Posted by MERM on 6/15/2008, 12:41 pm
If you are already diagnosed with either of these illnesses, you are luckier than all the people suffering without knowing what they have and without getting good advice about what they can do.
These pages are for people who may have one or more of these conditions and for their companions and health care providers. Many of these pages are referenced with medical texts and journal articles and are periodically updated. They may help you to discover and understand what's going on and what you can do about it.
Fibromyalgia syndrome (FMS) and chronic myofascial pain (CMP) are real conditions, and they are not the same. You may feel that FMS alone is too difficult to understand and control without adding another invisible illness that most care providers know little or nothing about. The understanding of myofascial TrPs will actually make things simpler. Myofascial trigger points (TrPs) are well documented and can cause the peripheral stimulation that is sustaining the central sensitization of FMS. You have what you have, and you need to deal with it. One of the reasons most people, care providers included, find FMS complicated is that CMP frequently co-exists and muddies diagnostic and treatment waters.
You need to understand both of these conditions to be able to separate the impact they are having in your life and to know how to deal with each symptom. Once you grasp the concepts behind these conditions and act on your knowledge, your health will improve and you will regain some control. Learning the separate pain patterns and symptoms associated with your TrPs may seem daunting, but it is no more difficult than learning the alphabet, and many of the TrP referral pain patterns may already be familiar. Once you know where they originate, you may be able to get at the sources of many of your symptoms. Identifying and controlling many of your perpetuating factors for both FMS and CMP is under your control. With a little direction, you can do a lot for yourself and your own well-being.
Fibromyalgia Syndrome
FMS is not a catchall, "wastebasket" diagnosis. FMS is a state of central sensitization. This means that your central nervous system may be unusually sensitive to pain (hyperalgesia) and you also may find certain sounds, vibrations, light, and other sensations (even smells) to be translated by your body into discomfort or pain. Certain types of sound, such as staccato music or talk, or certain pitches, may be unendurable and promote increased sensitivity to other stimuli. The same may be true of the pattern of shadow and light by trees passing along in a car, or even being stuck in an elevator or car with a woman with heavy perfume. Diffuse, body-wide pain is part of FMS, but not all of it by any means.
Fibromyalgia is not yet considered a disease. Diseases have known causes and well-understood mechanisms for producing symptoms. FMS is a syndrome, which means it is a specific set of signs and symptoms that occur together. Syndromes are no less serious or potentially disabling than diseases. Rheumatoid arthritis and lupus are also classified as syndromes. Lab tests for FMS do not exist right now. Lab tests are valid only to check for co-existing conditions. You can have other conditions and also have FMS.
You have probably heard about the official FMS definition requiring 11 of 18 tender points to be present. This was part of the criteria originally to be used to define patients to be admitted into clinical studies of FMS, and the tender points had to be present in all four quadrants — that is, the upper right and left and lower right and left parts of your body. You must have had widespread, more-or-less continuous pain for at least three months. This was not originally intended to be diagnostic. Since most clinical studies fail to separate symptoms of FMS from co-existing CMP, the conclusions of many studies may be faulty.
Tender points occur in pairs on various parts of the body. In traumatic FMS, tender points may be clustered around an injury instead of, or in addition to, the 18 "official" points. These clusters can also occur around a repetitive strain or a degenerative and/or inflammatory problem, such as arthritis. Localized pain usually indicates a co-existing condition, such as chronic myofascial pain (CMP), but even with CMP this can be misleading, as you will read later.
Neither FMS nor CMP are inflammatory conditions. FMS can occur at any age. Most patients, when questioned carefully, reveal that their symptoms began at an early age. About 25 percent of the FMS patients I have come in contact with are men. This ratio differs from most sources in the literature. I think that FMS is under-diagnosed in males.
Flu-like achiness is frequently the most prominent symptom of FMS, but there are many others. For example, your eyes may be too dry, but at other times they will water.
Your thermal regulatory system may be out of whack.
You may notice this when you get out of bed (which may be often, due to bladder irritability) during the night.
You may have to wait for your temperature to cool down after getting back in bed before you can pull the bedcover up.
You may experience confusional states, memory dysfunction, and an inability to do more than one thing at once.
You may be able to focus on a specific skill and function at a high level in you field, yet be unable to balance your checkbook or remember appointments. You may experience skin mottling.
Your finger and toe nails may have vertical ridges — a typical sign of endocrine imbalance.
Fingernails may break off, often in crescent-shaped pieces. If nails do grow, some may start to curve under (beaking).
People with FMS can be sensitive to changes in barometric pressure and temperature.
Rain beating on the windowpane may feel as if it were beating on the walls of your cells.
The noise emitted by fluorescent lights can drive you crazy, and you may have to avoid overcrowded areas such as malls or cities.
FMS sensitizes nerve endings as well as the rest of the autonomic nervous system. The actual ends of the nerve receptors may have changed shape, turning touch and other receptors into pain receptors. Pain signals then bombard your brain.
Your brain knows pain is a danger signal — an indication that something is wrong and needs attention — so it mobilizes its defenses. Then, when those defenses aren't used, it becomes anxious. Overstimulation is a major perpetuating factor of FMS.
Restorative sleep plays a crucial role in FMS. Perhaps you aren't getting enough sleep, or the right kind of sleep. You may have insomnia or a host of other sleep-related problems.
You may have sleep apnea, or your heightened sensitivity does not allow you to sleep deeply.
Our body heals and many neurotransmitters are balanced during deep sleep, and without it we soon suffer from the effects of sleep deprivation. It isn’t enough that you spend eight hours in bed.
When you wake, you must feel refreshed and restored.
Lack of restorative sleep is a major perpetuating factor of FMS, and you may need to work with your doctor to find medications that can help. You may also need to adjust your diet and life style to avoid stimulants such as sugar and caffeine. You may need help learning how to handle stress. You may also need to adjust your bedroom environment including the bed and pillows.
Myofascia
Myofascial pain is probably the most common cause of musculoskeletal pain in medical practice (Imamura, Fischer, Imamura et al.1997). It is a vital but often unrecognized factor in the practice of medicine.
Pain from myofascial dysfunction is probably at the source of many of your symptoms.
The white, translucent covering you sometimes see on a chicken breast under the skin is fascia, pronounced “fass-she-uh.” That is only part of the fascia story, however.
Fascial is not facial, although you do have fascia under your face.
Fascia is almost everywhere in the body, and its boundaries are hard to define. There is no specific field of medicine dealing with fascia or myofascia, and yet it touches all specialties as well as general practice. Fascial dysfunction can mimic many conditions and affect many body systems.
A small change in the myofascia can cause stress to other parts of your body. Restriction of one major leg joint can increase the energy used in walking by as much as 40%.
If two major joints are restricted in the same leg it can increase by as much as 300% (Greenman, 1996).
Multiple minor restrictions of movement, particularly those affecting the way you walk, can use up your energy and increase fatigue.
Fascia is medically separated into three layers, but it is all continuous and three-dimensional.
Message Thread:
« Back to thread