Is fibromyalgia in your imagination?

Fibromyalgia is a disorder of the muscles and joints characterised by widespread sensitivity to pain and marked tenderness in these areas. It appears that somewhere between 2 to 4% of the population suffer fibromyalgia of which 90% are women.

There are three common myths around this diagnosis:

  1. The most common myth is this condition is not real and is purely psychological. One of the real problems here is that there are no diagnostic tests to confirm the condition. I have often said that “science is only as good as its testing equipment.” When a doctor does not have a test to confirm a condition then there is often the suspicion that the condition is purely in the person’s head. There is no doubt that sufferers of fibromyalgia have often multiple trigger points throughout the body that are at times excruciatingly painful to touch.
  2. The condition generally affects older women. Although this is probably the case in around 80 to 90%. It still can commonly affect men and women at any age.
  3. The pain is minimal. The reality is that this condition can be incredibly debilitating in a number of cases.

As stated above, apart from the symptomatology and the finding of trigger points, there are no tests to confirm the diagnosis. There are, however, a number of associations and precipitants that may give you a clue to the diagnosis.

  1. Acute life trauma — significant physical accidents or emotional trauma such as the death of a loved one, relationship issues, may precipitate the condition.
  2. Recurrent injuries can cause tearing, twisting and bending of the muscles and joints and thus precipitate fibromyalgia
  3. There are some suggestions that there are genes involved as it does appear to run in families
  4. One of the major theories is that fibromyalgia is a problem with the way the central nervous system processes pain messages from the body
  5. There are a number of associations with this condition including post-viral syndrome, chronic fatigue syndrome, Lyme disease, any sleep disturbance, arthritis, adrenal and thyroid abnormalities, depression, headaches and migraines, painful periods and irritable bowel syndrome.

A flare up of fibromyalgia typically occurs when a person is under significant stress. This may be excessive physical stress, emotional stress, mental stress or even pharmacologic stress — legal or illegal. Poor diets, hormonal changes, changes in sleep, temperature or weather have all been precipitants.

Before a diagnosis of fibromyalgia is made, it is important to exclude other illnesses such as any inflammatory condition of the muscles. It is important that your doctor does do a screen for inflammatory and other arthritic conditions.

Some interesting associations of fibromyalgia are as follows:

  • Excessive sweating: 32%
  • Burning sensation of the skin or mucous membranes: 3.4%
  • Unusual skin sensations: 1.7%
  • Skin lesions from repetitive scratching, itchy lumps on the arms and legs or thickened skin areas that itch: around 2%
  • Itching with no identified cause: 3.3%
  • Inflammation of the skin that is not itchy: 9%

The American College of Rheumatology have given specific criteria to make the diagnosis of fibromyalgia

  1. Pain and other symptoms that have lasted for a least three months with painful areas in at least 7/19 body areas
  2. No other health issues to explain the pain and other symptoms
  3. Associated symptoms such as fatigue, waking up unrefreshed, memory or other problems with cognition and any other general physical problems.

Treatments

As with many conditions, one of the keys to managing fibromyalgia is maintaining a healthy lifestyle.

This is where the “Five Walkerisms for Good Health” are very important:

  1. Quit all addictions
  2. Good quality sleep — cultivating healthy sleep habits is a vital in managing fibromyalgia, along with having adequate rest and relaxation during the day.
  3. High quality nutrition is also important in this situation

The Cleveland Clinic has recommended an anti-inflammatory diet which may be of some help. Interestingly, this is basically a healthy diet which is good for anyone and includes an high intake of fruit and vegetables

  • Whole grains
  • Limiting excess dairy
  • Reducing red meat

It appears that low vitamin D levels maybe associated with fibromyalgia and having foods such as eggs, Fish and whole grains fortified with vitamin D maybe of some benefit.

4. Exercise — although exercise may be a bit difficult with a chronic pain situation, it is important to have moderate exercise every week if you’re a sufferer of fibromyalgia. This includes aerobic, along with strength and resistance training

5. Stress management — cultivating happiness, having a meditation habit and many other factors in relieving stress will certainly help the symptoms of fibromyalgia.

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created for Dr Ross Walker by brigital.com.au

Acupuncture, massage, yoga and tai chi are all very useful and important aspects of management.

Physiokey & PainMaster should also be considered for this condition.

A variety of painkillers are used for this disorder including common drugs such as paracetamol, ibuprofen and naprosyn. Some patients need to be on the stronger pregabalin or gabapentin. A variety of antidepressants also have pain modulating effects and may be useful in this situation.

There is some hope that medical cannabis may be an effective treatment for fibromyalgia although no good studies have been performed as yet.

Fibromyalgia is not a psychological disorder and can be very debilitating in many cases. It should be taken seriously by the medical profession and the friends and relatives of the person who is affected by this disorder. Although there is no magic bullet for this condition, as I have stated, a combination of lifestyle, physical and mechanical therapies are very effective in giving relief.

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Dr Walker is an expert in the field of preventative cardiology and has published seven books. He gives lectures nationally and internationally.

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