WHAT IS FIBROMYALGIA
An informational document created by Shari Ferbert

WHAT IS FIBROMYALGIA? (1-5)

As Dr. Yunus said, “for you spouses who just heard the word, it means more than just a grumpy wife”. There was a time when FMS was no more than a psychological problem of anxiety, stress and depression; mostly women complaining of aches, pains, fatigue and poor sleep with nothing to show for it. Most doctors did not take it seriously because there were no visible abnormalities. Now we know that the biochemistry is out of whack in FMS patients. Fibromyalgia syndrome (FMS) is a chronic, widespread musculoskeletal pain syndrome with tender points at multiple sites. Each word is important.
Chronic: If you were hurt in an accident, usually you would be better in three months or less, otherwise it is chronic.

Widespread musculoskeletal pain: Widespread in contrast to just the neck or shoulder. Very often the pain is experienced in all the four limbs as well as the neck, chest wall and the back. Pain affects muscles and joints as well as the ligaments, tendons, and skin.

Syndrome: A combination of many symptoms, such as pain, fatigue, sleep problems, tingling and headaches.

Tender points: Besides pain, the most important thing for a diagnosis of FMS is the large number of tender points on palpation by a physician. This is unique, that is why you do not need another exclusion to diagnose FMS. If someone has met FMS and rheumatoid arthritis (RA) criteria, they have two different diseases.

WHAT ARE THE SYMPTOMS? (1-3)

Fibromyalgia causes chronic, sometimes disabling muscle pain and fatigue. The joints or the muscles are not inflamed. The pain often originates in one area then becomes widespread. The pain varies day to day and is different from person to person. The intensity and frequency of FMS pain may depend on weather, physical activity and stress and is commonly described as aching, throbbing, stiffness, burning and radiating. Most people describe “good days” and “bad days”, with the symptoms being generally constant or intermittent. Fatigue and sleep disturbances are almost universal. Mood disturbances and concentration problems are common. Tension or migraine headaches, dizziness, a swollen feeling in the tissues, tingling or numbness, bowel problems, restless legs, bladder problems and painful menstrual periods are all common symptoms.


WHO GETS FIBROMYALGIA? (1-3)

Fibromyalgia affects more women than men (80-90% are women). It is typically diagnosed between the ages of 30-60, although fibromyalgia can be present in children, teenagers and the elderly as well. There appears to be a genetic predisposition to develop fibromyalgia. It is not unusual for multiple family members to have FMS. Many adults now being diagnosed can trace symptoms back to childhood. Sometimes the symptoms of fibromyalgia develop slowly over time, and other times fibromyalgia can present itself rather suddenly following an accident, emotional trauma, or an infection.

HOW IS IT DIAGNOSED? (1-3)

There is currently no reliable laboratory test available to make the diagnosis of FMS. The examining physician must rely on a patient’s medical history and physical findings of tender points on examination. Palpation of muscles and muscle-tendon junctions will show many tender points. In 1990, The American College of Rheumatology established criteria to make the diagnosis of FMS that include the presence of 11 tender points at 18 specified sites. A diagnosis is usually helpful because now you know there is a name for your symptoms. Usual laboratory tests come out negative. Previously we did not know if anything was abnormal, but now it is clear that many neuroendocrine tests are abnormal (for example, serotonin is low, substance P is high, etc). A recently reported blood test (still in experimental stage) detected an antibody (called APA) in about 50% of fibromyalgia patients studied. In the past 10-15 years significant progress has been made. A satisfactory test for FMS may be available in the future. RA has been researched for nearly 100 years, but only in the past 20 years has significant progress been made in many areas, including treatment. One needs to be patient with progress in FMS research.

CENTRAL SENSITIVITY SYNDROMES (CSS) (1,2,4)

Dr. Yunus introduced the concept that several syndromes similar to FMS are related to each other. As a group, they were initially called dysregulation spectrum syndrome (DSS). In view of current research showing that the central nervous system (CNS) is sensitized to pain and other stimuli in these syndromes, Dr. Muhammad Yunus of the University of Illinois College of Medicine at Peoria, has now collectively named them “central sensitivity syndromes” (CSS) in one of his recent publications (Current Practice of Medicine, 2000 Feb 3(2), serial available online at: http://www.praxis.md. In his 1981 paper, Dr. Yunus first observed that symptoms such as irritable bowel syndrome (IBS) and headaches were significantly more common in FMS as compared with normal controls. These syndromes and several others belong to a common umbrella with overlapping clinical features. The biophysiological “glue” among various members of the CSS group is a dysregulation of neuroendocrine functions, leading to a hypersensitivity of the nerve fibers in the CNS, including the spinal cord.

