WHAT
IS FMS?
Unfortunately
the truth is nobody knows, because it can not be tested for it was original
thought to be a mental problem rather than a physical one. Pain, muscle
and back specialists quickly noticed that there was a large number of people
with inexplicable back and muscle pain who also had a great number of supposedly
seperate medical complaints. These complaints had been present in the patients
for years and none had ever improved, or if they had it was only for a
short period and then they had returned. This could have been put down
to the fact that there are a lot of hypochondriac clinical depressives
around if it hadn't been for the fact that out of the list of symptoms
below (about 35) a very large number of patients had at least 25 of them
but nothing else wrong with them (obviously some were just hypochondriac
clinical depressives). This could have been coincidence apart from a quirk
these people all shared, from a total of eighteen possible trigger points
clustered around the shoulders, neck, chest, elbows, hips and knees there
was extreme sensitivity touch in at least eleven. This was more than enough
evidence for these specialists to conclude that there was a single condition
effecting these people and it was causing all of thew symptoms, this was
not however enough to convince the doctors.
Doctors
don't diagnose on evidence alone, if you can't test for it they don't believe
in it. This has created one major problem in the past, many of the pain
killers doctors prescribe can actually aggravate the fatigue in people
with FMS to disabling levels.
Research
carried out over the last couple of years in the States is now forcing
doctors to accept the condition although in the UK they are still very
slow to catch on. Its has been discovered that FMS causes tightening and
thickening of the bodies myofascia, this is a sticky film that covers your
muscles to form your shape and goes on to form your ligaments and tendons.
Sleep clinics have also discovered that people with fibromyalgia are severe
insomniacs and/or have an abnormal 'awake' like brain activity during the
period when they should be in deep stage 4 sleep, this is called an Alpha
EEG abnormality. The myofascia abnormality is thought to disrupt the bodies
chemistry and cause a break down in communication between the muscles and
mind resulting in uncontrollable muscle spasms particularly in the legs
(known as restless leg syndrome). This abnormality is also believed to
cause the body to over produce a chemical called substance 'P', this is
what the mind interprets as pain so what should be a mildly uncomfortable
condition becomes a very painful one. The muscle spasms and pain disrupt
your normal sleep, it is well known that low sleep quality can cause both
physical and mental illness including muscle stiffness, damage and pain,
it can also disrupt your body chemistry and the brain can become oversensitive
to substance 'P'. This of course aggravates the pain and spasms you normally
experience which will then disrupt your sleep still further, this process
cycles round and round becoming worse and worse.
FMS
is not new. It was first described by William Balfour, a surgeon at the
University of Edinburgh, in 1816. The medical profession called it many
different names, including chronic rheumatism, Magi, pressure point syndrome,
and fibrositis. The condition was also thought to be psychological by some
physicians, but that notion must now be relegated to the Dark Ages of medicine.
In
1987, the American Medical Association (AMA), recognized FMS as a true
illness and a major cause of disability. Now, nearly ten years later, it
is still, unfortunately, too often dismissed as the "newest fad disease",
and most physicians still lack the knowledge to diagnose and treat it.
FMS
is not a catchall, "wastebasket" diagnosis. FMS is a specific, chronic
non-degenerative, non-progressive, noninflammatory, truly systemic pain
condition. Diseases have known causes and well-understood mechanisms for
producing symptoms. FMS is called a syndrome, which means it is a specific
set of signs and symptoms that occur together. Don't let this fool you
into thinking that Magi is any less serious or potentially disabling than
a disease. Rheumatoid arthritis, lupus, and other serious afflictions are
also classified as syndromes. Lab tests for fibromyalgia are valid only
to rule out other conditions. There is no blood test that can accurately
identify fibromyalgia.
The
official definition requires that * Tender points must be present in all
four quadrants of the body -- that is, the upper right and left and lower
right and left parts of your body * You must have had wide-spread, more-or-less
continuous pain for at least three months.
Tender
points occur in pairs on various parts of the body. Because they occur
in pairs, the pain is usually distributed equally on both sides of the
body.
In
traumatic FMS, tender points are often clustered around an injury instead
of, or in addition to, the 18 "official" points required for a patient
to be able to enter a clinical fibromyalgia study. These clusters can also
occur around a repetitive strain or a degenerative and/or inflammatory
problem, such as arthritis.
FMS
can occur at any age. Most patients, when questioned carefully, reveal
that their symptoms began at an early age. About 25 percent of the FMS
patients I see are men. This ratio differs from most sources in the literature.
I think that this is due to FMS being under diagnosed in males. Flu-like
achiness is frequently the most prominent symptom of FMS, but there are
many others. For example, * Your eyes may be too dry, but at other
times they will water * Your thermal regulatory system is out of
whack. You may notice this thermal fluctuation when you get out of bed
(which may be often, due to bladder irritability) during the night. You
may have to wait for your temperature to cool down after getting back in
bed before you can pull the bedcover up.
