Cracking the Case of Fibromyalgia

Fibromyalgia (FM) is musculoskeletal syndrome that causes widespread pain in the joints and muscles coupled with intense fatigue, sleep, mood and memory issues. More than twelve million people suffer from FM syndrome with most of the affected being women between the ages of twenty-five and sixty. The fatigue that FM patients feel is one that often leaves them unable to get out of bed or stand well. Some of the effects of having FM culminate in anxiety, depression, tension headaches, IBS and TMJ.

What Fibromyalgia is And is Not

The disorder seems to amplify painful sensations, amplifying making the person with the disorder overly sensitive to even the slightest pain stimuli. It’s believed that the pain centers of the brain and the spinal cord in someone with FM process the signals very differently and small discomforts are processed as debilitating pain. In most cases the symptoms usually start after a particularly traumatic physical encounter, and infection or during a time of intense psychological stress. In other cases symptoms are accumulated over time without an event that triggers it. Because the symptoms of FM are so subjective, it can be hard to diagnose because of a lack of any sort of standardized, replicable  testing method, it is often misdiagnosed and many people spend years suffering before relief is found.

FM does not have a genetic component and the people that have the disorder don’t seem to share many points of commonality. It would be difficult to look at the medical histories of a group of people and figure out which ones are most likely to eventually suffer from FM. The most common point of connection for FM sufferers in that most are women. 

Stumbling Blocks to Diagnosis

Another difficulty that many with FM encounter is that even though the disorder is more widely acceptable than it once was, there is still an unwillingness on the parts of many doctors and other medical professionals to believe that FM is an actual disorder that bears treatment. Patients suffering intense pain were thought to be prescription seekers and turned away by many health providers. In the last decade or so, there has been considerable research done into the disorder and it has gained wider acceptance within the medical community, as such patients now have an easier time getting help with symptoms. 

FM patients may also play a role in either misdiagnosis of their disorder because the symptoms are so wide ranging. We are conditioned to expect medicine to pinpoint with precision the causes of our discomforts and most often offer an outright cure. Most of the time traditional diagnostic methods or treatment approaches don’t work with FM. But it’s not just a source of frustration for FM patients, but for the healthcare providers as well, because they want to help but are sometimes unable to do so when the disorder is not very well understood.

Beyond the symptoms of physical pain, there is an emotional component that is a part of FM due to sometimes debilitating nature of the disorder. There are times when simply standing for a few minutes, or sitting up are more than some patients can bear. Patients can become home bound for long periods of time that leads to an isolation that can be hard to get out from under when almost all in person social interaction ceases. This can lead to depression, anxiety and feelings of shame and hopelessness. 

Non-Medical Methods of Managing FM

There have great strides in treating FM with different medications, most being trial and error. But a great emphasis has been placed on lifestyle changes as it’s believed that it can mitigate some of the symptoms. There are advocates that insist that certain foods such as refined flour, gluten, dairy and sugar contribute to FM symptoms, but there is not enough research to support those claims. It’s also thought that there is some correlation between being overweight and FM, but once again is something that needs more study.

Perception of pain is often worse than the pain itself when it eventually happens. There have been studies that show people who suffer from intense pain anxiety often feel more pain than people who don’t when undergoing either the same trauma or procedure. Relaxation is a key part of lessening pain anxiety and meditation is recommended as tool to help FM patients learn to relax whilst so as to manage impending pain symptoms.

Another that is thought a good way to manage the pain of FM is through acupuncture. The process involves placing fine needles into strategic points of the body in varying degrees. They’re then left in place for various times frames and can be stimulated even further by applying heat or electricity. Acupuncture is often used to treat pain in other situations, and can be used to minimize the pain of FM but the gain seems to be modest at most. However the risk benefit ratio is low and it’s a perfectly safe practice when performed by someone that is trained in the art. FM is difficult to manage for most, so anything that provides even the slightest amount of relief is welcome to FM patients.      

Medical Management of FM

There are medications that can be used to treat FM although there hasn’t been anything that is specifically created for it, but some medications used off label are helpful in managing the pain and some non-medical symptoms associated with FM. The class of anticonvulsants Pregabalin and Gabapentin have been FDA approved for use in treating FM. These drugs are ones most often used by people with seizure disorders.

When used neither drug was found to have effect on significant pressure point pain, but it was thought that they way it interacts with the brain caused pain sensitivity in FM patients to decrease. Gabapentin and similar drugs is thought to affect the nerves that conduct pain impulses by binding a sub unit of voltage gated calcium channels on neurons, which reduces the calcium flow into the nerve cell, this in turn reduces the release signaling molecules that are part of pain processing. While being the most effective treatment for FM on the market at the moment, patients have reported side effects of drowsiness, dizziness and a slowing of the thought process.

The antidepressant Savella (milnacipran) also has FDA approval for treatment for FM though not as an antidepressant, but as an additional  tool targeted at treating the overwhelming fatigue that is a part of the disorder as well as the pain. It works by affecting the levels of the neurotransmitters serotonin and norepinephrine which lessen the effects of the nerve fibers that carrying pain signals in the brain. Muscle relaxants are also occasionally prescribed to treat FM. One rather dangerous side effects of both antidepressants and gabapentin is that they can lead to thoughts of or an increase in suicidal idealization particularly in young adults and persons predisposed such as people with Bipolar Disorder and other depressive disorders.

Living with Fibromyalgia

Along with medications and alternative medicine practices other activities such as deep tissue massages, moderate aerobic exercise as least twice a week are great additional steps that may relieve the pain. Life with FM doesn’t need to be one of chronic pain and suffering as it’s now being recognized as a legitimate disorder and studies are being conducted to into the most effect ways to treat and manage it, and people with FM now have more resources and options for treatment.