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Fibromyalgia & Women 

 Stop The Pain

Yes Virginia, Fibromyalgia Does Exist

There appears to be great controversy over the idea of whether fibromyalgia actually exists or not.

Seven years ago, when I became personally interested in chronic pain, I would estimate that probably 1 in 10 doctors believed in the existence of fibromyalgia. Over the past seven years I have seen a marked change. I would estimate that probably 50% to 75% of physicians truly believe in the existence of the condition known as fibromyalgia. 

I, myself, believe in the existence of this condition. I too suffered from it seven years ago. Although I believe in fibromyalgia’s existence, I dislike the methodology of diagnosis as it uses very vague signs and symptoms and does not focus on the origin of the problem. 

Currently, the diagnosis of fibromyalgia is somewhat arbitrary. It is based upon the findings of tender points in at least 12 of the 18 recognized pain sites for fibromyalgia. You will find that the number and location of pain sites will actually vary from country to country as there is significant difference of opinion. The inclusion or exclusion of various symptoms such as fatigue, limb numbness, headaches, back pain, neck pain can make it even more confusing. 

Furthermore there appears to be no consensus about the cause of the condition. Some physicians classify fibromyalgia as simply an extension of anxiety and depression. Other physicians recognize that trauma either repetitive or massive and singular, may start many of the symptoms associated with fibromyalgia.

Before I begin explaining how a patient develops fibromyalgia, I would first like to explain some of the basic behaviors of muscles. I would also recommend that you view the section on my Principles of Pain in the Understanding Pain section at www.drlamb.com. 

One of the basic principles that I would like to remember is that the skeletal muscles in our bodies are constantly being injured. The more severe the muscle injury or exercise, the more the muscle will shorten in response to that injury. As well, most of the shortening will occur at rest such as sleeping, standing, or sitting. 

Many of these muscles can develop scar tissue from prolonged shortening. The spinal muscles in the neck, mid back and low back are the most susceptible to scarring. Over time, our bodies will accumulate muscle injury and scarring throughout our spinal muscles and limb muscles. 

This scarring and shortening will cause minor and even major compression or traction syndromes in the spine and limbs. This could result in various patterns of entrapped nerves, herniated disks, and referred pain to virtually any part of the body. 

When I used the term pain, I often use it loosely. I will include the term pain to describe abnormal symptoms such as ringing within the ears or vertigo if the symptom is a result of a chronic pain syndrome. 

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There is also a poorly known principal known as Cannons Law of Denervation Supersensitivity that describes the effect upon the body when a nerve is "pinched". One important fact from Cannon’s Law, is that muscles will shorten and spasm irreversibly with the onset of nerve entrapment.

Let's now return to a  hypothetical illustration of fibromyalgia.  Since statistics show women are more at risk for this condition due to factors that I will discuss later, I will use a female example. Let's call her Dolores.

Dolores is a 20-year-old woman who just began her job as a legal secretary.  She stopped growing approximately 3 years ago.  Typically she has become a little more sedentary but she also has had a significant change in the levels of growth hormone in her body. 

This will have the effect of increasing the fat content in the body and decreasing the ability to repair muscle. Decrease in growth hormone levels will also have the effect of increasing the probability of injury. 

Now Dolores begins her job as a for approximately 6 hours per day. She spends much of the day typing reports.

One of the first problems that she notices is that she has an increase in headaches and some of them are migraine in nature. 

Over time, she begins to notice her headaches increasing. She may find that stress may aggravate her headaches and  notices heartburn or even the occasional tingling in her fingers when she is sleeping at night. 

Dolores is unaware that the cause of her headaches is coming from a nerve problem , caused by muscle and disk problems in her neck. She does notice though occasional neck pain. The muscle problems will get worse with stress and therefore will trigger more headaches. 

The occasional tingling she feels in her fingers is the beginning of the condition known as Repetitive Strain Injury or Carpal Tunnel Syndrome and ulnar neuritis.

Now Dolores, for fun, has several hobbies and pastimes. She likes to play the violin and enjoys some computer games. For exercise she will often ride her mountain bike and lift weights. She has a nice little sports car that she likes to wash and wax regularly. 

Dolores is now 29 years of age, approaching 30. She likes her work and sometimes works overtime. She has started to notice that she has occasional aching in her upper and lower back. She notices her arm, neck and upper back pain are worse after working overtime or waxing her car. 

