10 Things you should know about Fibromyalgia
by Katherine Greathouse
Most people at some point in their life have or have had pain somewhere in their body. There are those however, who experience chronic body-wide pain. These people may be suffering from a serious and often debilitating disorder called fibromyalgia. The word fibromyalgia comes from the Latin term fibro, meaning fibrous tissue and the Greek words for muscle (myo) and pain (algia).
1. Fibromyalgia is a chronic disorder characterized by widespread, nonarticular musculoskeletal pain and fatigue with multiple tender points. It is a commonly diagnosed musculoskeletal disorder. This debilitating disorder affects approximately 2% of the United States. It occurs 6 times more often in women than in men, and can affect people of all ages and ethnic groups.
2. People with fibromyalgia can also experience non-restorative sleep, morning stiffness, irritable bowel syndrome, and anxiety. Fibromyalgia however is nondegenerative, nonprogressive, and noninflammatory.
3. Fibromyalgia is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation. The pain amplification experienced by the affected patient is due to abnormal sensory processing in the central nervous system. Multiple studies identify many physiologic abnormalities in people with fibromyalgia.
a. Increased levels of substance P in the spinal cord.
b. Low levels of blood flow to the thalamus
c. Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis.
d. Low levels of serotonin and tryptophan.
e. Abnormalities in cytokine function.
4. Serotonin and substance P play a role in mood regulation, sleep, and pain perception changes in the HPA axis. They can also negatively affect a person’s physical and mental health, leading to an increased incidence of depression and a decreased response to stress. Researchers also think there may be a genetic susceptibility for fibromyalgia.
Additionally, researchers hypothesize that viral illness or Lyme disease may have an infectious trigger in susceptible people.
5. Typically during a physical examination the patient experiences tenderness at 11- 18 different sites. These people are often sensitive to painful stimuli throughout the body and not only at the identified tender spots.
6. Pain and tenderness can vary from day to day. Some days the patient can experience pain in less than 11 sites, and other days the patient may experience pain in more than 18 sites.
7. Fibromyalgia not only causes chronic pain, but it can also have cognitive effects ranging from difficulty concentrating to memory lapses. Patients may also experience a feeling of being overwhelmed when dealing with multiple tasks. Many patients will also complain of migraine headaches. Anxiety and depression may also occur
and may require drug therapy.
A definitive diagnosis of fibromyalgia is often difficult to establish. The lack of knowledge among health care providers may also cause delays in diagnosis and treatment. Lab results in most cases are used to rule out other suspected disorders based on the patient’s history and physical examination.
8. Patient motivation is required for the treatment of fibromyalgia and is often symptomatic. Getting a substantial amount of rest can help with pain, aching, and tenderness. Analgesics such as Tylenol and NSAIDs can be effective for some patients. Stress, fatigue, and sleep disturbances may be helped by taking low-dose tricyclic antidepressant.
9. Diets may also be able to help prevent some symptoms of fibromyalgia. Dietitians often urge patients to limit their consumptions of sugar, caffeine, and alcohol because these substances have been shown to be muscle irritants.
10. The American College of Rheumatology classifies an individual as having fibromyalgia if two
criteria are met:
a. Pain is experienced in 11 of the 18 tender points on palpation
b. A history of wide spread pain is noted for at least 3 months. (widespread pain is defined as occurring on both sides of the body and above and below the waist).
1. Lewis, Heitkemper, Dirksen, O’Brien, Buche. Medical-Surgical Nursing.
Philadelphia: Elsevier, 2007.
NOTE: All healthcare providers must maintain ACLS and BLS certification. They must become ACLS recertified every two years.