Sunday, September 1, 2013

What You Need to Know About Fibromyalgia


What is Fibromyalgia?

There are 5 to 6 million known cases of Fibromyalgia syndrome (FMS) in the United Stares, and many more that have yet to be diagnosed. Fibromyalgia is one of the most commonly misdiagnosed conditions in this country. False diagnosis for FMS is commonly diagnosed as chronic fatigue syndrome, lymes disease, chronic myofascial pain syndrome, rheumatoid arthritis, and many others. There is no definitive diagnostic test for fibromyalgia that can determine for certain that FMS is the cause of the symptoms. Fibromyalgia is a complex disorder involving several symptoms and is basically a rule-out diagnosis. A rule out diagnosis means that you cannot definitively diagnosis fibromyalgia based on any one test, symptom, or examination. No doctors can definitively diagnosis fibromyalgia without ruling out other causes of the symptoms first. There are many conditions which can mimic and present similar to fibro, and should be ruled out before the diagnosis is definitive. Some of these disorders include autoimmune disorders, tick-borne illness, genetic deficiencies and others. Some common disorders to rule out include lymes disease, lupus, irritable bowl diseases, arthritis, and others. Diagnosis will be discussed in further detail separately in the book.

Many doctors, studies, and institutions have tried to determine the root cause of FMS. FMS affects mostly women and typically the symptoms begin in young adulthood. Several hypotheses have been put forward to try to explain fibromyalgia and include immunologic abnormalities, chemical insensitivity, Epstein Barr Virus infection, Candidia Ablicans infection, chronic mercury poisoning from dental fillings, anemia, parasites, phyopglycmia, and hypothyroidism. However, as with most medical issues, I think that we overcomplicate things. In this book, I will try to describe complex medical terms, hypothesis and treatments in easy to understand language and recommendations.

There are lots of fancy medical words and large concepts that we could use to tell you about fibromyalgia. It would make me sounds smart and like I knew what I was talking about, however, it wouldn't help you all that much. Plus, most of those big words are just Latin that us doctors use to make ourselves sound smart. I would like to explain fibromyalgia to you in simple terms. I think anyone who has been diagnosed with fibro, thinks they may have fibro, or has a friend with fibro, knows that if you got 10 doctors in a room to discuss fibro, four wouldn't believe that fibro exists, and then you would get 10 opinions from the other six doctors. Unfortunately, the etiology (cause) of fibromyalgia is not completely known. However, I believe that it is easily explainable; we just try to over-complicate the issue.

Fibromyalgia is a disorder, which consists of an overly active, overly sensitive nervous system. That is it! I couldn't make it much simpler. Fibromyalgia consists of a body's own nervous system over-reacting. The nervous system is the master controller of the body. The human body can survive approximately 6 weeks with no food, about 6 days without water, about 6 minutes without a heart, and about 6 milliseconds without a nervous system. The nervous system is the master controller of everything your body does. The brain monitors and controls every cell, tissue and organ through the central nervous system, or spinal cord, down to the spinal nerves and then out to the cell, tissues, and organs. The brain sends messages through this control system, and the tissues send messages back, this forms the two-way communication, which is the essence of health and life. This messages lets the brain monitor and record everything that every little cell is doing, and it makes changes, or adjusts, based on the information it receives. This system lets our brain monitor, adjust, and optimize our environment and health.

One way I tell my patients to think of it is to imagine a garden hose coming out of the front of your house. The hose is supplying water to a sprinkler watering the grass. The sprinkler is like the smaller nerves that supply the smaller cells. Now, it is important for the grass to get the right amount of water. Lots of patients in my practice come to see me with a pinched nerve. Now, pinched nerves are like someone standing on the hose. The water doesn't come out as much as it should, and the water doesn't give the grass its nourishment, it wilts, and dies. Pinched nerves are very similar. Now, fibro is the complete opposite of that, Imagine hooking up a fire hose to the sprinkler? Probably would like right huh? Water flying up in the air, all over the place, putting lots of stress on sprinkler head, and probably giving way too much water to the grass. And what will happen if you keep over watering the grass that way? It will also get brown and die. The firehouse to a sprinkler is the best analogy I can give to fibromyalgia. The nervous system is hyper active.

Just as an under active nervous system can make you numb, and over-active nervous system makes you over sensitive to stimuli. We will be talking about diagnosis soon; however, one of the definitive diagnostic tests for fibro is the trigger point assessment. Basically the test discovers if certain points in the body are over-sensitive. This is testing the nervous systems response. If you touch a certain part of your body, in a certain way, your nerves should respond a certain way. In fibro patients, those certain points with a certain pressure, elicit an over reactive and over sensitive response. This demonstrates the body's hyperactive state. The over-active nervous system model can be applies to all signs and symptoms of fibro. Scientifically, this idea has been proven by several studies, which have demonstrated an increased level of substance P, a neurotransmitter in the brain and spinal cord that causes pain. (1,2,3)

This over active nervous system is more responsive to pain than a normal nervous system. Also the increased levels of substance P, tell us that the brain and spinal cord are inducing more pain. My neurology instructor in graduate school told our class that if our brain acknowledged all the pain our nerves felt all day, we would go insane. In fact, it has been shown in studies that 99 percent of all pain signals recorded by the nerves are ignored at the brain. The brain is normally trying to protect us from all the pain that we feel. The nerves do a great job at monitoring all that goes on in the body, especially pain signals. However, it's the brains and spinal cords job, to edit these signals. To decide which are important and which are not. Unfortunately, with FMS these edits don't seem to be working, and the patient feels much more than is normally tolerable.

This excess reaction is a root cause for all FMS symptoms. Of course there are other hypothesis for the cause of fibromyalgia. Some doctors have suggested that fibro is due to chronic of previous infection, some claim sleep disturbances can cause it, and some even believe that there is a genetic component. More studies will be done, however most are in the general agreement that the nervous system is key, and that it is overreacting. The final details will come, but that makes the most sense to me, and I see FMS every day. Several studies have come to similar conclusions as this to the root of FMS. However, this is my opinion based on years of clinical experience and the research that has been performed. Unfortunately like many aspects of FMS, there is no definitive widely believed root cause of FMS, however, most opinions and research studies have shown an over-active nervous system as the cause of fibro.

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