Fibromyalgia – extracts from August newsletter
Several of my patients have asked me to write about Fibromyalgia this month, whilst not a particular seasonal topic it is one of the top five conditions I see in my clinic. We all get aches and pains every now and then but fibromyalgia is more than that – another strange collection of symptoms caused by so many different things that makes it difficult to treat… a little like IBS I guess. Nearly everyone I have spoken to knows someone who is suffering. In the UK, fibromyalgia in the general population has a prevalence ranging from 1.3 to 7.3 percent, costing the NHS billions each year. However because it is difficult to diagnose, those figures could be even higher.
What is fibromyalgia syndrome (FMS)?
FMS is a rheumatic disorder characterised by chronic, achey, muscular pain that has no obvious physical cause. It most commonly affects the lower back, neck, shoulders, back of the head, upper chest and the thighs, although any areas of the body may be involved. The pain is described as burning, throbbing, shooting and stabbing. The pain and stiffness is often greatest in the morning than at other times of the day and it may be accompanied by headaches, strange sensations in the skin, insomnia, irritable bowel syndrome, and TMJ (sore jaw joint). Other symptoms often experienced by people with FMS include:
PMS, painful periods, anxiety, palpitations, memory impairment, irritable bladder, skin sensitivities, dry eyes and mouth, a need for frequent changes in eyeglass prescriptions, dizziness and impaired coordination.
Such activities as lifting and climbing stairs are often very difficult and painful. Depression often accompanies this disorder. Because the immune system is typically compromised, opportunists like viral and bacterial infections are common as well. The most distinctive feature of FMS, one that differentiates it from similar conditions, is the existence of certain tender points – there are eighteen specific spots where the muscles are abnormally tender to the touch. These points tend to cluster around the neck, shoulders, chest, knees, elbows, and hips and can include the following: around the lower vertebra of the neck, in the upper and outer muscles of the buttocks, on the side of the elbow, in the mid back muscles, in muscles connected to the base of the skull, in the middle of the knee joint and around the upper part of the thigh bone.
There are 5-6 million people suffering from FMS in the US, and between 1.5 – 7% of the population in the UK. However, the real number of cases is probably much higher as this condition is often misdiagnosed. FMS manifests itself in a similar way to chronic fatigue sydrome (CFS) and rheumatoid arthritis and as a result it can take a long time for a proper diagnosis to be made. In the past FMS was known as fibrositis or fibromyositis but these terms are now considered inappropriate because they imply inflammation of some sort.
Most people with FMS also have an associated sleep disorder known as alpha EEG anomaly. In this disorder the individuals deep sleep periods are interrupted by bouts of waking type brain activity, resulting in poor sleep. Some people with FMS are plagued by other sleep disorders as well, such as sleep apnoea, restless leg syndrome and bruxism. Not surprisingly given all these sleep difficulties people with FMS offer suffer from CFS. Other disorders that can be found along side are:
Chemical or food allergies
Dizziness and loss of balance
Memory loss and difficulty in concentrating
Sensitivity to bright lights or loud noises
Sensitivity to dairy products
Stiffness in the morning and often on waking
What causes FMS?
FMS is more common in females than in males and most often begins in young adulthood. In most cases, symptoms come on gradually and slowly increase in intensity. They can be triggered by a number of different factors, including overexertion, stress, lack of exercise, anxiety, depression, lack of sleep, grief, trauma, extremes of temperature and or humidity and infectious illness. In the majority of cases symptoms are severe enough to interfere with normal daily activities. The course of the disorder is unpredictable. Some cases clear up on their own, some become chronic, and some go through cycles of flare-ups with periods of remission.
The causes of FMS are unknown and there are no tests that can diagnose FMS with complete certainty. Some evidence points to a problem with the immune system. Also a disturbance in brain chemistry may be involved or sometimes depression. Other possible causes are the Epstein Barr Virus, systemic Candida albicans, anaemia, parasites and hypothyroidism. When a patient comes to me with fibromyalgia, the above is usually looked at plus an extensive food diary to distinguish if any foods are making the condition worse. There is a huge link between inflammation in the gut and FMS and this is usually where I start the investigation process.
Tips for FMS
Drink plenty of fluids.
Include pomegranate juice in the diet – it contains anti inflammatory and antioxidant properties.
Limit consumption of green peppers, tomatoes, white potatoes and aubergine. These foods contain solanine which interferes with enzymes in the muscles and can cause pain and discomfort in some. (This won’t help everyone though).
Try to avoid red meat and foods high in saturated fat – they can promote the inflammatory response and increase pain.
Try to avoid caffeine, alcohol and sugar.
Avoid wheat and brewers yeast until symptoms improve.
Maintain a regular programme of moderate exercise. A daily walk followed by stretching exercises would be good. If you have been sedentary before, start slowly and be careful not to over exert yourself.
Be sure to give your body sufficient rest. Set aside eight hours of sleep each night. Sometimes a hot shower on waking can stimulate circulation and help relieve morning stiffness. Or for some alternate between hot and cold. Cold showers seem to be better for pain whereas hot baths help relax muscles.
Have your doctor check your thyroid function. Symptoms of hypothyroidism can mimic those of FMS
Considerations with FMS
Chronic pain sufferers especially those with CFS or FMS tend to be low in magnesium.
Do get checked for other underlying conditions that could be causing your symptoms e.g. Lymes disease, depression etc.
Recent research points to the possible involvement of chemicals/food sensitivities in FMS. This is not surprising as humans have been exposed to more chemicals in the last fifty years than in all the rest of our history combined.
Studies are being conducted on the possible role of a genetic defect that interferes with the formation of ATP (the source of cellular energy).
Some doctors prescribe low dose antidepressants for FMS and these drugs can be beneficial but of course may cause other unwanted side effects.
Physical therapy, relaxation techniques, exercise therapy, massage therapies and biofeedback are all helpful in some cases.
FMS appears to be a complex syndrome (and certainly can be). When patients come to see me they bring a comprehensive food diary and more often than not will be suffering from some sort of IBS as well. The link between the two is complex but in much the same way as gluten can make you “ill all over” looking at inflammation in the gut, digestion and if foods are making you ill is paramount. Whatever the cause, each person needs to be treated individually as the causes will be different from person to person.
If you know anyone who is struggling with FMS and would like some help, please contact me on 01323 737814.