Questions and Answers about fibromyalgia

1. What causes fibromyalgia? - The etiology of fibromyalgia is, as yet, not fully understood. And, in fact, it may turn out to be the case that fibromyalgia has not one, but many different causes. Currently, the suspect causes for the onset of fibromyalgia (unfortunately, none of which are proven) include: sleep disturbances, physical injury, stress, viral infection, allergies, hormonal changes, changes in neurotransmitter levels, dietary deficiencies, bacterial infection, and contamination by environmental pollutants.
   
   
2. What determines if you have fibromyalgia versus another condition such as chronic fatigue or IC? - Though the symptoms of FMS also include depression, morning stiffness, tingling in the extremities, tension headaches (migraines), mood changes, and concentration problems, the symptoms which seem to be universal in fibromyalgia patients seem to be: pain, fatigue, and sleep disturbances. And some physicians are of the mindset that if any of these three criteria are absent from a patient's complaints, it may be that FMS is not the proper diagnosis.
   
   
3. What is fibromyalgia sometimes mistaken for? - Fibromyalgia is initially mistaken for several other conditions, including lyme disease, lupus, depression and rheumatoid arthritis to name just a few illnesses. Other conditions for which fibromyalgia is occasionally mistaken include digestive disorders, sleep disorders and thyroid problems. Often, it is because the various symptoms of fibromyalgia are so similar to the symptoms of other disorders that many FMS patients do not receive a proper diagnosis for many years. And this is also why it is especially critical to be seen by either a rheumatologist or a pain specialist to ensure a proper diagnosis, and to rule out other conditions.
   
   
4. What percentage of fibromyalgia patients have IBS? - Actually, a fairly high percentage of individuals with fibromyalgia aka FMS have also been diagnosed with IBS, or irritable bowel syndrome. How high is the percentage? It is believed that up to 70 to 80 percent of fibromyalgia patients also suffer from IBS, a form of inflammatory bowel disease. Irritable bowel syndrome seems to go hand in hand with FMS, similar to the way in which people with fibromyalgia are also found to have depression. Statistically, of course, those who have both IBS and FMS are overwhelmingly female, just as patients who are diagnosed with either depression, fibromyalgia, or irritable bowel syndrome separately, tend more often to be female versus male.
   
   
5. What is the criteria for fibromyalgia? - According to the ACR's criteria (American College of Rheumatology), a person can be diagnosed with fibromyalgia if they have the following signs and symptoms: pain in at least 11 different tender points. What are tender points? Tender points are areas along the skin that are painful to the touch and which overlie areas of joint and soft tissue pain. These tender points can be in the following areas: hips, knees, neck, shoulders, elbows and chest. They can also be on either side of the body. In addition to a specified number of tender points, an individual must also have had a long-term history of pain lasting for at least 3 months. Of course, symptoms that are typically associated with fibromyalgia also include muscle and joint stiffness upon awakening or after sitting in a fixed position for a prolonged length of time, headaches and facial pain (migraines, TMJ), sleep problems, memory lapses, confusion, digestive problems, paresthesia (burning or tingling sensations in extremities), restless leg syndrome, hypersensitivity to sounds, light, or odor, trigger points (points along the skin that, when touched, cause pain sensations to be felt in other areas of the body), and mood disorders (anxiety, depression).
   
   
6. What is the difference between tender points and trigger points? - A tender point hurts to the touch and causes some degree of pain in that area, while a trigger point may not necessarily be painful to the touch but causes a degree of pain to be felt in another area. Fibromyalgia patients typically have a number of tender points and, according to the American College of Rheumatology, the diagnostic criteria for fibromyalgia stipulates that an FMS sufferer should have pain upon palpation (i.e. touch) in eleven of the generally accepted eighteen tender points. A tender point is verified in a physical examination in which approximately nine pounds of pressure are applied by touch and the patient acknowledges that pain is felt.
   
   
7. What is the relationship between stresss and fibromyalgia? - No one really knows the answer to this question. It is believed that in some cases the onset of fibromyalgia may have followed a particularly stressful event or episode in a person's life. This stress may have been psychological in nature or may have been the type of stress experienced when trauma results from a serious injury or accident. Stress, however, also plays a role in triggering certain fibromyalgia symptoms or worsening the degree to which they are felt. The physical stress brought about by strenous exertion, for example, can result in a "bad day" for an FMS sufferer. And certain odors or loud sounds or bright lights have been known to bring about the headaches that are often associated with fibromyalgia as well.
   
   
8. Are over the counter medications helpful for fibromyalgia? - A large percentage of fibromyalgia patients use over the counter drugs like aspirin, ibuprofen, and acetaminophen to alleviate their symptoms and relieve pain. And certainly a larger percentage of individuals with fibromyalgia who have not been properly diagnosed with FMS use these sorts of non-prescription medication. In some cases, fibromyalgia sufferers may rely heavily on OTC meds simply because their treating physician either does not understand their condition, or is reluctant to prescribe stronger analgesics. However, even for those who are able to use over the counter medications, their effectiveness will vary tremendously from individual to individual.
   
   
9. How does a TENS unit help fibromyalgia? - A tens unit can sometimes reduce pain levels for a fibromyalgia patient. What is a tens unit? Tens stands for Transcutaneous electrical nerve stimulation. A tens unit is essentially a stimulation device consisting of electrodes that are attached to the skin, the unit itself, and a battery to provide current. A Tens unit uses electricity to block nerves from sending pain messages. Tens units are prescribed for chronic pain sufferers and fibromyalgia patients.
   
