Well Women guide to Fibromyalgia
Fibromyalgia is often referred to as the “invisible” condition as it is hard to diagnose. It affects millions of people worldwide and like rheumatoid arthritis, thyroid conditions and chronic fatigue syndrome, it affects mainly women. My friend runs a Fibromyalgia Tried and Tested Group and the group has been testing various products last year and the final report has now been written detailing all the results. It also provides details of our new treatment protocol. You can view the document in pdf here. (You will need adobe reader)
In order to diagnose, a doctor will apply pressure to certain trigger points, usually the neck, rib cage, hips, knees and shoulder area. If tenderness and pain is present in 11 out of 18 specific places on both sides of the body, then fibromyalgia is confirmed. The usual tests such as X-rays, MRI scans, blood and urine tests generally show no evidence of anything being wrong. Like chronic fatigue syndrome, it is frustrating to have so many symptoms and no conclusive biochemical or diagnostic evidence to show for it. There is also thought to be a link between chronic fatigue syndrome and fibromyalgia, but although the symptoms are similar in some ways, it is the fatigue in CFS that is paramount, whilst in fibromyalgia, the pain and inflammation is the main cause for distress. There is no know cause, but plenty of medical suppositions as usual, and stress or a traumatic event is thought to contribute to the disorder. It was suggested to me by my GP in 2007 that I also had fibromyalgia, but I went into denial on this. I had enough to cope with having Hashimoto's, so didn't want yet another condition. I found out that many patients with thyroid disorders also have Fibro, and many have low T3. Evidence suggests that if T3 levels are corrected, much of the pain can be allieviated. This year, 2010 it has finally been confirmed by a rheumatologist, that I do in fact have fibromyalgia. Treatment Generally the treatment is symptomatic and due to the fact that the underlying cause is not being treated, the patient continues to remain unwell. However, it is also now being thought that it could also be due to a hypo metabolism situation, caused by insufficient thyroid hormone, adrenal insufficiency, sex hormone imbalances, exposure to chemical contaminants, nutritional deficiencies, as well as other problems and even problems relating to prescription medication. The metabolism issue is also thought to pertain to chronic fatigue syndrome, M.E and depression. It all depends on the effect slow metabolism has on the affected person, and how symptoms will manifest themselves. Fitness levels are of course a contributory factor to metabolism, but correcting fitness alone will not result in the person becoming well, especially when there may be other factors contributing to their illness.
There are very many similarities in the symptoms of hypothyroidism and fibromyalgia with the exception of the widespread pain. Hypothyroid patients generally have muscle spasms, cramps and non location specific aches and pains. Doctor John Lowe has been researching and treating Fibromyalgia for over 15 years. He has discovered that of his patients:
“44% had evidence of central hypothyroidism due to problems in the pituitary and hypothalamus glands and these in turn caused the thyroid to produce incorrect amounts of thyroid hormone. 12% had evidence of primary hypothyroidism resulting from problems with the thyroid gland. 44% had normal results when tested for thyroid function, but still displayed all the symptoms of hypothyroidism” He also found that 56% of his fibromyalgia patients with abnormal blood results, when treated with synthetic T4, did not respond to treatment, but when given desiccated thyroid hormone like Armour thyroid or a synthetic T4/T3 combination enough to suppress their TSH levels below the normally accepted range, 91% recovered. The effective dose was usually the equivalent of 200-400mg of synthetic T4. The remaining group of 44% of fibromyalgia patients showing normal blood results, 75% were treated with T3 plus metabolic rehabilitation (aerobic exercise plus trigger point treatment) and recovered. Dr Lowe concludes that these ‘euthyroid’ patients suffer from what is known as thyroid hormone resistance. The remaining 25% of the group failed to respond to treatment and Dr lowe concluded that the hypothyroid symptoms presented were due to physical processes un related to hypothyroidism. Conclusion Doctor Lowe was able to reduce the symptoms of 85% of the group to or beyond the point where they no longer satisfied the ACR criteria for fibromyalgia.