*
Another symptom of FMS is spasticity (tightness) which can constrict the
peripheral blood vessels -- those close to the skin.
This symptom, especially in the winter, makes certain parts of our bodies
-- most often the buttocks and thighs -- feel like cold slabs of meat.
* You may experience skin mottling. Fingernails can break off, often in
crescent-shaped pieces. If nails do grow, they sometimes start to curve
under.
FMS is a sensitivity-amplification syndrome. This means that people with
Fibromyalgia can be sensitive to smells, sounds, lights, odors, pressure
and temperature fluctuations and vibrations. The noise emitted by fluorescent
lights can drive you crazy. FMS sensitizes nerve endings as well as the
rest of the autonomic nervous system, which means that the ends of the
nerve receptors may have changed shape.
Because
of this, for example, your body might interpret touch, light, or sound
as pain. Your brain knows pain is a danger signal -- an indication that
something is wrong and needs attention -- so it mobilizes its defenses.
Then, when those defenses aren't used, you become anxious.
Sleep plays a crucial role in FMS. Perhaps you aren't getting enough sleep,
or the right kind of sleep. You may have insomnia, or a host of other sleep-related
problems. People with FMS often have the alpha-delta sleep anomaly. As
soon as we reach deep delta level sleep, alpha waves (awake) intrude and
either jolt us to an awakening or to a lighter stage of sleep. The body
heals and many neurotransmitters are restored during delta sleep, so we
soon suffer from sleep deprivation.
Neurotransmitters are electro-biochemical agents that cross nerve synapses.
They are the vehicles that carry information back and forth between your
body and mind. One might say that neurotransmitters are the "information
superhighway" between the body and mind.
Much
of our mental and physical sense of continuity and security depends upon
our ability to repeat appropriate and predictable actions, but this is
disrupted in FMS. Neurotransmitters normally inform muscles constantly
about what they're doing so their actions can be modified.
Much
of our muscle tension function is improperly controlled by these neurotransmitters.
Healthy people think nothing of picking up a glass of water and bringing
it to their lips. They know just how tightly their hand has to grip, how
heavy the glass of water feels, and how much speed is appropriate to accomplish
this act smoothly. People with Fibromyalgia, however, lack proper sensory
feedback. The thumb grasps with too little pressure, and the wrist muscle
lets go when flexed. The economy of effort is not there. To enable us to
sit , walk, and stand, the entire musculature must be able to feel its
own activity, and we often can't do that.
Only about 20% of FMS cases have a known triggering event that initiates
the first obvious "flare." During a flare, current symptoms become more
intense, and new symptoms frequently develop.
------------------------------------------------------------------------
SYMPTOMS OF FMS = The majority of FMS sufferers will have a long history
of most (not all) of the symptoms below but normally will not have any
other long term medical problems (unless they are either very unlucky and
have something else as well or are just a normally clinical depressive).
PAIN
- The pain in FMS appears regularly and varies from moderate to unbearable,
the intensity has no limits and can be throbbing, shooting, aching, burning
and stabbing pains. The pain is most intense around the trigger points.
FATIGUE - Symptoms can range from mild to incapacitating, the fatigue can
come on in seconds and feels like someone has just unplugged your power
supply.
BRAIN FOGGING - A feeling of being 'on another planet', you can get very
confused and disorientated. This can also lead to the time spent ill as
feeling very 'unreal', many people with FMS when they are going through
a good patch think they imagined everything, this can make it very hard
to go and see a doctor.
SLEEP ABNORMALITIES- Whether the FMS causes or it causes the FMS isn't
known. someone an alpha EEG abnormality which means that as soon as you
reach deep sleep you alpha waves intrude and jolt you either awake or to
a lighter sleep. Can also include insomnia. Take licorice drops in beer
every time you wake and at bedtime. Bottle of beer lasts three days. Get
the big bottle, lasts a week unless there's a boy in the house. (Put it
into a mason jar write URINE TEST on label.)
CHRONIC
HEADACHES - Can be like having a migraine 24hrs a day 7 days a week and
can make life 72hrs. 50% of FMS sufferers have reoccurring migraines or
tension type headaches.
IRRITABLE
BOWEL SYNDROME (IBS) - 47% of FMS sufferers also suffer from IBS
FREQUENT
ABDOMINAL PAIN - Can be (so I've been told) similar to severe period pains.
NAUSEA - Can be frequent or permanent during a flare up and can make eating
very unappealing over long periods of time.
TEMPOROMANDIBULAR
JOINT DYSFUNCTION SYNDROME (TMJ) - Tremendous face and head pain suffered
by around 25% of people with FMS.
MUSCLE
TWITCHING - IRRITABLE BLADDER
FEELING
OF SWOLLEN EXTREMITIES - Take hawthorne, cayenne, ginger to get circ up.
THERMAL
REGULATORY SYSTEM OUT OF WHACK - Difficulty in maintaining body temperature,
sometimes feeling like your going to boil and others like you may freeze.
