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The origin of fibromyalgia, which causes muscle and joint pain and extreme fatigue, has been debated for years: Is the body or the mind to blame? “Initially, in the 1980s, it was thought that it originated in the muscles,” says Dr. Divakara Kedlaya, medical director of the pain and rehabilitation program at St. Mary-Corwin Medical Center. “But they couldn’t find anything different in the muscles of people who had it.” The syndrome’s name reflects this earlier thinking: “fibro” refers to soft tissues and “myalgia” to muscle pain.
Some specialists suspected it was psychological in nature. Patients complaining of widespread body pain also said they couldn’t sleep, couldn’t remember, couldn’t think clearly and felt “foggy.” “When I started training, in 1995 through 1998, there was a huge controversy whether it was a medical or psychological problem,” Kedlaya says, “but by about 10 years ago, it was pretty well recognized that it’s due to changes in the brain and spinal column.
“Nobody knows why some people develop it. There might be some genetic predisposition.” A Food and Drug Administration website on living with fibromyalgia says the exact cause is unclear, but it may be due to injury, emotional distress or viruses that change the way the brain perceives pain. The vast majority of people with fibromyalgia are women, though it does occur in men and children, according to Kedlaya. And many times, these people have co-existing conditions, such as chronic fatigue syndrome, endometriosis (in women), temporomandibular joint syndrome, lupus, inflammatory bowel syndrome and others.
Inflammation doesn’t appear to play a role in fibromyalgia because anti-inflammatory drugs like steroids, aspirin and ibuprofen don’t relieve its symptoms, Kedlaya says. ‘Problem in the brain’ Kedlaya says diagnosing fibromyalgia involves a process of elimination. There’s not a diagnostic MRI to detect it, but a functional MRI, which shows changes in the brain, is helpful because it can rule out disorders the patient doesn’t have and leave fibromyalgia as a possibility. Asked how it’s treated, Kedlaya says: “It’s a problem in the brain. Opioids (pain relievers such as morphine, codeine and hydrocodone) do not work at all (for it). They haven’t been shown to have any benefits, and they may make it worse.”
Medications that have been approved by the FDA to treat fibromyalgia include Lyrica, Cymbalta and Savella. Another medicine, which hasn’t been approved for this use but which shows promise, is naltrexone, Kedlaya says. It is an opiate antagonist that’s used to help people who’ve quit using alcohol and street drugs continue to avoid them. “Some small studies have shown some benefits,” he says. Relaxation, reducing stress, increasing sleep and slow, progressive exercise can help soothe the symptoms of fibromyalgia. Some form of aerobic activity for 20 minutes a day — starting out with five minutes and building up to 20 — is helpful because of exercise’s beneficial effects on the brain.
The good news, Kedlaya says, is fibromyalgia isn’t a progressive disease. It doesn’t get worse, though a person can have “flares” which she or he should understand how to cope with.
FIBROMYALGIA SYMPTOMS Chronic widespread body pain is the main symptom of fibromyalgia. Most people with fibromyalgia also experience fatigue; sleep disturbances; sensitivity to touch, light and sound; and cognitive difficulties. Many people also have other symptoms and overlapping conditions, such as arthritis. Pain. Fibromyalgia pain can move to all parts of the body and vary in intensity. It’s been described as stabbing and shooting pain, and deep muscular aching, throbbing and twitching. Numbness, tingling and burning also may be present. Pain and stiffness are often worse in the morning.
Factors that affect the pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress. Common sites of pain are neck, shoulders, back, hips, arms and legs. Headaches may be present. Fatigue. The fatigue of fibromyalgia is “an all-encompassing exhaustion that can interfere with occupational, personal, social or educational activities.” Sleep problems. Many fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep.
Researchers have documented abnormalities in the deep sleep of these patients. Other symptoms or overlapping conditions may include irritable bowel or bladder, headaches and migraines, restless legs syndrome, impaired memory and concentration, skin sensitivity and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, neurological symptoms and impaired coordination.
— Source: National Fibromyalgia Association, fmaware.org
Some specialists suspected it was psychological in nature. Patients complaining of widespread body pain also said they couldn’t sleep, couldn’t remember, couldn’t think clearly and felt “foggy.” “When I started training, in 1995 through 1998, there was a huge controversy whether it was a medical or psychological problem,” Kedlaya says, “but by about 10 years ago, it was pretty well recognized that it’s due to changes in the brain and spinal column.
“Nobody knows why some people develop it. There might be some genetic predisposition.” A Food and Drug Administration website on living with fibromyalgia says the exact cause is unclear, but it may be due to injury, emotional distress or viruses that change the way the brain perceives pain. The vast majority of people with fibromyalgia are women, though it does occur in men and children, according to Kedlaya. And many times, these people have co-existing conditions, such as chronic fatigue syndrome, endometriosis (in women), temporomandibular joint syndrome, lupus, inflammatory bowel syndrome and others.
Inflammation doesn’t appear to play a role in fibromyalgia because anti-inflammatory drugs like steroids, aspirin and ibuprofen don’t relieve its symptoms, Kedlaya says. ‘Problem in the brain’ Kedlaya says diagnosing fibromyalgia involves a process of elimination. There’s not a diagnostic MRI to detect it, but a functional MRI, which shows changes in the brain, is helpful because it can rule out disorders the patient doesn’t have and leave fibromyalgia as a possibility. Asked how it’s treated, Kedlaya says: “It’s a problem in the brain. Opioids (pain relievers such as morphine, codeine and hydrocodone) do not work at all (for it). They haven’t been shown to have any benefits, and they may make it worse.”
Medications that have been approved by the FDA to treat fibromyalgia include Lyrica, Cymbalta and Savella. Another medicine, which hasn’t been approved for this use but which shows promise, is naltrexone, Kedlaya says. It is an opiate antagonist that’s used to help people who’ve quit using alcohol and street drugs continue to avoid them. “Some small studies have shown some benefits,” he says. Relaxation, reducing stress, increasing sleep and slow, progressive exercise can help soothe the symptoms of fibromyalgia. Some form of aerobic activity for 20 minutes a day — starting out with five minutes and building up to 20 — is helpful because of exercise’s beneficial effects on the brain.
The good news, Kedlaya says, is fibromyalgia isn’t a progressive disease. It doesn’t get worse, though a person can have “flares” which she or he should understand how to cope with.
FIBROMYALGIA SYMPTOMS Chronic widespread body pain is the main symptom of fibromyalgia. Most people with fibromyalgia also experience fatigue; sleep disturbances; sensitivity to touch, light and sound; and cognitive difficulties. Many people also have other symptoms and overlapping conditions, such as arthritis. Pain. Fibromyalgia pain can move to all parts of the body and vary in intensity. It’s been described as stabbing and shooting pain, and deep muscular aching, throbbing and twitching. Numbness, tingling and burning also may be present. Pain and stiffness are often worse in the morning.
Factors that affect the pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress. Common sites of pain are neck, shoulders, back, hips, arms and legs. Headaches may be present. Fatigue. The fatigue of fibromyalgia is “an all-encompassing exhaustion that can interfere with occupational, personal, social or educational activities.” Sleep problems. Many fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep.
Researchers have documented abnormalities in the deep sleep of these patients. Other symptoms or overlapping conditions may include irritable bowel or bladder, headaches and migraines, restless legs syndrome, impaired memory and concentration, skin sensitivity and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, neurological symptoms and impaired coordination.
— Source: National Fibromyalgia Association, fmaware.org
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