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Some of this taken from: Fibromyalgia/Myofascial Pain Syndrome Handout # 3 Devin Starlanyl, M.D. Exactly what is Fibromyalgia?
FM is a "chronic invisible illness". It isn't just a form of muscular rheumatism. It's actually a type of neurotransmitter
dysfunction. (Neurotransmitters are what the brain uses to tell the body what to do.) We think 4% or more of all people have
FM. One symptom is a type of dysfunctional sleep called the alpha-delta sleep anomaly. As soon as people with FM reach
the deep level sleep, alpha brain waves intrude and jolt them back to shallow sleep. Not only are they denied refreshing sleep,
but delta level is when the body does its repair work and chemical replenishment. If people with FM are immobile at
any time, such as during travel, or sitting in a meeting, their muscles get rigid and painful. Morning stiffness can be severe.
Since neurotransmitters affect every part of the body, symptoms can show up all over, and yet the usual medical tests
come back negative. FM symptoms fluctuate from hour to hour and day to day, and often worsen with changes in barometric
pressure. It's no wonder that FM is one of the most misdiagnosed illnesses. Doctors often refer FM patients to psychologists
or psychiatrists, and yet recent studies show that psychologically, FM patients have about the same amount of abnormal psychology
as Rheumatoid Arthritis patients. An editorial in the Journal of the American Medical Association in 1987 stated that
FM, "...a disease which may have occupied five minutes of time in medical school really exists and is a major cause of morbidity
and disability." People with FM have a history of being misunderstood and doubted. Research is showing that people
with FM have defects in the neuroregulatory system, especially neurotransmitters. They have low growth hormone, which is involved
with muscle repair. Some researchers think that the key problem is a CNS abnormality upstream of the spinal cord. The
FM body is an engine idling at 35% power, rather than a normal 5%. Most FM patients have memory and cognitive impairments.
In FM there is an abnormal production of neurotransmitters such as serotonin, melatonin, norepinephrine, dopamine, and other
chemicals which help control pain, mood, sleep and the immune system. It looks like there is a genetic predisposition. Often
there has been a trigger event, such as an accident. An American College of Rheumatology study in 1992 found that
the impact of FM on your life is as bad, or worse, than Rheumatoid Arthritis. They listed one major factor in this as "clinician
bias". FM patients don't look sick, so they are often victimized by clinicians, family, and friends, leaving them with self-doubt,
guilt, and loss of self-esteem. FM patients have 3 times the normal amount of substance P in their spinal fluid. Substance
P tells the body how much pain it feels. They also have more pain receptors. They are hypersensitive to everything--sort of
like the "Princess and the Pea" in nursery stories. Little things that others take for granted, like wringing out a wash cloth,
or writing a letter, become pain endurance sessions. A comparative analysis in the "Journal of Rheumatology" this
year found that the quality of life for women with FM is worse than for those who have Rheumatoid Arthritis, osteoarthritis,
chronic obstructive pulmonary disease, or insulin-dependent diabetes. The Copenhagen official Fibromyalgia Syndrome definition
states that you must have at least 11 out of 18 specified tender points to qualify for entry into a clinical study of FMS.
Tender points hurt where pressed, but do not refer pain elsewhere -- that is, pressing a tender point does not cause pain
in some other part of the body.(Note that when examining yourself for tender points, you must use enough pressure to whiten
the thumbnail.) The official definition for patients to be admitted to a clincal study on FMS further requires that tender
points must be present in all four quadrants of the body -- that is, the upper right and left and lower right and left parts
of your body. Furthermore, you must have had widespread, more-or-less continuous pain for at least three months. Tender points
occur in pairs on various parts of the body. Because they occur in pairs, the pain is usually distributed equally on both
sides of the body.
On your back, they are present in the following places:
- along the spine in the neck, where the head and neck meet on the upper line of the shoulder, a little less than halfway
from the shoulder to the neck three finger widths, on a diagonal, inward from the last points
- On the back fairly close to the "dimples" above the buttocks, a little less than halfway in toward the spine
- Below the buttocks , very close to the outside edge of the thigh, about three finger widths
On the front of your body, tender points are present in the following places:
- On the neck, just above inner edge of the collarbone
- Still on the neck, a little further out from the last points, about four finger widths down
- On the inner (palm) side of the lower arm, about three finger widths below the elbow crease
- On the inner side of the knee, in the "fat pad"
The tender point locations are not "written in stone." They can
vary from person to person, which can cause further problems with diagnosis. In traumatic FMS, for example, tender points
are often clustered around an injury instead of, or in addition to, the 18 "official" points. These clusters can also occur
around a repetitive strain or a degenerative and/or inflammatory problem, such as arthritis.
It is also said that Some illnesses that Often Accompany FMS are:
Rheumatoid Arthritis (12% of FMS sufferers)
Systemic Lupus Erythematosus (22% of FMS sufferers)
Primary Sjogren's Syndrome (11% of FMS sufferers)
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