Dr Jacob Teitelbaum's treatment protocol for fibromyalgia states that treatment for thyroid dysfunction plays a major part. It showed that thyroid disease plays a major part in the treatment of Chronic fatigue, fibromyalgia and M.E sufferers. All of the 38 in his treatment group were also treated for nutitional deficiencies and put on multivitamins which clarified that this needs addressing too. Many supplements are absolutely necessary to normal thyroid function and general wellness.
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Fibromyalgia (FMS) can also coexist with Myofacial Pain Syndrome (MPS) MPS is characterised by regional pain and FMS by widespread pain Both conditions are characterised by a REDUCED pain threshold, presence of tender points, and evidence of central sensitization. Elevated levels of substance P in Fibromyalgia patients is commonplace. One third of fibro sufferers experience significant minor depression and/or anxiety. Because of the low pain threshold, FMS patients experince pain where others would not, and are lesser able to tolerate pain than those who do not suffer. Syndromes such as IBS, CFS, and dysmenorrhagia often coexist with FMS. FMS also occurs concomitantly in patients with other conditions such as rheumatoid arthritis and systemic lupus. This suggests that these conditions predispose patients to FMS. MFP (myofacial pain syndrome) is characterised by regional areas of chronic pain, arising from taut bands of muscle. This can include neck and shoulder pain, tension headaches and lower back pain. Trigger points are found at discreet areas across the body which are hypersensitive. Palpation of these areas causes local and referred pain. It has been suggested the MPS is a precursor to FMS or one of the many factors that contributes to the syndrome. Since it was first described in the 1800's FMS has been labelled by a variety of titles, including: muscular rheumatism, myalgia, interstitial fibrositis, myofascitis and myofacial pain. In 1977, Smythe and Moldofsky applied the term Fibrositis to patients with localised or generalised musculoskeletal pain associated with tender points. This is a misnomer since the term Fibocytis implies that inflammation is present in fibrous tissue, but this has never been demonstrated by a biopsy. Diagnosis is problematic as there is no objective test. Since then, Rheumatologists have criteria for diagnosing FMS. 1. Patients must have a history of widespread pain lasting more than 3 months 2. Pain in both sides of the body, above and below the waist 3. Axial skeletal pain (cervical spine, anterior chest, thoracic spine, or low back) must be present 4. Pain in 11 of the 18 tender points on digital palpation with an approximate force of 4kg (until the colour of the nail blanches) The patient must report these areas as "painful" and not just tender. Some physicians state that FMS is not a distinct disease entity and that labelling patients with FMS encourages chronic illness behaviour which would increase healthcare consumption. However, research in the UK has showed the contrary to be true. Once patients are educated contructively about the diagnosis of FMS, they are able to manage the condition themselves Due to the wide range of symptoms associated with FMS, it has been hypothesized that patients can be divided into three different sub groups reflecting the syndrome aspect of this condition the three groups were identified by cluster analysis and could be identified as those exhibiting: 1. moderate anxiety, depression, catastrophising, and poor control over pain, the highest pain thresholds and low tenderness 2. High levels of anxiety, depression and catastrophizing, low pain control and considerable tenderness. 3. Low levels of anxiety, depression and catastrophizing and good control over pain but very low pain threshold, and the most tenderness. The first subgroup represnted typical FMS as more than half of the patients fell within this subgroup. Myofacial Pain Similar to FMS, MPS has many different labels and also cited under different headings including fibrositis and myofibrositis and in the 1950's it was decided that trigger points characterised the condition. Research has led to clearer definition between MPS and FMS. In MPS the trigger point feels harder than the surrounding muscle as within the trigger point the muscle has formed a knot. Palpation of a trigger point causes local and referred pain which is not a feature of FMS. This trigger point also has a twitch response which is also termed "the jump sign" MPS can be labelled under different terms depending on the area of the body that it affects such as TMD (temporomandibular disorder)low back pain or tension headache. It is also associated with limited movement, weakness and autonomic dysfunction. Criteria for Myofacial pain syndrome; 1. Regional pain 2. Presence of taut palpable band 3. Distinct pattern of referred pain 4. Exquisite local tenderness at one or more points in the taut band 5. Limited range of motion in the affected area Plus one of the following: 1. local twitch response to snapping palpation or needling 2. pressure on myofacial trigger points reproduces pain 3. Pain allieviated by deactivating the myofacial trigger point Prevalance of chronic widespread pain is more common in women than men, increases with age with the highest prevalence being in the 59 to 74 age group. However, children also suffer with a prevalence of 7.5 per cent. Myofacial pain is the most common cause of chronic regional pain. It can include low back pain, shoulder pain, tension headaches and facial pain amongst others. 