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What Type (s) Of Fibromyalgia Do You Have?

Over the years, working in the pain field, I have concluded that there is more than one form of fibromyalgia. The following are some of my ideas on types of fibromyalgia. The same concepts may apply to lesser pain syndromes such as headaches, neck or back pain, and limb pain syndromes.

I have already written a fair amount on the subject of fibromyalgia, and what I believe to be the origin of many of the symptoms and signs. In this section, I will break up fibromyalgia into the different types as I see it when I see a patient. When I refer to different types or forms of fibromyalgia, I am referring to the different contributing causes of the condition with that individual. When I see pain patients, I find it very important to attempt to recreate the "mechanisms" - whether chemical, electrical or mechanical that are involved in that person. On most occasions the mechanisms are mixed.

For the most part, most (but not all) fibromyalgics will fall into the following categories:

  • Post-Traumatic

  • Repetitive Strain (or Repetitive Traumatic)

  • Mood-Related & Sleep disruptive

  • Rheumatoid and Chronic Disease

  • Hormonal

  • Age-Related

In Post-Traumatic cases (which represent about 50% of cases statistically), there is a history of a single event such as a car accident that pre-dates the pain syndrome. The accident commonly causes profound spasm and scarring of the spinal muscles, and it tends to worsen over weeks or months. Patients often complain of headaches first, and then complain of arm or leg numbness or tingling or pain.

Carpal tunnel syndrome, disk injury will commonly eventually occur from the persistent spinal muscle compression. To complicate insurance claims, many of these cases have a history of minor pain syndromes before the accident, giving the insurance companies an easy out for the injury claim.

In general, the sooner therapy can be initiated the better, as spinal muscle scarring will soon develop. As well, I find it very common for the spinal problems to be delayed about two to four months, or more. Trauma can cause fibromyalgia to anyone at any age; but trauma is particularly problematic for older individuals, as the elderly have greater difficulty in recovery.

Repetitive Strain Injury or RSI was certainly a buzzword of the nineties and I believe is fairly accurate term. The idea is that a repeated injury can add up to the same result as one big car accident. In some ways, I believe an RSI can be worse. In RSI the spinal muscles can insidiously shorten and scar, and become very weak. As well, most RSIís (computer work, Piano and assembly work) are typically a static injury which is a very bad combination as it causes the spinal muscles to shorten at rest and while performing the static activity (see static injury). Return to work or the pain causing activity can be very difficult as it causes static shortening. Most of the cases of RSI fibromyalgia begin gradually with carpal tunnel syndrome, tennis elbow, ulnar neuritis and shoulder Dr. problems. The reason for this is that the repetitive work is causing progressive compression or traction polyneuropathies, or nerve entrapment. I often call RSI a "slow whiplash", as the same problems occur, but just more slowly. Prevention is very important in these cases, as well as early recognition of the pain patterns. I believe it is important to begin thorough stretching as prevention in people who have repetitive-type professions. Unfortunately, most of us fall into this category.

Mood-Related fibromyalgia is important to talk about. However, I find that most physicians are fairly quick to apply anxiety and depression to sufferers of fibromyalgia and chronic pain. I agree that anxiety and depression may aggravate any pain syndrome and it is very important that anxiety or depression be dealt with properly whether a pain syndrome exists or not. However, It is my opinion that most fibromyalgics suffer the syndrome as a result of the other reasons mentioned. I find that the pain syndrome will often cause depression both from the pain and from the suspected alteration of neurotransmitters within the brain. Nevertheless, I have found some patients can develop a diffuse myofascial pain and neuropathic pain syndrome (Fibro) from a profound and persistent anxiety or depressive disorder. Disruption in sleep will tend to contribute to progressive muscle shortening and scarring in the neck and back and limbs. The result can be joint and nerve compression and therefore pain. It is important to note that chronic pain disrupts sleep and sleep disruption will aggravate or cause chronic pain and muscle dysfunction.

Rheumatoid Disease and Chronic disease can easily cause a chronic pain syndrome that recurs with every flare up and can cause permanent joint and muscle dysfunction. Rheumatoid basically refers to a "blood-borne" disease. Rheumatoid is a fairly general term that indicates the body is "attacking" itself with the immune system. The most common form is rheumatoid arthritis but there are other forms such as Crohnís Disease and Lupus. These reoccurring "auto-immune" arthritic diseases will cause spinal and limb spasm that is persistent, even after the rheumatoid attack has settled. Often, one joint (such as the ankle or knee) may remain painful and rheumatic but I find many of the other joints can be very receptive to rehabilitation. Many chronic diseases can contribute to a neuromusculoskeletal pain syndrome. Chronic disease such as anaemia, cancer and radiation treatment are to name a few.

Hormonal abnormalities can contribute to many problems including a pain syndrome such as fibromyalgia. Hyperthyroid (overactive thyroid) disease will commonly increase muscle tension and cause agitation and sleep disruption - a perfect recipe for fibromyalgia. Hypothyroid disease (underactive thyroid) can also be associated with chronic pain. Menopause and perimenopause are commonly associated with disruption of almost every aspect of a womanís life, and may contribute to headaches, neck or back pain, and, of course, the big Fibro. Other hormone disorders may also alter muscle dysfunction, and contribute to various pain syndromes proving once again that the body likes to be a finely tuned machine.

Age-Related Fibromyalgia is actually quite common and often works in conjunction with other contributing factors. It should not surprise anybody to find that a young healthy twenty year old person is more likely to come through a major accident without chronic pain when compared with an eighty year old person with multiple levels of degenerative disk disease and arthritis. Furthermore, the ability of an older person to heal is greatly impaired both at the hormonal level and at the DNA level. Even without trauma, hormone abnormalities, chronic disease, mood disorders or repetitive work, the elderly will have to fight to prevent the onset of spinal compression in their necks and backs. Degenerative spinal disease, loss of flexibility and spinal or joint compression can easily cause a progressive compressive polyneuropathic condition causing many pain syndromes including Fibro.

The "Three-in-one combo pak" is probably the most common form of chronic pain and Fibro. Most sufferers have a bit of a "Heinz 57" mixed version. These individuals usually have a combination of repetitive minor trauma (including improper exercise), single major trauma, are on the older side of life or have a chronic disease or any other possible combo-pak. Others will have one major factor. Still others will have other identifying causes that do not fit into the above recipes. However, my point is that I believe it is important to identify as many of the major factors as possible, as they may be ongoing and contribute to a difficult recovery to a pain syndrome. They may also be reversible, making the pain syndrome more manageable or even aid in recovery.

Finally, it is interesting to note that most acute and chronic pain will fall under similar tendencies. So people suffering chronic headaches will be triggered or aggravated by sleep disruption neck trauma, aging, hormonal disruption, repetitive work, chronic disease, anxiety and sleep disruption. The same will apply to tennis elbow, back pain, arthritis and most other pains including emotional pain.



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