Her headaches have remained about the same but she has noticed that she gets occasional aching in her fingers and hands and even shoulders and jaw. Her heartburn is a little worse and she finds she can only tolerate non-spicy foods. She occasionally takes one of those new antacid pills like Zantac or Pepcid. 

Our hypothetical person nearing 30, has experienced increasing and accumulating spinal muscle traumas over the past 10 years. She is already developed some of the symptoms of multiple muscle neuropathy, also known as partially entrapped nerves or pinched nerves. 

Her stomach symptoms are probably related to the fact that she's developed thoracic spinal neuropathy or pinched nerves in the upper back. The upper back problems are causing abnormal muscle movement within the stomach and gut. This results in the stomach bloating and irregular bowel movement and pain (Irritable Bowel Syndrome). 

The bloating of the stomach will increase reflux and heartburn and it will also decrease the diameter of the lining of the stomach causing an increase risk of ulceration. 

The increase in joint pains are directly related to persistent compression of the joints in her hands, shoulders and jaw. She may even notice that her joints crack or pop frequently which is described as crepitus in medicine. 

Her pastimes of playing the violin, computer games, bicycling and washing her car will also contribute to accumulated muscle trauma within the spine in the neck, which in turn can cause partial nerve root irritation and pain referring into the arms, legs and head. 

The symptoms will come and go but will typically be worse at rest after you have exercised more than usual. 

Her symptoms are very intermittent and are easily passed off as the simple aches and pains of exercise and aging.

Dolores is now turning 40. She visits her doctor regularly and she has mentioned  her aches and pains. She is now married, has two kids and is quite rushed in her life style. Her doctor orders X-RAYS of her neck and low back and also of her shoulders and hands. The x-rays show very little abnormalities but may show early changes of arthritis in parts of the neck and low back. 

She cannot understand why her hands hurt, but she figures that it must be related to her typing. She now notices that she is always tired and her sleep is frequently interrupted. Her headaches are getting a little better but her stomach problems seem to be getting worse and she's having bizarre pelvic pain and irregular periods. 

Dolores has been involved in two car accidents- one in which she experienced fairly significant whiplash injuries. She was enrolled in physiotherapy for three months, which has helped but found that she did not recover fully from that injury. 

Now she has noticed that she has more cramping of her leg muscles at rest and nighttime. She is more tender to touch in her arms, shoulders, legs, neck, upper back, and low back. She has tried massage therapy to help with her achy muscles but finds that this often aggravates her pain more. 

She has tried chiropractic therapy, which she found somewhat helpful for her headaches but did not seem to help the rest of her body.

Dolores is now 50 years old. She's been seeing her doctor on-and-off for the past two years because her body pains are becoming too intense to deal with. She is having trouble working. 

She has been told that she is entering menopause and has begun therapy with hormone replacement. She has noticed that the hormone replacement has been helpful with some of her symptoms. 

Her pain now prevents her from static repetitive work like typing. She sleeps very poorly and is taking regular sleeping medication and pain medication, so that she gets a least some relief. 

Dolores has finally seen a rheumatologist that has diagnosed her as suffering from fibromyalgia. He offered her some anti-inflammatories, muscle relaxants and suggested that she keeps active and exercises. Every time she increases her exercise level though, her pain level flares up intensely. 

Her husband is understanding but is still concerned about the situation, as his wife is quickly becoming unable to function. The woman does not know that the compression in her neck and spine is causing more and more referred muscle abnormalities in her arms, legs and even gut. 

She tries yoga and stretching and finds this helps somewhat but that the benefit is temporary. Her x-rays now show that she has early signs of osteoarthritis in her neck and low back, as well as her shoulders, hands, fingers and knees. 

Summary

Dolores was not based upon any particular patient of mine but really a compilation of people that I commonly see. I have tried to describe the subtle changes of the development of a chronic pain syndrome called fibromyalgia. 

I hope you have learned that "fibro", as known by most of my patients, is actually quite common and is a natural phenomenon of muscle and nerve. 

It is accelerated by bad diet, smoking, lack of activity but is probably most affected by early trauma from accidents and sports, lack of regular stretching, static repetitive work such as computer work and assembly work. 

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Stress will increase the muscle tension and therefore the likelihood and severity of the disease. 

It is simply a compilation of pain disorders, which are caused by spinal muscle dysfunction causing nerve, disk and vertebral compression and traction. 

It is reversible and curable. In general, better recoveries occur with young, motivated, non-agitated patients.