   
10. Fibromyalgia and sleep studies - Individuals who have been diagnosed with fibromyalgia, or who suspect they have fibromyalgia syndrome, sometimes submit themselves to sleep studies. Sleep studies can provide confirmation of a patient's sleep related problems by monitoring brain wave activity. By monitoring such neural activity, information can be gleaned regarding the quality and nature of sleep that a fibromyalgia patient experiences. Recent evidence indicates that fibromyalgia may be related to insufficient amounts of deep level delta wave sleep . Delta wave sleep is the level of sleep at which a person's body both recuperates and regenerates. Failure to reach or maintain deep level sleep may have something to do with the pain that is experienced by those who have fibromyalgia.
    
    
11. Should you get a fibromyalgia diagnosis from a rheumatologist? - A rheumatologist can rule out a diagnosis of rheumatoid arthritis by determining a patient's sedimentation rate. Rheumatologists also have extensive experience dealing with patients who complain of "pain all over". But there is also another reason for getting a fibromyalgia diagnosis from a rheumatologist. Rheumatologists report fibromyalgia is one of their most common diagnosis, while internists and general practitioners often under report fibromyalgia, or fail to adequately comprehend a patient's fibromyalgia-like symptoms.
    
    
12. Why is fibromyalgia misdiagnosed? - Fibromyalgia is often misdiagnosed because so many of the symptoms of FMS appear in a wide variety of other illnesses (such as depression, cfids, and arthritis). However, there are other reasons that account for why fibromyalgia is misdiagnosed. For one thing, fibromyalgia is not accepted as a legitimate and distinct disorder by all practicing physicians. Also, FMS is considered by some to be a condition peculiar to women, perhaps based on the fact that fibromyalgia is overwhelmingly diagnosed in women versus men and also the fact that FMS symptoms are substantially more severe in post-menopausal women versus pre-menopausal women. Additionally, fibromyalgia is often confused with depression and this problem is compounded by the fact that many mental health professionals will render a diagnosis of fibromyalgia when they are, in fact, not qualified to evaluate this musculoskeletal disorder.
    
    
13. Is fibromyalgia related to genetics or family history? - A great many disorders and illnesses seem to have a genetic component that results in a person's predisposition for developing a condition. Depression, and high cholesterol levels are just a couple of examples of conditions for which an individual's family history and inherited genetics may play a significant role. Fibromyalgia syndrome may be no different in this regard. In fact, recent research does seem to indicate a family predisposition for developing fibromyalgia.
    
    
14. What is the relationship between depression and fibromyalgia? - At least half of all fibromyalgia patients have some degree of depression and/or anxiety. But though it may be rare to find an individual with FMS who does not have depression, it is questionable as to whether or not a causal link exists between depression and fibromyalgia. Unfortunately, a certain percentage of the medical establishment does not distinguish between fibromyalgia and various mood disorders, such as depression. And the consequence of this failure to recognize the syndrome as a physical disorder in its own right is that some fibromyalgia patients are kept from receiving adequate care or have the progression of their treatment significantly delayed. Unfortunately, as well, many mental health professionals, typically psychologists and psychiatrists, will render a diagnosis of fibromyalgia when, in fact, this diagnosis should strictly be made by a practicing physician. And, even then, the physician rendering the FMS diagnosis should, ideally, be a pain specialist and/or a rheumatologist.
    
    
15. Which mental conditions are typically associated with fibromyalgia? - Fibromyalgia is often associated with a number of mental conditions and, in fact, FMS is frequently diagnosed by mental health professionals (which may not be a good thing since many internists/family doctors have trouble conceptualizing fibromyalgia as a physical disorder with a physical origin). Which mental problems are most frequently associated with FMS? Typically, the conditions that seem to be most frequently associated with fibromyalgia are depression and anxiety. Because this is the case, questions often arise as to whether or not a causal link exists between fibromyalgia and either depression or anxiety. Of course, it would only be natural for a condition that results in pain, fatigue, and sleep to have an adverse affect on mood and contribute to the rise of anxiety levels. Recent scientific evidence, however, increasingly points to a medical cause for FMS. The leading candidates at the moment have to do with a patient's failure to achieve sufficient amounts of restorative delta-stage (deep level) sleep, and with the levels of certain hormones and neurotransmitters, such as estrogen and serotonin.
    
    
16. Fibromyalgia and brain fog - Brain fog aka fibro fog is a commonly reported symptom of fibromyalgia. Fibromyalgia patients often describe multiple sensations of fatigue and listlessness combined with transitory states of confusion, poor attention and concentration, and short-term memory loss. This fibro fog tends to exacerbate the deficits in daily functioning that a fibromyalgia sufferer must deal with. What causes fibro fog? There's no conclusive origin for this symptom of FMS, nor an explanation as to why it exists in varying degrees for different fibromyalgia patients. Sleep deprivation and significant difficulty in achieving and/or maintaining deep level sleep, however, may very well point to the answer. It is at the deeper levels of sleep (delta wave sleep) that a person's mind conducts its internal "housekeeping". During this phase of sleep, newly acquired information is assimilated and integrated. The inability to get enough restorative deep-level sleep may have an impairing effect on an individual's ability to recall information or operate at a normal level of mental efficiency.
    
    
17. Why is fibromyalgia not taken seriously? - Well, in actuality, fibromyalgia is taken quite a bit more seriously than it was just a few short years ago. This is probably due to the fact that recent information regarding certain chemical substances seem to validate a physical origin for many of the substances of fibromyalgia. For example, lower levels of Serotonin in the brain may point to why some fibromyalgia patients have such low pain threshold. Likewise, higher levels of a chemical known as Substance P in many individuals with fibromyalgia speaks of this as well. There also seems to be a great amount of disagreement over the involvement of various mood disorders, such as anxiety and depression.