Karla awakes at 6:30 AM to start her day feeling
exhausted. She was in bed attempting to sleep at 10:00PM and readily fell
asleep only to awaken several hours later due to pain in her hips and
back. She woke up three other times during the night because of being
uncomfortable and having pain in various parts of her body. This is
nothing new for her. She has suffered from widespread pain as well as a
multitude of other symptoms for many of her 42 years.
She has sought treatment with at least 6 or 7 doctors
all of whom have run various tests only to reveal normal results. She has
been told that she has pain related to depression and had suggestions to
see a psychiatrist and counselor on a regular basis. She faithfully
followed those instructions for about 2 years with no significant benefits
in regards to her pain.
She has also been told that she will just have to
live with the pain because there is nothing really wrong with her as
documented by the testing. This is Karla’s life: wake up in pain, drudge
through the day and try to sleep every night in pain.
Karla suffers from a condition known as Fibromyalgia
or Myofascial pain syndrome. She is but one of millions of patients in
the United States and throughout the world who have a multitude of
symptoms but have completely normal laboratory and radiological test
results.
How is it possible to be afflicted with widespread
muscular and joint pain, subjective soft tissue swelling, headaches,
fatigue, paresthesia (an abnormal sensation, as burning, prickling etc),
irritable bowel and bladder syndromes, and a long list of others including
difficulties with memory and concentration, without having a medical
disease or illness????????
This is the conundrum of Fibromyalgia!!!!!!
An American neurologist named Beard seems to be the
first to describe and record widespread muscular pain as well as fatigue
and psychological disturbance as early as 1880. He used the phrase
“neurasthenia” and suggested these symptoms were the result of daily life
stressors.
The term “fibrositis” was coined by the British
physician Sir William Gowers in 1904 in an article on lumbago (lower back
pain). He felt there was an inflammatory component to the condition with
associated complaints of fatigue, poor sleep, worsening of symptoms with
cold weather and muscular strain, and sensitivity to mechanical pressure.
Many studies ensued over the following years to prove
or disprove the inflammatory component of the syndrome.
In 1952, Travell and Rinzler published their work on
“myofascial pain” and the theory of injecting “trigger points” for
treatment of these complaints. Their work is widely published and
referenced for treatment of “myofascial pain syndromes”.
A modern description provided by Eugene Traut M.D. of
the University of Illinois: widespread musculoskeletal pain and stiffness
with all-over aching, fatigue, poor sleep, headache, anxiety, and
widespread tender points on palpation. He noted that almost all patients
were women between the ages of 20-50 years.
The very nature of fibromyalgia as a valid clinical
entity remains in doubt to this day.
The term “fibromyalgia” was officially “accepted” by
the American College of Rheumatology in 1990 when they published a paper
on the criteria for the diagnosis of the condition. This paper is widely
referenced in the medical community.
There is much ongoing research related to
fibromyalgia and other associated conditions such as Chronic Fatigue
Syndrome. This research continues to be undertaken by physicians,
academic institutions, and patient support and education groups. Such
organizations include the National Fibromyalgia Association, National
Institute of Health, and the Arthritis Foundation, among others.
There is a wide array of accepted treatment
regimens for the conditions and it’s associated symptomology. The
following should be considered to formulate a plan of care:
Diet and Nutrition
These are considered key to one’s basic health and
wellbeing. The digestive system is extremely important to the optimal
efficiency of one’s immune system.
Exercise and Weight control
Also considered integral to overall wellness and
optimal organ system function.
Restorative and Recuperative sleep
Sleep efficacy and quality is imperative for
individuals who experience chronic pain.
Pharmaceutical and prescription medications
A vast array of medications, are available to assist
with pain and sleep, as well as other symptoms associated with
fibromyalgia and myofascial pain syndrome.
Alternative medicine and Complementary Medicine
Acupuncture, Trigger/Tender Point injections
Massage, Reiki, Biofeedback etc.
Homeopathic Medications
Yoga, Pilates etc.
There are a myriad of alternative techniques and
treatments that many patients find helpful for the symptoms associated
with fibromyalgia as well as other conditions and disease processes.
Lora Thaxton, M.D.
lthaxton@hotmail.com
Academy of Medicine of
Toledo and Lucas County
