THE ESSENTIEL POINTS ABOUT FIBROMYALGIA

THE ESSENTIEL POINTS ABOUT FIBROMYALGIA

 

WHAT IS A SYNDROME? 

Syndrome means a group of symptoms that collectively indicate or characterize a disease. It is most often used to refer to the set of detectable characteristics when the reason that they occur together (the pathophysiology of the syndrome) has not yet been discovered. The description of a syndrome includes a combination of major symptoms and signs – essential to the diagnosis – together with minor findings, some or all of which may be absent.

 

 WHEN WAS THE TERM FMS FIRST USED?

Fibromyalgia was officially declared a syndrome by the World Health Organisation in the Copenhagen Declaration on the 1.1.1993. It was declared the most common cause of widespread chronic muscle pain.

 

THE INCIDENCE OF PEOPLE SUFFERING FROM FMS 

3% to 5% of the general population suffer from FMS.

FMS exists in all ethnic groups in all parts of the world. 85% of the fibromyalgics are women, while 15% are men. At least 11 millions of Americans suffer from FMS, and 200 000 people in Israel (of which at least 170 000 women). Rheumatologists report that FMS is the most common disorder they see. It may occur at all age, from children to elderly people, at most in women of childbearing age (34-53 years). Juvenile cases of FMS are not rare.

 

THE FIBROMYALGIA SYNDROME

Fibromyalgia is a complex, cyclic and chronic disease. It is different from other illnesses as it does not affect one particular type of cell or part of the body. Instead, it is manifested by a myriad of apparently unrelated symptoms. In addition there are an almost endless number of combinations, with daily variations. Each patient's prime complaints are different, and patients find it difficult to pinpoint exactly when the symptoms began. With the progression of the disease, there are conditions which are in common to all patients: fibromyalgia affects family and professional life, relationships, and disturbs the mental state.

 

DESCRIPTION OF THE MOST COMMON SYMPTOMS

Musculoskeletal: generalized pain and stiffness in muscles, tendons and ligaments, which are often worse on waking in the morning. Pains can assume any form and intensity, such as throbbing, burning, stabbing, stinging, grabbing, and any combination of these. Injured or old operative sites are often most affected. Temporomandibular joint pain is common, associated with difficult chewing, and excruciating facial and head pain originating in the neck. As well headaches, generalized, or neck-occiput, or half-head. Joint pains (or soft tissue pain next to the joints) with or without swelling are frequent (shoulders, elbows, wrists, fingers, knees). In addition there are excruciating pains in the ankles. Muscles can often be seen twitching, and the restless leg syndrome can make it impossible to find a comfortable spot. Patients often suffer from a feeling of pins and needles in their muscles or of a burning sensation, and from a generalized muscle weakness.

       The American College of Rheumatology (ACR)has established criteria of fibromyalgia diagnosis.

    1. History of widespread pain present for at least three months:
      - Pain in both sides of the body
      - Pain above and below the waist. In addition, axial skeletal pain (cervical, anterior chest, thoracic spine or low back pain) must be present
    2. Pain in 11 of 18 tender points sites on digital palpation
    3. Exclusion of other disorders that can cause similar symptoms

Those criteria are widely known and used. According to the ACR, digital palpation should be performed with an approximate force of 4 kg. A tender point has to be painful at palpation, not just "tender". But all of the criteria are not always met, and a lot of patients who actually have fibromyalgia were told that they did not have fibromyalgia. (Click for more)

Central Nervous System: fatigue, irritability, nervousness, anxieties, depression, impaired memory and concentration ("fibrofog"), apathy, insomnia, frequent awakening during the night, non-restorative sleep, blurring of vision, dizziness, vertigo or imbalance, headaches, migraines.

Gastro-intestinal: in 60% of the cases, irritable bowel syndrome (IBS) includes gas, bloating, constipation, diarrhea, or alternating diarrhea-constipation, abdominal cramps. Occasionally nausea, stomach pain and burning, hyperacidity and abnormal tastes occur.

