you feel like you have the flu all of the time, being achy
with pain all over? Is the pain worse in the morning, often
with increased muscle stiffness? Do you feel fatigued every
day, even after a full nights sleep, Headaches, irritable
bowel syndrome, premenstrual syndrome, dysmenorrhea (menstrual
cramps), chest pain, intolerance to cold or damp weather,
or TMJ syndrome? Do you often feel anxious or depressed?
Do you know someone who complains about similar symptoms?
Have you started to wonder if you are crazy? Don't! What
is described above is very real but little understood condition
that is neither disfiguring nor life threatening syndrome
known as Fibromyalgia!
- Successful Management of Symptoms:
is a common and disabling disorder affecting 2-4% of the
population, women more often than men. Despite the condition's
frequency, the diagnosis is often missed. Patients with
fibromyalgia usually ache all over, sleep poorly, are stiff
on waking, and are tired all day. They are prone to headaches,
memory and concentration problems, dizziness, numbness and
tingling, itching, fluid retention, crampy abdominal or
pelvic pain and diarrhea, and several other symptoms. There
are no diagnostic lab or x-ray abnormalities, but a physician
can confirm the diagnosis by finding multiple tender points
in characteristic locations. Fibromyalgia often runs in
families, suggesting an inherited predisposition. It may
lie dormant until triggered by an injury, stress, or sleep
disturbance. It is closely related to the chronic fatigue
and irritable bowel syndromes. Some have suggested that
these are all just different facets of the same underlying
has mistakenly been thought to be either an inflammatory
or a psychiatric condition. However, no evidence of inflammation
or arthritis has been found, and patients with fibromyalgia
are now known to be no more depressed or anxious than those
with other chronic, painful, debilitating conditions. It
is now believed that depression and anxiety when present
are more often the result than the cause of fibromyalgia.
There is some evidence that fibromyalgia may be due to an
abnormality of deep sleep. Abnormal brain waveforms have
been found in deep sleep in many patients with fibromyalgia.
Fibromyalgia-like symptoms can be produced in normal volunteers
by depriving them of deep sleep for a few days. Low levels
of somatostatin, a hormone important in maintaining good
muscle and other soft tissue health, have been found in
patients with fibromyalgia. This hormone is produced almost
exclusively in deep sleep, and its production is increased
should point out though that while this is my personal favorite
among the theories of the cause of fibromyalgia, there are
several others, and at this time there is probably not a
majority of fibromyalgia researchers that supports any one
is it treated?
is difficult to treat, not because treatment isn't usually
successful (it is), but because it will take a lot of work,
education, and involvement on your part for it to be successful.
Simply starting the right medication will have little effect.
Successful treatment of fibromyalgia requires:
sleep hours and an adequate amount of sleep.
to improve deep sleep.
gentle aerobic exercise.
of physical and emotional stress.
of any coexisting sleep disorders.
Chiropractic and massage therapy.
any of the following is omitted, significant improvement
with FMS must get to bed by the same time every night and
sleep as long as they need to. Staying up just one hour
late may precipitate an exacerbation that lasts for several
days. Many patients with fibromyalgia have exacerbations
triggered by the change over to or from Daylight Savings
time. Try to make the switch in fifteen minute increments
every few days instead of by one hour overnight. I have
had no success getting patients truly feeling well who work
off shifts that prevent them from having a consistent bedtime.
gentle aerobic exercise is very important. While patients
who do too much exercise too soon or of the wrong kind will
make themselves temporarily worse, most patients who don't
begin a daily aerobic exercise regimen will notice little
improvement in their fibromyalgia symptoms. Aerobic exercise
is defined as exercise that gets your heart rate up to a
target heart rate for the duration of the exercise period.
Heart rates are measured in beats per minute. It is accurate
enough for our purposes just to take your pulse for 6 seconds
and multiply by 10. The aerobic target heart rate is calculated
from the following formula:
- Age - rhr) x .6 + rhr
age is your age in years and rhr your resting heart rate,
determined by taking your pulse when you wake up but before
getting out of bed. A good place to feel your pulse is at
the wrist turned palm up, next to the large bone on the
thumb side at the end of your forearm. If you are exercising
hard enough you should be able to feel your heart beating
and can just count that. For most people, the aerobic target
heart rate is at about the point where they can no longer
sing but can still talk comfortably.
kind of exercise is unimportant. Just make sure to pick
something that doesn't make you hurt worse. It may take
trying several different kinds before finding one or more
types that agree with you. Popular kinds include walking,
regular or exercise bicycles, ski simulators, rowing machines,
elliptical machines, swimming, and *gentle* aerobic dance.
Jogging, vigorous aerobic dance, and weight lifting tend
not to very good choices. If your pain is mainly in your
legs or back, consider exercising just your arms with a
Thigh master or similar equipment. While many patients insist
that they get plenty of exercise at work, doing housework,
or in their yard, this is rarely the case. These types of
exercise are rarely helpful, as they don't result in a sustained
elevation of the heart rate, and often increase pain and
make patients feel worse. You need to set aside a time specifically
for daily exercise. Particularly if you are out of shape,
start out with just 3-5 minutes of exercise and gradually
increase as tolerated, shooting for twenty to thirty minutes.