85 per cent of those who visit pain clinics with lower back pain may suffer from Myofacial pain and 90 per cent with chronic neck pain and tension headaches. Associated conditions there are a group of disorders which have been termed "affective spectrum disorders" and which frequently coexist with one another. These include Fibromyalgia, but also IBS (irritable bowel syndrome) depression and anxiety disorders and migraine. These are all associated with psychological distress. It hasbeen thought that depression may eventually lead to widespread pain, and, although it is commonly reported in Fibromyalgia, (in 20 to 30 per cent of patients) it is more likely that it in fact occurs the other way round (the pain results in depression) as the majority of patients do not suffer from any psychiatric illness, and, when present, the depession can be treated without improving the pain state. Risk Factors Many studies have shown that psychological features are risk factors for chronic generalised musculoskeletal pain and/or fibromyalgia, and these incude: somatization, having a mental disorder, presence of psychological distress, major depression, panic disorder, and familial major mood disorder. In my own experience from interacting with other fibromyalgia and myofacial pain sufferers, this does not appear to be true however. most sufferers were high achieving, or perfectionists, suffered from thyroid illness, other conditions including dental problems causing trauma through pain, or had experienced trauma in their lives for whatever reason, be it financial, divorce, bereavement, etc which had, in time resulted in Fibromyalgia or MPS. Studies also showed that sociocultural factors such as low level of income, being divorced, disabled, immigrant status, smoking or lower social class have been implicated but definative evidence is lacking. This is certainly not the case in the group I represent, but each one suffered trauma of some kind, had low T3 or adrenal fatigue also present. Pathothysiology Fibromyalgia The generalized muscle pain appears frequently to be exhibited following suffering of localized muscle pain. this can be due to an injury such as whiplash or low back pain. Although no obvious muscle damage or tissue damage is present in FMS patients, some changes within the muscle have been reported. The micdrocirculation of muscles appears to be altered resulting in reduced muscle tissue oxygenation. This is not specific to FMS, but may be important for onset of pain and hypersensitivity in chronic pain conditions. This can cause other muscle changes which have also been observed in fibromyalgia patients including "red ragged and moth eaten fibers" possibly due to distribution and proliferation of mitochondria and various metabolic effects. Hypoxia of muscle tissue may lead to the release of pain substances including serotonin, bradykinin, substance P and histamine which sensitize nociceptive fibers and is exacerbated during contraction of the muscle. Genetics Buskila et al suggested a possible genetic factor in the developement of FMS by demonstrating that 28 per cent of mothers with FMS suffered from chronic widespread pain. Offspring with and without FMS did not differ on anxiety, depression, global well being, quality of life and physical functioning. In a case controlled study in which the frequency of FMS in 533 relatives of 78 probands with rheumatoid arthritis, Arnold et al found that FMS aggregated strongly in families. Therefore the risk of suffering from FMS in a relative of a proband with FMS was increased eight-fold when compared with probands with Rheumatoid arthritis. They also were found to have significantly higher number of tender points and major mood disorders. More recently, a study compared he prevalence of chronic widespread pain in twins and they found that genetic factors accounted for 50 per cent of the total variance. This provides persuasive evidence supporting the importance of genetic factor in the pathogenesis of FMS. Neuroendocrine Alterations In patients with FMS, a reduced hypothalmic-pituitary-adrenal (HPA) axis response to stress has been demonstrated. The neuroendocrine response acts normally under baseline conditions, but not when subjected to