Genito-urinary:65% of the women have genito-urinary pains. Vulvodynia (or vulvar pain syndrome), in 15% of the cases, includes vaginal spasms or cramps, raw, irritated, burning vaginal lips (vulvitis) or opening (vestibulitis) and painful intercourse (dyspareunia). In 25% of the cases, pungent concentrated urine, frequent urination, bladder spasms, burning urination (dysuria) with or without repeated bladder infections and chronic interstitial cystitis are frequent manifestations. Intense pre-menstrual syndrome (PMS) and uterine cramps are often presenting symptoms. All symptoms of fibromyalgia are worse premenstrually.

Dermatological: crawling feeling, electric vibrations, prickling, itching, rashes (many varieties with or without itching: hives, red blotches, tiny bumps or blisters, eczema, neurodermatitis, seborrheic dermatitis), burning and sometimes swollen and hot-itching palms and soles of feet, dry skin, super-sensitivity to touch, or flushing sometimes with heavy sweating. Chipping and breaking of fingernails, hair of poor quality, splitting ends, hair that falls out prematurely and slow growth. Patients often describe intense itching, that can occur anywhere, and is usually worse at night. The skin can also display dermatographia.

Miscellaneous Symptoms: excessive nasal congestion and mucus; irritated tongue, dry mouth, abnormal tastes (bad, scalded or metallic); transient ringing in the ears or swishing sounds (tinnitus); numbness of hands, feet or face, and tingling anywhere; leg or foot cramps; low grade fevers; greater susceptibility to infections and allergies; heightened sensitivity to sounds, lights, odors or chemicals; swelling of eyelids and hands in the morning; weight gain; dry eyes with itching or burning and blurred vision; skipping heartbeats (palpitations); occasionally hypoglycemia syndrome with sugar craving.

5, 10 or 20 DIFFERENT SYMPTOMS

All the cells of the body tissues may be affected. People can experience 5, 10 or 20 different symptoms, but one alone, or two, can be devastating, while to other individuals a few of them together, of more or less intensity and frequency, can affect their life. Before a number of symptoms makes a sense and grab the attention of the doctor, some may not be constant and intense, some may be experienced two to three times a month, some are even more intermittent, intense for several days and then disappear for months. And when a condition seems resolved, it returns, or a new symptom inexplicably comes to take its place. Each condition is usually studied independently by specialists, and this prevents a more complete picture of these conditions from being seen. The practitioners and their patients are intrigued that so many apparently common conditions remain medical enigmas with a lack of an effective treatment.  

 

RECOGNIZING THE INTERRELATIONSHIPS BETWEEN THESE CONDITIONS

Because each symptom has a different intensity and frequency of occurrence, it does not seem to no one, even to their doctors, that the various symptoms are connected. A long time goes on, usually years, before all the symptoms get related to FMS, nevertheless with no obvious logical explanation.

It is a revelation to my patients to discover me that a great many of their  apparently non-related different health problems, that frequently occur together, have a close relationship between them and are actually the result of one underlying problem. They feel comfort in knowing they do not have 5, 10, or 20 different problems, but one problem with 5, 10, or 20 different manifestations. And it becomes obvious that they all have one underlying problem when gradually experiencing with GUAIFENESIN a significant and long-lasting relief of all associated symptoms in most patients, and, in many cases, eventually elimination of the symptoms. One medication will reverse the course of the disease: GUAIFENESIN

 

MAJOR SYMPTOMS AND MINOR SYMPTOMS

Minor symptoms to some people may be major ones to others

1) The three most common conditions of the syndrome are:

    - Fibromyalgia, for the chronic and diffused pain in muscles, joints and tendons

    - Chronic fatigue syndrome (CFS), for low energy, sleeping, cognitive and mood disorders

    - Irritable bowel syndrome (IBS), also called by many names – colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease

It is possible for an individual to have only one of these three main conditions, but usually not for a long period of time. Most people have all three and even more conditions. The other conditions can be considered satellite conditions, but the latter may occur alone to start with, and become a main disabling condition together with others.