SKIN
SENSITIVITIES AND THE DEVELOPMENT OF NEW ALLERGIES
DRY
EYES AND MOUTH
FREQUENT
CHANGE IN EYE PRECIPITATION
DIZZINESS
IMPAIRED
CO-ORDINATION
PREMENSTRUAL
SYNDROME AND PAINFUL PERIODS
CHEST
PAIN
MORNING
STIFFNESS
COGNITIVE
IMPAIRMENT - Difficulty in concentration, memory lapses.
MEMORY
LOSS - Frequently struggling to find words and names
NUMBNESS
AND TINGLING SENSATIONS
ANXIETY
DEPRESSION
IRRITABILITY
ITCHING SKIN
CLUMSINESS
COLD SENSITIVITY
COMPRESSION OF THE SPINE
TENSION
BRUXISM (GRINDING OF TEETH DURING SLEEP)
SENSITIVITY-AMPLIFICATION - Sight, hearing, touch, taste and smell are
all over sensitive and many supposedly normal things either cause pain
or extreme irritability, the most common is the buzz from fluorescent lights
driving you round the bend.
RESTLESS LEG SYNDROME - knee jerks?
SLEEP MYOCLONUS (NIGHTMARE JERKING OF ARMS AND LEGS)
From the list above the symptoms highlighted in blue can be found repeatedly
in my medical history over the last five years and yet my doctor like many
other peoples insisted that there was nothing wrong with me. It was not
until about eight months ago (June '98) when I paid to see an osteopath
that the condition was diagnosed, it was rejected by my doctor as a condition
that in his opinion did not exist, then confirmed again by a second osteopath,
a different doctor and my works occupational health department. Although
it took my first osteopath a few months to work out what may be wrong the
condition itself can be pretty much diagnosed in under five minutes. Without
knowing why I was quizzed for a while about my medical history and then
poked in certain points and asked if it hurt which of course it did (apparently
it wasn't supposed to). Although the diagnosis could not be definite it
was highly probable. Once diagnosed the condition is very easy to control
for most, unfortunately there in no actual cure and you may always be prone
to flare ups but as long as you take care of yourself these can be kept
to a minimum. It can take up to two years to recover to a degree were you
are likely not to have any more flare ups but it is possible.
CAUSES -It is often said that the cause is unknown but it is far more likely
that the causes are limitless in people prone to the condition. It is thought
that anything or a combination of things that can start the self perpetuating
cycle of disrupted sleep, muscular pain and chemical imbalance can be responsible.
Common causes include insomnia, stress, caffeine, depression, trauma (mental
or physical), long periods of illness and physical injuries such as back
injuries and whiplash. Once it starts additional factors can increase the
intensity of the condition. You can have periods of remission where you
are almost normal but it can rapidly deteriorate over weeks or even days.
TREATMENT
- The most important thing is to re-establish good quality sleep and improve
fitness. You should avoid pain killers and sleeping tablets as these tend
to aggravate the condition. If you regularly drink regularly in drinks
like tea, coffee or cola you should cut these out completely and change
to decaffeinated or stick to water as this should improve your quality
of sleep almost immediately. If you do not drink a lot of caffeine it would
be a good idea to get a referral to a sleep clinic to find out how disturbed
your sleep is and what can be done about it. You should avoid alcohol as
although it helps you to get to sleep it does seriously lower the quality
and length of the sleep. You should take up some regular aerobic exercise
to improve your general health and in particular improve the blood supply
to the muscles. If you smoke you must give up to reduce the chemical toxins
in your body and improve circulation. A fully balanced healthy diet is
essential, you should never skip breakfast as this starts your body going
in the morning, you should also have your evening meal quite early rather
than just before going to bed. You should have a fasting day on one day
a week (i.e. one day where you do not eat), this helps your body to dispose
of toxins. Cold bathing is known to help, this means having a cold (not
too cold) bath rather than a hot one. Amino acid supplements are known
to help, you can get these from health shops. You should make sure you
have good posture.You should avoid taking any medication if possible, although
some mild anti depressants have been found to help recovery (if you are
prescribed medication you should discuss it with your doctor).
The
most important thing to remember is that FMS is a chemical condition and
you are not in as bad a shape as your body would like you to belive. The
exhaustion and pain is not as bad as it feels, your body is effectively
lying to you. You have to push yourself through this, although to start
with the pain and fatigue will hold you back you will quickly start to
feel the benefits.
NEW TREATMENTS AND INFORMATION - With more and more evidence to support
FMS more research is of course being done. They are currently looking into
the possibility of corrective spinal surgery which is believed to be having
good results, personally I don't like the sound of it. There is also research
being done on two particular mild antidepressants with very promising results.
These drugs are thought to calm down the brain activity allowing better
sleep.
RELATED
CONDITIONS- FMS is often diagnosed as chronic fatigue syndrome, the conditions
are very similar but the connection is unknown. Gulf War Syndrome is Identical
to FMS in every way, the connection is unknown.
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