997, a team of researchers found that
there was a relationship between spinal injury and the onset of fibromyalgia.
Cervical whiplash injuries tend to result in fibromyalgia-like symptoms
around 90% of the time.
Symptoms of Fibromyalgia
A diagnosis of Fibromyalgia requires fulfillment of the following major
criteria and 4 or more minor criteria:
Cells: Fibromyalgia patients have been found to have a high incidence of
damage to the Mitochondria of their Cells 6.
Musculoskeletal System: The primary symptom of Fibromyalgia is chronic
Musculoskeletal Pain characterized by generalised pain or stiffness of at
least 3 anatomic sites for at least 3 months; 11 or more typical,
reproducible tender points (the American College of Rheumatology describes 18
points over Muscles and Tendons).
Exclusion of other ailments that can cause similar symptoms.
Digestive System: Irritable Bowel Syndrome
Metabolism: Generalised Fatigue (similar to Chronic Fatigue Syndrome)
Musculoskeletal System: Joint and other soft tissues inflammation (swelling)
Nervous System: Anxiety, Depression, Chronic Headache, Insomnia and other
Sleep Disorders, Neurological and psychological ailments, Numbness, Variation
in symptoms associated with activity, stress and weather changes, Vertigo
Frequently misdiagnosed, fibromyalgia is often confused with myofascial pain
syndrome, hypothyroidism, rheumatoid arthritis, chronic fatigue syndrome, and
systemic lupus erythematosus, which often have comorbidity with fibromyalgia
The pain of fibromyalgia usually consists of diffuse aching or burning
sensations and is often accompanied by muscle spasm. It may be generalised or
localised" 8. and can vary from day to day and can change location,
becoming more severe in parts of the body that are used more often. In some
people the pain can be intense enough to interfere with normal activities of
daily living including occupational activities.
The fatigue associated with fibromyalgia may vary between individuals,
ranging from a tired feeling to the exhaustion experienced with influenza.
Symptoms are exacerbated by environmental and emotional stress, "or an
uncaring physician who gives the patient the message that it is 'all in the
The condition exists worldwide and whilst most prevalent in adult women, it
can occur in children, the elderly and men.
Fibromyalgia may remit spontaneously with decreased exposure to stress, but
can recur at frequent intervals or may become chronic 8..
Researchers have collected useful evidence during the past several decades to
determine the link between FMS abnormalities in the hypothalamus (limbic
system and other cerebral areas), the autonomic ("automatic" or
self-controlling) nervous system and the HPA axis, which regulates production
of certain hormones and the body’s response to stress as likely in the
underlying cause of fibromyalgia 9..
The following are some significant points of investigation:
• psychological factors,
• deprivation of restorative sleep,
• local tissue factors,
• neurobiochemical abnormalities,
• physical trauma and viruses, and
• genetic factors.
Orthodox Medical Treatment of Fibromyalgia
Ibuprofen is sometimes prescribed to persons afflicted with fibromyalgia
(although clinical studies have shown that Ibuprofen is no more effective
than placebo for the treatment of Fibromyalgia10.)
Amitryptyline is sometimes prescribed to persons afflicted with fibromyalgia
(although amitryptyline provides some relief from fibromyalgia symptoms (NOT
THEIR CAUSE), its long term use is discouraged due to the severe side effects
associated with long term use of tricyclic Antidepressants).
Incapacitating areas of focal tenderness may be injected with a 1% lidocaine
solution or in combination with hydrocortisone acetate suspension 8..
Diagnosis of fibromyalgia can only be made by your medical practitioner, who
can then refer you to us.
Alternative / Complementary Approaches to Fibromyalgia
It takes time for the body's homeostatic mechanisms to readjust and
accordingly, recovery from FMS is often a slow process. Patience is required
on the part of both the practitioner and the person suffering FMS. The best
practice management of FMS is one which incorporates a personalised approach,
designed around the person's unique biochemistry and psycho-social profile.
It needs to be comprehensive, ambulatory, patient motivated and determined
upon patient involvement in order to better discover and resolve the
individual underlying causes in each case, thus addressing the whole person,
not just the physical symptoms.
Biofeedback techniques - utilises various physiological measures such as EEG,
Heart Rate, RSA Breathing, Skin Conductance, Temperature, Electromyography -
or muscle tension. These are then 'fed back' to the person via a computer
monitor, the individual is guided into various states of relaxation and
learns to monitor their own body tensions, rhythms and thoughts in order to
promote balance in the autonomic nervous system (ANS) and musculoskeletal
Nutrition and Diet - Supplemental and dietary nutritional education based
around best support for the individual at the cellular level, - addressing
such things as genetics, cell growth and function, allergic reactions,
malabsorption and autotoxicity problems, bacterial overgrowth, as well as
lifestyle and goal-setting coaching.
Body Work – Bowen therapy, CranioSacral Therapy, therapeutic massage,
osteopathy, acupuncture and vibrational therapies all have a place in relief
of musculoskeletal pain and mobilising the body's innate healing potentials.
Aerobic Exercise - light aerobic exercise has been shown to be of benefit in
1. Stedman's Medical Dictionary
2. ME Williamson, 1996, Fibromyalgia: A Comprehensive Approach, New York:
Walker and Company.
3. S Krsnich–Shriwise, 1997, "Fibromyalgia Syndrome: An Overview,"
Physical Therapy 77, January.
4. Wolfe F., 1993, Fibromyalgia: on diagnosis and certainty. J Musculoskel
5. Bennett, RM, 1996 , "A New Era of Understanding," Paper
presented at the Oregon National Convention on Fibromyalgia: A New Era of
Understanding; Oregon Convention Center, Portland, Oregon; 6-8 September 1996
6. Bengtsson, A., et al., 1989, Mitochondria damage and Fibromyalgia, Journal
of Rheumatology. 16(supplement 19):144-149.
7. DL Goldenberg, 1992, "Controversies in Fibromyalgia and Myofascial
Pain Syndrome", in Evaluation and Treatment of Chronic Pain, Edited by
GM Arnoff, Baltimore, Maryland: Williams & Wilkins.
8. The Merck Manual of Diagnosis and Therapy, 1999, Merck Research
Laboratories, Whitehouse Station, New Jersey.
9. Gail K. Adler, MD, PhD, 1999, Harvard Medical School , American Journal of
10. Yunus, M. B., et al., 1989, Short term effects of Ibuprofen in primary
fibromyalgia syndrome. Journal of Rheumatology. 16:527-532.
11. Gowans, SE., deHueck, A., Voss, S., et al., 2001, Effect of a randomized,
controlled trial of exercise on mood and physical function in individuals
with fibromyalgia. Arthritis Care Res, vol. 45, pp. 519--529