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Information on Diagnosis and Treatment of Fibromyalgia -
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If you or someone you care about has been diagnosed with Fibromyalgia then this is the place to learn about the history, diagnosis, prognosis, treatment and management of this condition.
Fibromyalgia is considered to be a syndrome not a true disease. In fact, the condition is not even listed as a diagnosis in the ICD9 as defined by the ICD9 coding book. This can be referenced on line at http://icd9.chrisendres.com.
What we do know about this condition is that it is a set of symptoms that occur together but, according to current medical texts and literature, do not have a known or defined specific cause. There are a number of theories as to what may cause it, but there is not enough evidence to support any single theory. The condition is felt to be familial (occurs in families). It is more common in women (2 to 1). A patient with a family member with fibromyalgia is more likely to develop it themselves. It has only been recently recognized as a medical disorder since the 1980s.
Some theories suggest that fibromyalgia may be linked to:
- Hypersensitivity (oversensitive) nerve cells in the spinal cord and brain. Oversensitivity may be due to changes in chemicals in the brain or spinal cord that regulate pain. As a result a patient with fibromyalgia senses pain more easily, and therefore more widespread muscle and nerve pain occurs.
- An imbalance in the brain chemicals that control mood, which results in a lowered tolerance for pain and may also cause a disrupted sleep cycle and the resulting fatigue. Once this occurs, a person becomes less physically active, and the muscles and tissues become more sensitive and painful and more easily irritated.
- An imbalance of hormones such as cortisol and growth hormone.
- Their release is controlled by the pituitary gland and the hypothalamus. Imbalances of these hormones can result in fatigue, mood changes, concentration and memory difficulties, a lowered tolerance for pain, and other symptoms.
- A disturbance in the deep phase of sleep. Some chemicals, such as growth hormone, are secreted by the body during this phase of sleep. If sleep is disrupted, the body produces less of the hormone. Disturbed sleep may be both a cause and an effect of the pain of fibromyalgia.
- Hypersensitivity to certain foods, and allergic theory. Constant exposure to allergens in food, food additives, food colorings, preservatives and chemicals may be causing a disruption on the chemical structure of the brain, nerves or muscle fibers.
- Heavy metal exposure or other toxicity that results in the perception of pain in areas that otherwise appear normal.
- An infectious agent (virus, parasite or bacteria) that causes an immune response or lack thereof resulting in recurrent illness and chronic pain.
- Vitamin deficiency causing an imbalance in the nerves and muscles of the body along with changes in the brain chemicals that control mood. This in turn can result in lower tolerance for pain and may also cause a disrupted sleep cycle and fatigue. Once this occurs, a person becomes less physically active, and the muscles and tissues become more sensitive and painful and more easily irritated.
Many people connect the beginning of their fibromyalgia symptoms to a certain event. These events can include an illness such as the flu, an injury or surgery, or emotional trauma and stress. An event of this type combined with other factors, such as increased sensitivity to pain and an ongoing sleep disturbance, may lead to fibromyalgia syndrome in some people.
Treatment of this condition is based on the cause. Most patients who have sought care by their doctor or who have been diagnosed with this syndrome have been disappointed in the results. Since the cause is very difficult to determine, the standard (typical) treatment is to treat the pain and resultant depression with narcotics, anti-inflammatory medications or anti-depressants respectively. The vast majority of fibromyalgia patients have seen three or more physicians including a general practice physician, a rheumatologist or a pain specialist and/or a psychiatrist.
The typical fibromyalgia patient is on an antidepressant, pain medication and an anti-inflammatory medication. These medications are not a cure, and they rarely provide adequate relieve of symptoms. Most do not improve on this regimen due to the fact that anti-depressants, anti-inflammatory medication and pain pills are not designed to cure. They treat the symptoms only.
So what is a patient to do who is in this situation? The most important this to do is to find a physician willing to thoroughly and carefully investigate their condition with a view to treatment of the underlying cause. The current theory is that there may be a single or multiple causes including a genetic predisposition to the condition (this is why some people are more sensitive to toxins than others). Although happens rarely, the work-up should include a highly detailed history and very thorough physical examination (typically 30minutes to an hour face to face with the physician). The work-up and investigation should include more than just basic blood work (a basic blood workup is typically a complete blood count (CBC), electrolytes, liver functions, kidney functions, thyroid test, cholesterol, blood fats and some tests for inflammation). An investigation into the cause should ensue. It is very important that the physician and patient consider an infectious, toxic, allergic, hormonal, traumatic, dietary or acquired cause to this condition. Special testing must be directed by a physician trained to look for causes based on the patient's presenting symptoms. Treatmen is based on the causes identified or the most likely cause in the event an underlying cause cannot be determined.
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