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Fibromyalgia Syndrome

Bartholomew Skinger, LMT Mar 9, 2011

Fibromyalgia is a chronic pain disorder (not contagious) which is characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness (including ligaments and tendons), general fatigue, and sleep disturbance.  The most common sites of pain include the back, neck, shoulders, pelvic girdle and hands though any part of the body can be affected.  This disorder affects about 3 million to 6 million people each year in the United States alone.  It mostly affects women, usually Caucasian, and typically develops between in early to middle adulthood, according to the FDA.  Men only account for about 2.7% of the patients affected.  Overall, people with fibromyalgia account for about 3% to 6% of the total U.S. population.

Diagnosis can be difficult.  Some patients have pain far worse than others.  For some, the pain is continuous while for others it comes and goes. The muscle pain can range from mild discomfort to severe enough that it limits a person’s everyday life, including work and social activities.  The pain is often described as burning, gnawing, throbbing, stabbing or aching.  When the person relaxes, the pain may be more noticeable – and less so when they’re active.  Although its one of the most common muscle problems, the cause is a mystery as there is no inflammation or joint damage, as occurs with arthritis.  There is no damage to internal organs, as with rheumatoid conditions like lupus.  The National Fibromyalgia Association provides a list of doctors and specialists who understand the disease – experts in pain management, rheumatology and neurology.

Currently, there are no laboratory tests available for diagnosing fibromyalgia.  Doctors are forced to rely on patient histories, self-reported (subjective) symptoms, a physical examination and an accurate manual tender point examination.  This exam is based on the standardized American College of Rheumatology criteria.  Patients must meet the following diagnostic criteria:
  -widespread pain in all four quandrants of the body for a minimum duration of three months
  -tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied
It is estimated that it takes a fibromyalgia patient an average of five

years to get an accurate diagnosis. 

Fibromyalgia patients experience a wide range of symptoms which wax and wane over time.  The list of possible symptoms is a long one: chronic muscle pain, muscle spasms or leg cramps, sleep disturbance, severe fatigue, anxiety, depression, morning stiffness, headaches, difficulty concentrating, skin sensitivities, irritability and intestinal problems. 

Treatment for fibromyalgia includes medications that decrease pain and improve sleep, lifestyle changes including stress reduction, exercise to improve heart and lung health as well as flexibility and strength, and relaxation techniques to relieve muscle tension.  Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen may help decrease the pain.  Steroids which fight inflammation, such as prednisone, have also been used in treatment.  Experts recommend avoiding caffeine, sugar and alcohol before bed and getting up and going to sleep at the same time every day.  One important aspect of pain management is a regimen of light exercise and stretching at least four times a week, which helps maintain muscle tone and reduces pain and stiffness.

Additionally, a number of alternative medicine modalities and natural therapies can be beneficial.  While these are not proven treatments, they may definitely help relieve symptoms.  Doctors generally advise that alternative treatments be used as complementary therapies, in combination with other traditional treatments, for a complete mind-body program.  Some of these alternatives include, but are not limited to, acupuncture, therapeutic massage, nutritional counseling, meditation, biofeedback, homeopathy, as well as vitamin, mineral and herbal supplements.  Massage is a popular treatment for those seeking pain relief.  It also reduces the stress response in the body associated with pain, such as elevated Cortisol, and helps aid in lymph drainage which is essential as dysfunction in the limbic system is common.  Ideally, a light massage with light friction techniques on the tender points, myofascial release and lymph drainage are the best techniques and modalities to use.  Neuromuscular therapies can exacerbate the tenderness, and are probably not good for treatment of this disorder.  Additionally, chiropractic manipulations can be effective in treating back and neck pain.  Capsaican is an ingredient found in cayenne peppers and available in over-the-counter creams and ointments.  Capsaican cream warms the skin when applied over the joint and temporarily blocks the release of Substance P, which delivers pain messages to the brain. 

In conclusion, the prognosis is better than ever before.  Better ways to diagnose and treat the disorder are on the horizon.  Many people with fibromyalgia will continue to have symptoms despite treatment, especially when life is stressful. 

Elements at University Park has two therapists who specialize in working with those suffering from the discomfort of fibromyalgia. If you would like to see if massage therapy might benefit you, schedule an appointment with Bartholomew or Zolla.

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