Take a few minutes to stretch your muscles, then start out
slowly, increasing to full speed after a minute or two.
Slow down again for the last minute or two and repeat the
stretches. There are five recommended stretches, each done
for 20 seconds a side. They should be gentle and painless.
Hold onto a tree or post for support for #s 3-5:
your shoulders in a circular motion.
your arm over your head and bend to the opposite side.
forward with your legs straight.
your foot towards your buttock while standing on the other
your feet flat on the ground and one foot ahead of the
other, lean forward, bending just the front knee.
is more effective if done in the late afternoon or evening.
If you absolutely can't do it then, exercising earlier in
the day is better than not exercising at all, but you will
probably need to exercise longer for the same effect. Some
patients find that exercise provides an immediate benefit,
making them feel more alert and comfortable for several
hours. If you experience this effect, you may want to try
exercising three times a day instead of just once. Patients
who can do this are the ones most likely to eventually be
able to get off medication. Exercise seems not to work through
conditioning of muscles but rather through a direct, possibly
hormonal effect on pain and sleep. Patients who have been
exercising regularly and then miss a day usually find that
their fibromyalgia symptoms are significantly worse the
physical and emotional stress:
is an indispensable component of successful treatment, but
too much physical activity of the wrong kind can precipitate
a relapse. Rather than doing housecleaning, yard work, or
other physical activity all on one day, break up the task
so that you do a half hour or an hour every day until it
is done. While it is difficult to learn to do this, it is
essential that you be able to sense when you have reached
your limit and stop. You need to be able to say no to family
and friends when you are not up to some outing or other
activity. Don't take on extra stressful responsibilities
if you don't have to. If you have ongoing problems with
depression or anxiety, consider seeking help for them from
your family doctor or psychiatrist in an attempt to lower
your overall stress level. Relaxation techniques or a chronic
pain program can also help lower your stress level. Fibromyalgia
patients must learn to manage their physical and emotional
other sleep disorders:
other sleep disorders besides insomnia may aggravate fibromyalgia.
Almost half of men with fibromyalgia and some women have
obstructive sleep apnea. In this condition the patient snores
loudly and has periodic pauses in breathing after which
he starts breathing again with a snort. Periodic limb movements
of sleep are a condition in which patients twitch every
30 to 90 seconds for long periods during the night. Patients
may be completely unaware of either of these conditions
until the spouse complains. Not only will it be difficult
to get fibromyalgia symptoms to improve without treating
these disorders, but if sleep apnea is left untreated it
may lead to accidental death or injury as well as early
strokes or heart attacks.
common sources of repeated sleep disturbance are a spouse's
snoring and young children. If the spouse drinks alcohol
in the evenings or is overweight, then avoidance of alcohol
after supper or weight may eliminate snoring. Sleeping propped
up on the side will often help. At the very least, the patient
can wear earplugs. Children are harder to put off but fortunately
most soon outgrow their need for care at night. It is important
to avoid prescription tranquilizers and sleeping medications
of the benzodiazepine group. While these may help you get
to sleep, they suppress deep sleep and therefore often make
and Narcotic Pain Medications:
in the evenings they have the same effect on deep sleep
and should be avoided. Try not to exercise just before bed,
as this may make it harder to fall asleep. Patients with
fibromyalgia should probably give up caffeine completely
as even one cup in the morning can sometimes disrupt sleep
at night and may also directly increase muscle pain and
headaches. If you are drinking more than a cup a day you
should gradually taper yourself off caffeine-containing
beverages over two weeks or so to minimize caffeine withdrawal
symptoms such as headaches. It is also helpful to refrain
from protein consumption in the evening.
Chiropractic and Massage Therapy:
patients report that chiropractic adjustments, gentle massage
as well as heat and rest help relieve their symptoms. Others
find that, as with migraine, certain foods can precipitate
their symptoms. Specific chiropractic adjustments can give
considerable relief by getting the nerve-muscle-joint component
working properly and to help the body to metabolize waste
products, thereby decreasing the patient's pain sensitivity
and eliminating the tender nodules. It often takes two weeks
or more before the beneficial effects of chiropractic adjustments
take effect. Patients should be warned that despite optimum
treatment and good initial results, brief relapses are common.
best results, you need to be actively involved in your treatment
and to have as clear an understanding of this complicated
disorder as possible. Patients with fibromyalgia often elicit
less sympathy and support from family, friends, and employers
than they deserve because of the lack of outward evidence
of disease. Many patients have been told by other physicians
that there is nothing wrong with them or that it is "all
in your head" which can be very demoralizing. For these
reasons, and just because it is good to know that you are
not alone, I strongly encourage attending support group
meetings. There are local chapters in most areas now of
the Fibromyalgia Network. Call us today at 408-739-2273
and start improving today!