The abnormalities include:
A sensitized CNS by neurophysiologic tests

Serotonin deficiency

Increase of substance P in spinal fluid

Norepinephrine deficit

Abnormal dopamine and other neurotransmitters

A disturbed autonomic function

Dysregulation of the hypothalamic pituitary adrenal axis (also referred to as the body’s stress response system), often stimulated by stress of any kind including infections
For too long the medical community had a theory that if there is no pathology (absence of microscopic findings such as inflammation), then it must belong to a psychiatric compartment. According to Dr. Muhammad Yunus, there is a third model different from pathology and psychiatry and it is a neuroendocrine dysregulation (NED) model.
Members of the “central sensitivity syndromes” (CSS) include:
Fibromyalgia syndrome

Chronic fatigue syndrome

Irritable bowel syndrome (IBS)

Tension-type headache

Migraine

Primary dysmenorrhea

Periodic limb movement disorder

Restless legs syndrome

Temporomandibular pain and dysfunction syndrome

Regional fibromyalgia/myofascial pain syndrome
Members of the “central sensitivity syndromes” (CSS) share common features such as:
Chronic pain and/or fatigue

Higher prevalence of a CSS member in another member of the CSS group, as compared to the general population.

Predominance in women

Absence of tissue pathology

Abnormality of neuroendocrine functions

Familial clustering

FACTS ABOUT FMS (1-5)

There appears to be a genetic component (28% of children of mothers with FMS develop it, and Dr. Yunus and his group recently showed a genetic linkage to certain antigens on the cells.)

Repetitive injury: Pain begins in one area then gradually becomes widespread and more intense. Soon pain is on the other side. Spreading of pain occurs through new changes in the central nervous system (spinal cord and brain), resulting in central sensitization. It will not occur in everyone, but perhaps if predisposed genetically, the pain can become widespread.

Substance P is high in spinal fluid (three times higher than normal). That means you have more pain. Pain tells the body to “do something about it”. The body has a mechanism to stop the process of pain, but it goes wrong in FMS patients. The serotonin level is inappropriately low in this situation. What happens when the substance that is supposed to inhibit pain does not have enough of the substance? You have increased pain and less ability to stop it.

Chronic sleep disturbances can create or aggravate FMS symptoms.

Biological factors are involved, such as abnormal nervous system function, hormone dysfunction and chemical imbalance.

SPECT brain scans reveal abnormalities: reduced blood flow to certain regions of the brain related to pain perception and sensation.

Low level of the neurotransmitter serotonin and of tryptophan (an amino acid that is converted to serotonin). A neurotransmitter is a chemical in the nervous system that serves as a messenger between neurons. Low or high levels of certain neurotransmitters or chemicals are associated with depression and other symptoms (such as bowel problems, migraine and anxiety), but the serotonin receptor(s) may be different in FMS than depression.

Defects in systems that regulate serotonin and other neurotransmitters such as substance P or norepinephrine.

Hypervigilance involves an amplification of sensations including noise and pain through the CNS mechanisms, causing patients to be oversensitive to external stimuli. Such hypervigilance may occur without the presence of psychiatric factors.

Some factors or combination of factors such as genetic susceptibility, biologic abnormalities, chronic sleep deprivation, infection, trauma and mental or physical stress may bring on FMS.

FMS is not a disease of exclusion. All you need are widespread chronic pain and tender points. If you have RA or lupus in addition to FMS, it means you have more than one disease.
IS FMS DUE TO DEPRESSION? (2,4)
Prevalence of depression in FMS is generally similar to other chronic pain conditions. Biochemically FMS and depression are different. FMS responds to much smaller doses of antidepressants. Serotonin is low in both depression and FMS, but the difference may be in the serotonin uptake or release, or in the serotonin receptor types, and there are many different serotonin receptors. There is no correlation between tender points and psychological status according to some studies. If a physician sees a patient who is sore all over to touch, it does not mean the patient is psychologically disturbed. Thus, FMS and depression are not the same disorders. However, psychologic or psychiatric factors, including stress, anxiety and depression are important aggravating factors of FMS symptoms, and should be managed when present.

FACTS VS MYTHS

We all heard various stories about fibromyalgia from family, friends and our doctors. On this page, we will attempt to sort through these and separate fact from fiction. If you have heard something that you are unsure about, please send us an e-mail and we will attempt to help get to the truth and post it here. You may also contact us through the information at the bottom of this page.
Fibromyalgia is more of a psychological problem or is seen more in people who have trouble dealing with stress.
Current studies show that psychological problems are not common symptoms in fibromyalgia.
(Editor's note: But anyone who deals with chronic pain can tell you that pain can tire you out creating a tendency to be irritable and feeling depressed.)
http://my.webmd.com/content/Article/74/89418.htm

There is more than one type of fibromyalgia.
According to a study by co-researcher Daniel J. Clauw, MD, there are three subtypes of fibromyalgia that are recognized. Researchers tend to agree that Cluster 2 is the most difficult to treat.

Cluster 1 -- 52% of patients
Moderate levels of anxiety and depression
Reacting to pain in a way that moderately amplifies distress
Moderate control over pain
Highest pain threshold
Moderate to low tenderness
Cluster 2 -- 32% of patients
Highest levels of anxiety and depression
Reacting to pain in a way that severely amplifies distress
Lowest control over pain
Considerable tenderness
Cluster 3 -- 16% of patients
Lowest levels of anxiety and depression
Reacting to pain in a way that minimally amplifies distress
Highest control over pain
Lowest pain thresholds
Highest level of tenderness

http://my.webmd.com/content/Article/74/89418.htm