You ache all over, and your energy
level is nonexistent. You can't get a good night's sleep,
you can't concentrate, and to top it all off, you're
frustrated because your doctor doesn't seem to take
any of this very seriously.
Sound familiar? Symptoms such as
unexplained fatigue and body pain are typical of
fibromyalgia syndrome (FMS), a condition that
affects millions of Americans, eight out of 10
of them women. Unfortunately for these women,
fibromyalgia and its 'cousin' Epstein-Barr Virus,
get little respect. Sufferers are viewed as not
really being sick. But, as sufferers of these
conditions know very well -- there is
something going on.
According to Timothy B. McCall,
MD, scholar in residence at the Kripalu Center for
Yoga and Health in Stockbridge, Massachusetts,
fibromyalgia is a very real medical condition.
Unfortunately, he observes, many doctors are not
educated about it, there is no clinical test for
FMS, and doctors often don't know what to do for
people who suffer from it.
The good news is that FMS can
be managed successfully. It's a matter of finding
an appropriate doctor to get the correct diagnosis
and identifying the right combination of treatment
modalities that work for you.
Do You Have FMS?
In 1990, the American College
of Rheumatology (ACR) identified specific criteria
for fibromyalgia -- it is the definition that the
insurance companies use. If a person has at least
11 of 18 specific areas of the body that are painful
under pressure and has experienced widespread pain
for at least three months, he/she has FMS. However,
technically, fibromyalgia means that muscle pain is
a result of fibrous tissue being deposited in the
muscle. This can -- and should -- be visible on an
MRI before a legitimate diagnosis is given.
Dr. McCall explains that FMS
symptoms wax and wane over time. They may develop
after a period of stress or lack of sleep or unusually
heavy physical activity, and then subside. Symptoms
vary from person to person and include...
Widespread musculoskeletal pain
and multiple tender points. Severe fatigue. Sleep
disturbances. Stiffness upon waking. Irritable
bowel syndrome (constipation, diarrhea,
abdominal pain and bloating). Chronic headache
and facial pain. Heightened sensitivity to
bright lights, noise and odors. Depression
and anxiety. Numbness or tingling. Memory
and concentration difficulties. Painful
menstrual periods and/or pelvic pain. Dry eyes,
skin and mouth.
What Causes FMS?
No one knows the exact cause.
There may be a connection with sleep disturbances,
but on the other hand, it is unclear whether these
are a cause or an effect of fibromyalgia. The ACR has
identified several associated factors that contribute
to the development or perpetuation of this condition...
Stress. Immune or endocrine
abnormalities. Biochemical abnormalities in the
central nervous system.
Dr. McCall adds that FMS sufferers
have greater levels of substance P, a neurotransmitter
associated with pain, stress and anxiety. This causes
them to perceive the symptoms of pain at a lower level
than people with normal levels of this chemical.
However, the presence of elevated concentrations
of substance P is neither causative nor confirmatory
of the presence of FMS -- it is just something that
is found in people with the condition.
Diagnosis and Treatment
Even with the ACR's designated
criteria, diagnosis can be tricky, since fibromyalgia
mimics the symptoms of other conditions, such as
chronic fatigue syndrome and chronic sinusitis.
(See Daily Health News, October 28, 2003.) Dr. McCall
believes that it is generally underdiagnosed. He says
that the key is to find a physician who has expertise
in the field.
According to Daily Health News
contributing editor Andrew L. Rubman, ND, your best
bet is a team that consists of a rheumatologist and
naturopathic physician.
Clearly, you are more
likely to get good care from a doctor
who not only believes that fibromyalgia
exists, but who also has experience in treating
it. Beware of doctors who patronize you and
don't believe you're sick, advises Dr. McCall.
When it comes to treatment,
there is no one magic combination that works for
everyone. Whatever you think may work is worth a
shot, encourages Dr. McCall.
Treatment options include...
Pain relievers, antidepressants
and muscle relaxants. Some people find these helpful,
others don't. But keep in mind that these medications
merely suppress symptoms -- they do not help 'cure' the
condition. Additionally, many painkillers (COX-2
inhibitors in particular) now have been indicted for
their significant health risks.
Engage in regular mild exercise
to relieve body aches and pains. Dr. McCall recommends
mind-body modalities such as gentle yoga. The cumulative
effect of steady practice is best, says Dr. McCall.
He recommends that you do 15 minutes of yoga daily
instead of attending a one-and-a-half hour class
each week.
Practice good sleep hygiene.
Go to bed and get up at the same time every day,
and limit daytime napping. Sleep difficulties,
fatigue and exhaustion are all characteristic of
FMS, so getting a good balance of rest and exercise
is essential.
Pace yourself. Dr. McCall
warns that on your good days, you may be tempted to
overdo with physical activity... but don't! This
can backfire.
Reduce stress. Choose
your favorite stress-management technique, or
try a new one, such as meditation. Choose a quiet
space, close your eyes and follow your breath or
repeat a mantra. People give up on meditation too
easily, says Dr. McCall, but he encourages everyone
to persevere. It can be transformative.
Join a fibromyalgia network.
People with FMS tend to feel isolated. To find
like-minded people, visit the Fibromyalgia Network
at www.fmnetnews.com.
Educate yourself. The
more you learn about your condition, the more
control you will have over it. Visit Web sites
such as the American College of Rheumatology at
www.rheumatology.org and the Arthritis Foundation
at www.arthritis.org.
Maintain a healthy lifestyle.
Follow a balanced diet... get an appropriate
balance of rest and exercise... don't smoke...
and limit your intake of caffeine.
Other alternatives include
cognitive-behavioral therapy, physical therapy,
trigger point injections (injections to break up
painful, hardened knots in muscles), bodywork,
Traditional Chinese Medicine, acupuncture and
chiropractic care.
Dr. McCall's personal favorites
for addressing fibromyalgia are yoga and meditation.
He notes that fibromyalgia is a disempowering condition,
and these are strategies that can help you seize control
of your health. In the long run, you may have to
experiment a bit, mixing and matching the various
modalities, but be patient -- while there is no cure,
there are steps you can take to improve your health
and reduce symptoms while living with FMS.
Sources...
Timothy B. McCall, MD, scholar
in residence at the Kripalu Center for Yoga
and Health in Stockbridge, Massachusetts. American
College of Rheumatology, www.rheumatology.org. The
Arthritis Foundation, www.arthritis.org. Fibromyalgia
Network, www.fmnetnews.com