stress or even normal activities of daily living. However, this deficit may have more impact on depression, a common associated feature of FMS, as well as chronic pain. Patients with FMS often report experiencing previous stressful or traumatic events A reduced HPA axis response to stress can contribute to FMS developement or worsening of FMS. The HPA axis is also linked to the autonomic nervous system which is involved in modulating sleep, mood, pain and cardiovascular activities (including microcirculation of muscles) This could explain many clinical features and the association of FMS with sympathetic nerve system over-activity, although more detailed studies will be needed to confirm a causative relationship. Abnormal HPA axis activity has also been observed to a lesser extent in chronic low back pain sufferers, therefore it does appear to be linked to chronic pain. Hormones such as cortisol, growth hormone (GH) and thyroid hormone can be affected particularly in patients with an altered HPA axis. Studies have reported increased levels of adrenocortical trophic hormone (ACTH) and decreased levels of insulin-like growth factor (IGF-1), triiodothyronine (T3), GH, Oestrogen and urinary cortisol A reduction in IGF-1 levels has also been proposed as a contributing factor for FMS development and it has been observed that patients had declining levels over the following one to two years. These patients with low levels of IGF-1 also failed to secrete GH after stimulation with clonodine and l-dopa suggesting that low IGF-1 in patients with FMS are a secondary phenomenon due to hypothalamic-pituitary-GH axis dysfunction. Some have suggested that the HPA deficit may be a secondary phenomenon rather than having a causative role as it has also been observed in patients with sleep disturbances. FMS patients have been reported to have a reduction of stage 4 non-REM or deep sleep, which also leads to reduced pressure pain thresholds, increased aching and fatigue. FMS patients are typically more painful and tender in the mornings and experience significant morning stiffness. This is lessened after nights where more restful sleep is achieved. Although a cause and effect relationship has not been established, this does appear to be an important factor in FMS. Here is an important article about fibromyalgia which discusses potential causes and associated conditions. Also, please take a look at Anita Murray's Site about Fibromyalgia Anita is a professional health coach with many qualifications. She is also a former sufferer of Fibromyalgia, so knows exactly what it is like. On her site you can get valuable information about the condition and also benefit from her coaching programs, designed to "uncover your unique motivations and bring clarity and accountability to your health and lifestyle goals." You can read about her personal experience with the condition and how she has coped. You can also request her E-book which has 8 strategies to support you on your journey or sign up for her free E-course. Anita is running free teleclasses and you can book a class through her site. It's a great idea to motivate you towards getting well and can only benefit you in the long run. There is no one more qualified to help and motivate you than someone who had been through it and conquered it. You have nothing to lose, but everything to gain. Remember, knowledge is power and the best people to learn from are those who actually have the condition and have, through research, found ways of managing their illnesses and going forward in leaps and bounds on the road to wellness. Supplements to help? Like Autoimmune Disease, Fibromyalgia will be helped by Plant Sterols and Sterolins as there is also an autoimmune component. Zell Oxygen is considered to be an essential supplement for all Chronic Illness Serrapeptase digests dead tissue throughout the body and will be helpful for chronic inflammation.
Latest 13 April 2008 I have been contacted by a lady, herself a Fibromyalgia Sufferer who has sponsorship for a "Get Well" project and who is looking for 16 volunteers in the Surrey and Susses area to participate. This will involve testing new products for Fibromyalgia Sufferers that are not readily available, so if you think you would like to be part of this project, then please contact me using my contact form and I will pass your details to her. She can then provide you with more information. Please Click here for the latest news on this.
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The most common symptom is widespread chronic muscle pain and joint stiffness and it accounts for 1 in 8 visits to a rheumatologist in the UK alone.
Simply correcting thyroid hormone imbalance alone will not result in making the person well if adrenal insufficiency is also part of the cause and therefore all hormonal factors must be corrected and as well as fitness and diet for the person to maintain wellness.
