Fibromyalgia is considered a soft tissue syndrome characterized by chronic musculoskeletal aches, pains, and stiffness that occur primarily in muscles and their attachments and are also associated with specific sites of exaggerated tenderness called trigger points. To date, no clinical biochemical serologic inflammatory immunologic or structural pathologic findings have been consistently implicated in the fibromyalgia syndrome. It occurs primarily in women and is seen very commonly by doctors who practice rheumatology.
The pain of fibromyalgia consists of a diffuse aching or burning and is sometimes accompanied by muscle spasm or muscle tightness. It varies from day to day and sometimes changes location, becoming more severe in some parts of the body that are most used, for instance the face and jaws and feet. This is the reason why almost all patients with fibromyalgia have a TMJ and facial head and neck pain component along with the diffuse body component of fibromyalgia.
Sometimes the pain of fibromyalgia can be so intense that it interferes with normal activities of daily living, including work activities. Also, the fatigue of fibromyalgia varies amongst different people and it can range from just a vague tired feeling to a complete exhaustion of flu-like illness. Most of the time, FMS is not fatal but it is certainly a very debilitating and depressing type disease.
There are estimated almost 8 million Americans who have fibromyalgia and the condition exists worldwide and seems to be most prevalent in adult women, although it can occur in children, the elderly, and in men.
Widespread pain is the usual central dominating feature of the fibromyalgia syndrome, accounting for the major part of disease severity. Its presence is essential for diagnosis. The most common areas are the axial skeleton and the shoulder and pelvic girdles. These areas of pain have some diagnostic value as well because it is very unusual for fibromyalgia patients not to have cervical or low back pain. With the generalized pain, there is also sometimes a sensation known as paresthesia, which is more frequently described as prickling or burning sensations.
The second core feature is the presence of widespread tenderness. Specific locations have been identified in tendons, muscles, and other structures that cause pain when palpated in patients with fibromyalgia. Multiple tender points widely and symmetrically distributed are the usual characteristic feature of fibromyalgia.
Overwhelming fatigue can also be another major fibromyalgia symptom and patient complaint, although it sometimes can just be a minor complaint. More than three-quarters of all patients with fibromyalgia indicate that they are just too tired to do what they want.
Another symptom of fibromyalgia is morning stiffness. Although morning stiffness is an essential characteristic of fibromyalgia, it is also found in other rheumatic disorders.
Patients with fibromyalgia tend to complain of being highly sensitive to temperature change or ambient temperature. Some complain of feeling abnormally cold (compared to others around them) while others feel constantly warm or hot. Any unusual sensitivity to cold in the hands or feet occurs in persons with fibromyalgia.
Persons with fibromyalgia report a number of cognitive symptoms which tend to vary from day to day. These include difficulty concentrating, “spaciness”, short-term memory lapses, and being unable to focus on projects at hand completely.
Some patients may suffer from the condition known as sleep apnea and loud, incessant snoring. In sleep apnea, these patients get insufficient oxygen at night because of obstructed nasal or throat areas and have difficulty achieving enough oxygen intake. Despite sufficient amounts of sleep, these patients may awaken feeling un-refreshed, tired, and as if they had not slept at all. Some may have trouble falling asleep or staying asleep during nighttime hours. The resultant loss of sleep or alpha intrusion in non-REM sleep results in daytime sleepiness, a feeling of tiredness, lack of alertness, and can lead to increased injuries, accidents, and non-attentiveness.
Almost all fibromyalgia patients have pain and dysfunction of the temporomandibular joint or TMJ. The resultant symptoms are headaches, jaw and facial pain, limited and painful mouth opening, popping and clicking in opening and closing the jaw, grating sounds in the jaw joint, pain provoked by prolonged chewing or chewing hard to chew substances, yawning, sneezing, etcetera. There is also referred pain to the temporal areas and behind the eyes and most fibromyalgia patients complain of frequent migraine, tension, and/or vascular headaches.
Along with TMJ disturbances and sleep disturbances, most fibromyalgia patients are heavily involved in involuntary nighttime grinding and daytime clenching and grinding of teeth, resulting in a cycle of TM joint pain and muscle pain. Also, symptoms such as generalized body stiffness, stick back, stiff arms, and stiff legs are reported upon awakening or after prolonged periods of sitting or standing or activity in front of a computer screen. This is particularly noticeable after being in one position (i.e. long airplane flights or automobile rides) or it may coincide with changes in temperature or relative humidity.
One of the most disturbing areas of symptoms that is attributed to fibromyalgia is functional bowel disorder or irritable colon. Digestive disturbances, abdominal pain, bloating, and intestinal distention are quite common in FM in addition to alternating constipation and/or diarrhea, which is really termed Irritable Bowel Syndrome. There is also some swallowing difficulty due to a TMJ dysfunction or dislocated lower jaw. This is attributed to a decreased lumen in the esophagus due to a dysfunctional TMJ.
Many patients with FM are frequently directed to psychiatrists or psychologists because of depression or anxiety and are frequently misdiagnosed as being depressed or anxious (it is all in your head). However, research has recently shown that fibromyalgia is not a type of depression or patients with fibromyalgia are not hypochondriacs. However, it is possible that depression and anxiety exist in conjunction with fibromyalgia or TMJ dysfunction and their treatment is important as depression and anxiety can both exacerbate FM or TMJ problems and interfere with successful treatment.
Other symptoms of fibromyalgia are multiple tender points in at least six specified anatomic sites and an absence of any underlying disease as performed by routine medical tests for related rheumatoid diseases. There is also a hypersensitivity to light, noise, odors, and weather patterns in patients with fibromyalgia. Allergic-like reactions to a variety of substances (i.e. medications, food additives, pollutants, airborne pollens, chemicals, purified water) are common and many patients experience a form of non-allergic rhinitis, which is nasal congestion and discharge with sinus pain, but it is usually in the absence of immunologic reactions which the body usually experiences in allergic conditions.
Presently, it is definitely not known what the causes of fibromyalgia are, although much research and investigation is being done into the causes of fibromyalgia. One theory is that fibromyalgia develops after physical trauma (i.e. an accident, severe illness, injury, or emotional shock) that appears to act as a trigger in predisposed individuals. These types of trauma can affect the central nervous system, which in turn produces the condition that we know as fibromyalgia. Newer studies also show that whiplash of the cervical spine results in damage to the TMJ, which can produce a regional fibromyalgia of the head, neck, and face.
Also in most cases, a moderate amount of physical activity is usually advised, such as walking and/or bicycling or a treadmill in order to support the functioning and elasticity of muscles, tendons, and ligaments. Medications may also be prescribed, such as the before mentioned tricyclic antidepressants, which would ensure more restful, restorative sleep and reduce anxiety and stress. Additionally, long term use of nonsteroidal anti-inflammatories are usually prescribed to reduce the pain and inflammation that most probably exists in all areas of muscles, tendons, and ligaments.
There are various support groups that are now in existence to help people with fibromyalgia and most of them are involved with helping most patients cope with the depression and debilitating symptoms that they are experiencing by themselves with this syndrome.
Another type of treatment is muscle injections of anesthetic and steroids into trigger points or muscle groups that cause referred pain to other areas. These areas of pain that refer pain to other areas of the body are called trigger points. These injections are usually administered in the head and neck area by a dentist or a physician that is trained to treat trigger points and trigger areas.
Dr. Steven J. Wilk
3540 S. Poplar St., Suite #301
Denver CO 80237