Fibromyalgia

I found this article published in the Korea Herald, Friday, October 12, 2012, as very interesting. The article got a lot of space on page 5 of the physical newspaper with an article on the sharp increase in breast cancer among Korean women as taking the most space. Fibromyalgia is something that was rarely discussed just a few years ago, but in the past few years the autoimmune disease is rather widely known and commonly discussed. In my home church of about 60 members, I can quickly name four women who have it, and I will add that I don't know the health situation of probably one-half of the church. That's dramatically higher than the estimated 2%, or 1.4 people in our congregation, who are guestimated to have fibromyalgia within the American population.

I'm always comparing autoimmune diseases, looking for similarities and in how they differ, because all diseases are a result of some, but varying, imbalance(s) and if the imbalance can be found, it can be altered by careful food selection and a change in lifestyle. This does not mean the disease can be forever cured but in many instances, the disease can be managed or completely subdued with a carefully restructured lifestyle. Another article "Fibromyalgia" by Leslie Arnold, MD, gives evidence that fibromyalgia is the result of reduced neurotransmitters norepinephrine and serotonin creating an abnormal central nervous system response. Comparing reduced neurotransmitters with two other autoimmune diseases having reduced neurotransmitters creates an interesting comparison. Both Parkinson's disease and Tourette's syndrome have deficiencies and/or misfirings of the neurotransmitters dopamine and serotonin.

The common factor for these three diseases is serotonin, which is a mood neurotransmitter. Without proper levels of serotonin, a person could feel very anxious and depressed. Add anxiety and depression to low levels of norepeinephrine, which controls pain, cognition, mood and movement, and the outcome is moody depression in pain aka fibromyalgia. Or, add anxiety and depression to low levels of dopamine, which controls regulation of movement, emotional response, and pain and the outcome is frozen expressionless depression aka Parkinson's and also Tourette's by neurotransmitter definition but I wouldn't call their bodies "frozen" but rather impaired by jerks, another type of movement disorder.

In any case, on the anthropological level, this article, by its inclusion in the newspaper and getting such a large area of print, is making clear that there is a rising problem within society, and although medical science cannot pinpoint the exact cause of the problem, there are treatments and lifestyle methods to treat the disease. BTW, I find this picture very interesting also, especially as the picture is of a man supposedly suffering from fibromyalgia whereas the majority of sufferers are women (80%).

 

The article: Fibromyalgia

 

Fibromyalgia commonly occurs in adult women aged between 20 and 60 years old. There are broad areas of the body that are painful and there is chronic pain in the musculoskeletal pain. Patients often complain of fatigue, sleep disturbance and sub-chronic spasticity, irritable bowel syndrome, edema, poor circulation in the fingers or extremities, anxiety and depression and loss of function. An important characteristic of the pain is pressure pain, which occurs when a certain part of the body is pressed. Fibromyalgia may temporarily alleviate but it is a chronic condition. Treatment may improve the symptoms but the condition often lasts for several years.

Cause

The cause of fibromyalgia is not yet known. It is thought that trauma, or several emotional stressors such as divorce or loss of spouse, contributes to the condition. It is also believed to be associated with sleep disturbances. Recent studies have suggested the association with imbalances in neurotransmitters, abnormal amino acids in the blood, abnormal oxygen use of tissues and viral infection. The cause of fibromyalgia has not yet been found from investigations and tests, so patients are often told that there are no known problems with their condition.

Symptoms patients feel:

●Painful areas on the body and a feeling of fatigue even without doing hard work.

●Areas on the body which show pressure pain

●Stiffness and a lack of feeling refreshed in the morning

●Light sleeping

●Tingling or changes in sensation

●Headache and dizziness

●Anxiety or depression

●Abdominal pain and frequent diarrhea or constipation

●Decreased concentration or memory problems

●Skin rashes or itchiness

Diagnosis
*American College of Rheumatology Diagnostic Criteria (1999)

●The diagnosis is made by exclusion of other conditions

●At least 11 out of the 18 pressure points are painful to pressure and this pain should continue for at least 3 months. There should be pain in the right and left side, the lower and upper body, neck and the lower back musculoskeletal system.

●Decreased movement due to musculoskeletal pain.

●Disturbances and sleep and not feeling refreshed after sleep.

●Temporary joint spasticity in the morning

●Decreased tolerance to cold or high humidity

Treatment

Treatment requires the patient to engage in regards and emotional modification, so the most important aspect of treatment is patient education.

Drugs such as amitriptyline, cyclobenzaprin, NSAIDs can be used, as well as cognitive behavioral therapy.

Local anesthetic injections at pressure pain spots and heat therapy can be effective, depending on the patient.

Medications are also used to help people sleep deeper. The patient should not feel dizziness or stagger when waking up in the morning. The symptoms start to improve after treatment for 4 to 6 weeks.

Sleep disturbance or lack of sleep can make the symptoms worse so it is important to develop regular sleeping habits. Patients should go to bed at a set time and avoid taking naps during the day.

Light cardiovascular exercises are helpful but strenuous exercises can worsen the symptoms.

Support and education

The patient needs to understand about the characteristics of the condition and will need support and understanding from their families.

Patients should be aware that physical, emotional and environmental stressors could contribute to their pain and fatigue. Therefore, it is important that they make appropriate lifestyle adjustments. Patients should avoid worrying too much about their symptoms and should try to relax the mind and the body.

By Cha Hoon-suk

The author is a doctor at the Division of Rheumatology at Samsung Medical Center and a professor of Sungkyunkwan University school of Medicine. ― Ed.