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What are the Symptoms of Fibromyalgia?
Fibromyalgia (FM) is a syndrome, meaning it has
an array of symptoms that collectively characterize the illness.
Each fibromyalgia individual is unique and may suffer all or some
of the 50 reported symptoms for FM. Because fibros suffer such a
wide variety and unlimited number of symptoms it has been called
"irritable everything syndrome". For instance one day
a fibro might suffer stiffness and the next day battle something
unrelated like a tension headache.
The hallmark symptom is widespread pain in all
four quadrants of the body for a minimum of 3 months. Wolfe and
colleagues(1), in 1990, published the standards that have become
the basis for diagnosing FM. In that classic article, they reported
widespread pain exists in 98% of all fibros. This pain manifests
itself as generalized or flu-like symptoms in varying degrees of
intensity ranging from mild to severe. Pain can take many forms,
including, gnawing, sore, stiff, aching, nagging, burning, radiating,
or bruising. This pain varies according to time of day, activity
level, nutrition, physical and emotional condition, weather, restorative
sleep and stress perception. Fibros most commonly experience pain
in the central regions of the neck, shoulders, back and pelvis.
This pain also includes tenderness in 11 or more of 18 tender point
sites located bilaterally that cluster around the neck, shoulder,
chest, hip, knee and elbow regions of the body. Tender points hurt
when pressed with about 10 pounds of pressure to varying degrees
only in that area (i.e., without diffused pain). Dr. I. Jon Russell
has shown that fibros perceive pain levels as much as 3X that of
normal individuals (2). This may be due to a 3-fold increase of
Substance P, a neurotransmitter in the spinal cord that transmits
pain to the thalamus, the main sensory organ in the brain.
Besides pain fibromyalgia is also a fatigue disorder.
Fatigue has been found in 78% of fibros (Wolfe et al., 19901). Fatigue
can be experienced as tiredness, lack of energy, decreased endurance,
lethargy, chronic fatigue, and exhaustion to being completely immobilized.
If a fibro is not getting restorative sleep it can turn into what
seems an endless cycle of sleepless nights and daytime exhaustion.
Once in this phase of chronic fatigue it feels hopeless as though
there is no end to the cycle. But you can break through this cycle
(depending on the individual) with exercise, proper nutrition, and
sleep and stress management and a positive attitude.
The next common symptom is morning stiffness reported
in 76 % of fibros (1). Body stiffness is most noticeable upon awakening
or after prolonged periods of standing or sitting in one position.
Stiffness worsens with a sedentary or inactive lifestyle, another
reason to stay active and adopt a regular exercise program.
Sleep plays a critical role in relieving FM symptoms. Wolfe reported
76% of fibros had sleep disturbances (1). Insomnia can be caused
by chronic pain, stress and other anomalies. Generally fibros wake
up feeling tired or unrefreshed, even after sleeping the entire
night. Scientific studies have demonstrated that some fibros are
awakened by alpha wave intrusion during stage 4 or delta sleep (Drewes
et al. 1995; Branco et al. 1994; Roizenblatt et al. 1997). They
usually have trouble getting back to sleep since the intrusion leaves
them in a high state of arousal.
It is critical to get stage 4 delta sleep since
your body resynthesizes or reconstitutes levels of growth hormone
which is needed for muscle tissue repair and energy. According to
Moldofsky's hypothesis (3) alpha wave intrusion on stage 4 sleep
prevents adequate restoration of growth hormone. Preventing the
production of these key hormones (e.g., growth hormone) could affect
restoration of normal muscle function or make it difficult for the
muscle to function properly. There are several pharmacological and
non-drug techniques available to help induce restorative sleep.
Tension or vascular headaches or migraines are
common in FM. Wolfe found 54 % of fibros experience headaches. Tender
point pain, widespread pain, TMJ or constricted and expanding blood
vessels inside the skull may be factors in precipitating headaches.
In varying degrees other symptoms are reported from individual to
individual and include:
Depression, carbohydrate cravings, irritable bowel
syndrome, fibrofog, cognitive difficulties, hair loss, dizziness,
numbness and tingling, restless leg syndrome, mitral valve prolapse,
nausea, shortness of breath, yeast infections, allergies, chest
tightness, esophageal reflux, sore throat, rash, swollen glands
and tender lymph nodes, hot and cold sensitivity, clumsiness, bruising,
dropping things, high and low internal temperature regulation, muscle
spasms, emotional problems, confusion, mood swings, irritability,
trouble concentrating, memory blanks, panic attacks, word mix-ups,
dry eyes and mouth, lack of endurance, sensitivity to environmental
conditions, TMJ, itchiness, menstrual cramps, heartburn, sleep apnea,
achiness, and other sensitivities, etc.
To summarize, symptoms associated with FM that
have been described in this article can be classified into three
categories: core, characteristic and common features (4).
In the core category it has been found that close to 100% of
all FM patients experience generalized pain and widespread tenderness
in all four quadrants of the body for at least the previous thre
months. Symptoms categorized in the core category are necessary
for the diagnosis of FM.
More than 75% of FM patients possess characteristic features
of chronic fatigue, disturbed sleep patterns and morning stiffness.
Common features experienced by more than 25% of fibros include
Raynaud's Phenomenon (tingling fingers), irritable bowel syndrome,
headache, subjective feeling of swelling, paresthesia, various
psychological abnormalities, and some aspect of functional disability.
From a functional viewpoint Mannerkorpi reported that FM patients
demonstrate a 30-50% reduction in aerobic capacity, reduced range
of motion and some reduction in muscle strength and endurance (5).
White observed that fibros report more days in bed, more healthy
years of life lost and greater disability vs. control subjects (6).
It also appears that pain and stiffness are more important as limiting
factors in lifestyle habits of fibros than among patients with various
arthritic conditions (7). Although Chronic Fatigue Syndrome (CFS)
patients also experience pain, the primary diagnostic hallmark of
their condition appears to be fatigue. Over 75% of the symptoms
from FM and CFS appear to overlap, and many medical authorities
believe that FM and CFS are different manifestations of the same
disease (8).
References
1. Wolfe F, Smyth H, Yunus MB, et al. The American College of Rheumatology
1990 criteria for the classification of fibromyalgia: report of
the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160
-172.
2. Russell IJ. Substance P and fibromyalgia. J Musculoskeletal Pain.
1998;6:29-35.
3. Moldofsky H, Scarisbrick P, England R, et al. Musculoskeletal
symptom and non-REM sleep disturbance in patients with fibrositis
syndrome and healthy subjects. Psychosom Med. 1975;37:341-351.
4. Wolfe F, Ross K, Anderson J, et al. The prevalence and characteristics
of fibromyalgia in the general population. Arthritis Rheum. 1995;38:19-28.
5. Bondy B, Speath M, Offenbaecher M. The T102C polymorphism of
the 5-HT2A-receptor gene in fibromyalgia. Neurobiol Dis. 1999;6:433-439.
6. Yunus MB, Khan MA, Rawlings K.K, et al. Genetic linkage analysis
of multicase families with fibromyalgia syndrome. J Rheumatol. 1999;
26:408-412.
7. Yunus MD. Muscle biopsy findings in primary fibromyalgia and
other forms of non articular rheumatism. Rheumatic Dis Clin North
Am: Controversies in Fibromyalgia and Related Conditions. 1989;15:115-134.
8. Starlanyl D, Copeland ME. Fibromyalgia and Chronic Myofascial
Pain Syndrome: A Survival Manual. Oakland CA: New Harbinger Publ
Inc. 1996;ch 23:219-227;ch 28:267-276.
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