2) The most common satellite conditions that can be majors complaints are:

   - Interstitial cystitis (IC) characterized by discomfort or pain in the bladder, frequent need to urinate

   - Vulvar pain syndrome (VPS) including itching and dryness around the vulva, pain or discomfort during intercourse (called vulvodynia)

   - Restless legs syndrome (RLS) with an irresistible urge to move the legs often more severe in the evening and at night, together with uncomfortable feelings

   - Numbness in hands and/or feet, similar to carpal or tarsal tunnel syndrome but with a normal EMG 

   - Dizziness or lightheadedness

   - Headaches, migraines

   - Multiple chemical sensitivity (MCS), to odors, light or sounds

 

CHRONIC FATIGUE SYNDROME (CFS)

This syndrome is not really new. Only the name "chronic fatigue" is new. Similar symptoms have been consistently described in the medical literature for the past several hundred years. In fact, CFS, one of the mysteries of modern medicine, is the same disease as fibromyalgia, with the same underlying cause.

For most patients, both labels, fibromyalgia and chronic fatigue syndrome, apply at various times during their illness. For others, one symptom may always be more prevalent than another.

There is no case of pure chronic fatigue syndrome. When a careful history is taken and a proper examination conducted, it is clear that both conditions exist simultaneously. All the symptoms, although not with the same intensity, meet the criteria for fibromyalgia.

We are therefore dealing with a single condition that presents itself differently, generally dependent on an individual's pain threshold and on the areas predominantly affected. When patients have extremely high pain thresholds, fatigue is their dominant complaint. Careful questioning can elicit the symptoms of irritable bowel, bladder or vulvar pain as well as musculoskeletal complaints that seem mild to patients when compared to their fatigue, depression and cognitive dysfunction.

Depending on the severity of a brain cycle, fibromyalgics suffer from short-term memory loss; they cannot remember things they have just been told, nor can they remember where they have left things. This and the fact that their sense of direction is disrupted cause patients to get lost even in places they know very well. They often forget what they are doing or saying in the middle of a task. Reasoning and deduction range from difficult to impossible. Patients cannot read because they cannot absorb the material, follow a plot, or remember the names of characters.

They completely forget appointments and things they were supposed to do, and cannot remember whether or not they have paid their bills. During these brain cycles, patients become oversensitive to noise, bright lights, smells, and other external stimuli. They cry easily and become frustrated and angry at the slightest provocation.

It is vital to recognize that all these cognitive impairments and emotional over-reactions are a normal part of fibromyalgia experienced to some degree by those who suffer from the disease.

Chronic fatigue syndrome and patients who complain primarily of pain, are successfully treated with GUAIFENESIN.

FMS ASSOCIATED WITH OTHER ILLNESSES

Statistics reveal that other pathologies occur more frequently in persons with FMS. In more than 20% of the cases, FMS is associated with various systemic illnesses with immunologic abnormalities, such as rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, Behcet disease, Crohn disease, ulcerative colitis, Hashimoto's thyroiditis, as well hyperparathyroidism and non auto-immune hypothyroidism.

They do not have a clear cause and effect relationship. It is not always an easy matter to deal with both conditions, but they have to be treated in parallel because they have an influence one another.

 

BLOOD TESTS AND OTHER TECHNOLOGIES TO RULE OUT OTHER DISORDERS

There is not one specific laboratory test to confirm the fibromyalgia.

Many symptoms, main ones or satellites, common in FMS are also present in dozens of other disorders, making FMS difficult to diagnose. Merely FMS is a diagnosis of elimination (exclusion) after routine diagnostic tests. It may take years to rule out other disorders.

However, the practitioners and their patients are left confused because no diagnostic technology such as x-ray, ultrasound, scan, MRI, EMG or laboratory test can identify the reason for the existence of the symptoms, main or satellites ones. But normal diagnostic tests are somewhat helpful by telling doctors what conditions a person does not have. What add to the confusion is that no long-term relief treatment is found for none of the symptoms.

norkurld@zahav.net.il
Back to top of page