Fibromyalgia

WHAT YOU SHOULD KNOW

Causes

Although no single cause has been identified, there are a number of theories. Some researchers think the culprit may be an imbalance in the nervous system's chemical messengers, in particular serotonin. Low levels of this chemical are typical among fibromyalgia sufferers; and the depression, migraines, and digestive distress that frequently accompany fibromyalgia have also been linked to a serotonin deficit.

Sleep disturbances may also play a role. People with fibromyalgia often suffer from a lack of the deep, non-rapid eye movement sleep that's especially restorative. Stress and emotional pain are other suspected causes, and doctors have noticed that a physical injury to the upper spine can trigger the disease in some people. Viral infection is another possible cause, though no specific virus has been identified as the culprit. Some studies also suggest that a tendency toward fibromyalgia may run in families.

Signs/Symptoms

If you have a true case of fibromyalgia, you'll be troubled by at least 11 of 18 "tender points"---specific areas on your neck, shoulders, upper chest, elbows, hips, and knees---that feel intensely painful when touched. There may be additional tender points throughout the body; and it isn't unusual for the most significant area of pain to shift over time. This widespread pain lasts for at least 3 months.

You're also likely to suffer general aches, pain, and stiffness. Some people are plagued by deep, muscular aching; others suffer burning or stabbing pains. The pain and stiffness are often worst in the morning, especially after a bad night's sleep. Most fibromyalgia victims also suffer from a variety of additional symptoms, including fatigue, sleep disturbances, irritable bowel syndrome (constipation, diarrhea, abdominal pain, and bloating), chronic headaches, pain in the muscles and ligaments around the jaw, and heightened sensitivity to changes in the environment, such as odors, lights, and noise.

Other potential symptoms include depression, mood changes, anxiety, memory problems, trouble concentrating, numbness or tingling in the hands and feet, chest pain, pelvic discomfort, irritable bladder, dry eyes and mouth, and dizziness.

Care

To establish a diagnosis, your doctor will have to rule out a variety of disorders with somewhat similar symptoms, such as lupus, rheumatoid arthritis, multiple sclerosis, and Lyme disease. Once the diagnosis is firm, your first priority will probably be an exercise program. Exercise eases sore muscles, increases range of motion, and promotes deep sleep.

Certain medications may also be helpful. The doctor may prescribe low doses of antidepressants such as Elavil and Prozac. The muscle relaxant Flexeril may relieve pain and promote better sleep. Pain-relieving shots directly into the tender points sometimes help. The over-the-counter pain reliever Tylenol can also be helpful. (On the other hand, nonsteroidal anti-inflammatory pain killers, including aspirin and ibuprofen, are rarely effective because the disease does not involve inflammation. For the same reason, cortisone and steroid medications are unlikely to help.)

A variety of stress-management techniques can prove beneficial. Meditation, biofeedback, hypnosis, and movement training have all shown promise. Acupuncture has helped in at least one study. Other possibilities include massage, chiropractic manipulation, and application of ice and heat packs.

Although a few people recover completely; the majority continue to suffer periodic bouts of pain. Fortunately, a multipronged attack on the problem can provide significant relief. It's also reassuring to remember that this is one disease that doesn't get worse: It won't become physically crippling or life-threatening.

WHAT YOU SHOULD DO

• Keep yourself as healthy as possible. Talk with your doctor about the diet, exercise, and stress-management strategies that can help you cope with fibromyalgia.
• Eat a balanced, nutritional diet regularly. To combat fatigue, experts recommend a diet low in fat and high in fiber, with plenty of fruits, vegetables, whole grains, and beans, and only limited amounts of dairy and beef products. Some studies indicate that fish oil, magnesium/malic acid combinations, and vitamins may help. However, before drastically changing your nutritional intake, talk with your doctor or a nutritionist about designing a diet specifically to meet your needs.
• Limit your intake of sugar. The brief burst of energy it gives you at first is usually followed by a slump. Eat more fruit and grain products instead.
• Reduce your consumption of alcohol and foods and drinks that contain a large amount of caffeine, such as coffee and soft drinks.
• Participate in some form of moderate exercise three to four times per week. Low-impact aerobic exercise, such as stretching, walking, swimming, or biking is best for people with fibromyalgia. This type of exercise will not increase your pain, while vigorous activities such as jogging or high-impact aerobics may make your symptoms worse. Start off slowly and increase your exercise time gradually until you can exercise continuously for 20 or 30 minutes per session. In the long run, a good exercise program will reduce your pain---just don't overdo it.
• Because a lack of deep, uninterrupted sleep is thought to be a contributing factor to fibromyalgia, try to get at least seven hours of sleep each night and nap during the day if you feel tired.
• Try to reduce the stress in your life. Experiment with various ways of dealing with it, such as deep breathing exercises, muscle relaxing techniques, meditation, or yoga.
• Join a local support group. Talking with others who are experiencing the same type of problems often can help.

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