“I am exhausted and hurt all over. I can’t get to sleep at night and when I do, I wake up at the drop of a dime. I went to my doctor and they ran some blood tests and took some x-rays and said that nothing was wrong. I just don’t know what is wrong or what to do about it.”
This is a classic history obtained from a patient suffering from fibromyalgia or FM. Because the onset of fibromyalgia is slow and gradual, it is common for patients to postpone visiting their healthcare provider until the symptoms are quite significant. The diagnosis may also be delayed as many healthcare providers do not feel fibromyalgia is a legitimate medical condition and minimize the symptoms and frequently categorize the patient as “depressed,” which postpones an appropriate diagnosis and treatment.
The classic definition as defined by the American College of Rheumatology includes at least a three-month duration of symptoms with the presence of 11 out of 18 potential tender points although diffuse, widespread pain not necessarily restricted to these exact locations may also represent an appropriate diagnostic finding in fibromyalgia.
Fibromyalgia is more common in females and affects approximately 2% of the population in the United States. The risk for fibromyalgia increases with age, usually developing during early and middle adulthood but can also develop in children and older adults. Other risk factors include a positive family history where one may be more likely to develop FM if a relative suffers with the same condition.
A major risk factor of developing fibromyalgia includes is disturbed sleep pattern and this remains controversial as to whether sleeping disorders are a direct cause or simply the result of fibromyalgia. However, in either case, people with FM cannot obtain deep “restorative” sleep and feel fatigued and tired upon waking in the morning. Sleep disorders, including sleep apnea and restless leg syndrome, are often present in patients with fibromyalgia.
Certain conditions such as rheumatoid arthritis, irritable bowel syndrome, hypothyroid, and other endocrine/hormonal conditions may preceded the onset of fibromyalgia in which case the condition is considered “secondary fibromyalgia.” Hence, a diagnostic evaluation usually includes a blood test for hypothyroid, autoimmune diseases such as rheumatoid arthritis, and a complete blood count to rule out infections and/or anemia. In most cases, these tests prove negative and the diagnosis is made by excluding other possible primary conditions.
Other causes can include physical and/or emotional trauma where a high-level of stress can trigger this condition. Although experts still debate why patients with fibromyalgia hurt so intensely, the current explanation centers around a theory called central sensitization. This is essentially a lower pain threshold where patients with FM feel pain much sooner than those without it because of increased sensitivity in the brain and/or spinal cord to incoming pain signals.
Treatment of FM relies on a multidiscipline, multifactorial approach including stress reduction, obtaining enough sleep, exercising regularly, pacing yourself, and maintaining a healthy lifestyle, including diet and exercise. Medications to facilitate sleep, treat depression and any other underlying medical conditions may be appropriate. Other highly effective treatments, according to the Mayo Clinic website, include chiropractic treatment, massage therapy, and/or acupuncture. The concepts of chiropractic treatment includes restoring movement in restricted spinal joints resulting in improved nerve function and subsequently, improved overall function and reduced pain. Chiropractic care also includes soft tissue therapies, physical therapy modalities, nutritional counseling, patient education, and many utilized in-house massage therapy.