Fibromyalgia is also a musculoskeletal pain disorder, which is different from myofascial pain dysfunction.
Fibromyalgia (fibrositis, myofibrocytis) is a chronic, painful muscle condition characterized by pain in the skeletal muscles, tendons (which attach muscles to bones), ligaments (which attach bones to bones) and bursa (sac-like structures which are filled with synovial fluid and provide lubrication and nutrition to joints). Recently, much has been written about this disorder in health magazines and newspapers. Although Hippocrates first described fibromyalgia, it has been only in the last few years that much attention (and credence) has been given to this syndrome. Controversy and disbelief by the medical profession has been associated with fibromyalgia simply because objective evidence in the form of x-rays or biopsies can’t be found. However, with the use of thermography, or the measuring of heat produced by areas of the body, this syndrome is now more widely accepted by many, but not all, doctors.
Fibromyalgia is characterized by generalized muscle soreness and stiffness lasting more than three months, poor sleep with morning fatigue and stiffness, tenderness at 11 of 18 specific sites, and normal blood test results. The more common painful areas are the low cervical spine, the shoulder, the second rib, the arm, the buttocks and the knee. These symptoms are often worsened by stress or a change in the weather. Depression, which may be due to a chemical imbalance in the brain or the development of chronic pain, is common with fibromyalgia. Virtually all physical activity not only increases the patient’s pain complaints, but also makes the next few days miserable, producing intense muscle pain.
Note the location of specific tender points, 11 of 18 of which are required for the diagnosis of fibromyalgia to be made. From: Fibromyalgia & Chronic Myofascial Pain Syndrome: A Survival Manual, by Starlanyl, DJ and Copeland, ME. New Harbinger Publications: Oakland (CA), 1996.
Fibromyalgia may be caused by physical trauma (such as a motor vehicle accident, a sudden fall, or even the trauma of surgery with a general anesthetic). This terrible disorder may also begin after an illness like the flu. Often, women experience the effects of fibromyalgia due to hormonal changes after a hysterectomy or around the time of the beginning of menopause. Also, the sudden emotional trauma of the loss of a loved one may trigger fibromyalgia.
Many “experts” feel that fibromyalgia effects only those people with “Type A” personalities, but this notion has not been demonstrated either by statistics or by scientific experimentation. It may plague people with all types of personalities and life styles, all age ranges, and those in all states of health. However, many of those suffering with fibromyalgia also suffer with TMJ.
Many other physical conditions are found frequently along with fibromyalgia.* Each of these can and do occur separately; however, they are also quite commonly associated with fibromyalgia.
• TMJ. Many patients suffering with TMJ problems also sufferer with fibromyalgia. Unfortunately, many doctors (1) don’t recognize either TMJ or fibromyalgia or (2) fail to see the connection of these two pain syndromes. Fibromyalgia almost always intensifies the painful symptoms of TMJ and when one or both temporomandibular joints are dislocated, the pain of fibromyalgia in the neck and upper back is greatly magnified. Both TMJ and fibromyalgia produce similar painful symptoms in the muscles of the neck, shoulders, back, face and head as well as often causing dizziness.
• Chronic Fatigue Syndrome. This debilitating disorder, just like fibromyalgia and TMJ, is often misdiagnosed and at best, misunderstood by many medical professionals. In addition to chronic fatigue, CFS, just like fibromyalgia, produces muscle pain and weakness.
• Irritable Bowel Syndrome. Nearly half of all patients with fibromyalgia have frequent bowel cramping, severe diarrhea, and severe abdominal pain.
• Depression. As with most conditions which produce chronic pain, depression is a common problem with fibromyalgia. Common depression symptoms include a feeling of low self esteem, helplessness, hopelessness, poor appetite, loss of sexual drive, sleeplessness, frequent crying, and basic lack of interest in life.
• Anxiety Disorder and Panic Attacks. Often, those afflicted with fibromyalgia also experience extreme anxiety and panic attacks, especially at nighttime. They may awaken in terror with their heart beating rapidly, their chest feeling tight with a feeling as if breathing is impossible. The patient will be convinced that they are going to die. There are many causes of such attacks, and perhaps alterations in certain body chemicals produced in excess with fibromyalgia may be one cause.
• Concentration and Memory Problems. Like those suffering with severe TMJ, patient with fibromyalgia often report difficulty in thinking and even remembering. They often forget where they’ve parked the car at the mall, for example. Simple facts and numbers are often forgotten. Understandably, great frustration often accompanies these memory problems.
• Irritable Bladder. Those with fibromyalgia often complain of frequent, painful urination. Although they feel as if their bladder is infected, urine and blood tests are negative
• Mitral Value Prolapse. There may be a statistical correlation with those suffering with mitral value prolapse (a weakness in the mitral value of the heart) and fibromyalgia. Since the mitral value is mostly fibrous connective tissue, perhaps the same process that effects other connective tissue of the body (eg, muscles, ligaments, tendons and bursae) also damages the mitral value of the heart.*
• Fibrocytic Breast Disease and Endometriosis. Although there is no known explanation (yet!), both fibrocystic disease of the breast and endometriosis are often seen in women with fibromyalgia.* *Pellegrino, MJ. Fibromyalgia: Managing the Pain. Columbus: Anadem Publishing, 1993.
Treatment of fibromyalgia is physical therapy, trigger point anesthetic injections, stress management, non-steroidal anti-inflammatory drugs, dietary changes and antidepressant drugs, especially at bedtime. Recently, there has been a lot of research concerning the use of herbs and homeopathic remedies (eg, Vitamin C, Rhux Tox 6x, melatonin, magnesium, and many others) in the treatment of fibromyalgia. An excellent article addressing this and other issues about fibromyalgia appeared in the January 1996 newsletter of the USA Fibromyalgia Association (details are given below about the Association).
Physical exercise, preceded by stretching and followed by application of ice, is very beneficial. One of the worse things a sufferer of fibromyalgia can do is to become sedentary and inactive. You’ll only gain weight, become depressed, and lose all desire to participate in life.
Many sufferers of fibromyalgia also suffer with TMJ problems. In fact, each of these disorders make the other far worse than they’d be alone. When one or both TMJs are injured, the muscles in the head and neck automatically tense-up, develop trigger points, and, among other symptoms, intensify the symptoms of fibromyalgia. Unfortunately, many doctors who effectively treat fibromyalgia do not understand or recognize TMJ and visa versa. Also, many patients suffering with TMJ have been misdiagnosed as having fibromyalgia.
For more information about fibromyalgia, click on: USA Fibromyalgia Association, or contact:
USA FIBROMYALGIA ASSOCIATION
P.O. Box 20408
Columbus, OH 43220
Phone: (614) 764-8010
(Be sure to say that you found them on Dr. Shankland’s Web Page [for statistical purposes])