A female friend just turning 60 could not lift a heavy carton. She said, "it's fibromyalgia".
We know a doctor who does not ‘believe’ in fibromyalgia.
We wanted to take a look at this issue. And apparently fibromyalgia is real!
Fibromyalgia, has 15 million patients in the U.S.. They report fatigue and widespread musculoskeletal pain. It costs thousands to treat one patient and the 33% of patients who have this, cannot work. Patients are often seen by rheumatologists but due to the existence of depression and anxiety that goes along with it, often a psychiatrist handles this.
Patients have headaches, non-restorative sleep and irregular bowel habits which can also be signs of depression. Treatment by psychiatrists includes psychopharmacology as well as cognitive behavior therapy, and educating the patient.
Aerobic exercise.[i] seems to help too. A study showed that people improved when they engaged in aerobic dance, whole body aerobics, stationary cycling and walking.
Criteria about fibromyalgia pain[ii] include:
- Having at least 3 months of chronic pain.
- 11 of 18 fibromyalgia tender points must be causing pain. Tender points of fibromyalgia according to WEBMD, are pain points around joints which hurt when pressed-but these are not the joints themselves and they are superficial and seem to be right under the skin. They are as big as a penny and "scattered all over the neck, back, chest, elbows, hips, buttoks and knees".
- Doctors need to rule out if pain is based on another cause like arthritis or as a reaction from medicine such as a statin or steroid. Also autoimmune diseases need to be ruled out.
Usually women between 55 and 79 years are at risk for fibromyalgia.
We were surprised to learn that patients with fibromyalgia, had lower "well-being scores" than people with rheumatoid arthritis or advanced cancer.
Fibromyalgia patients also have or have had: osteoporosis, hysterectomies, appendectomies, back and neck surgery and carpal tunnel surgery.
Further they can suffer with TMJ, RLS/restless leg syndrome, affective disorders, irritable bowel/bladder, migraine and chronic fatigue and affective disorders—depression bipolar and anxiety.
A study in Barcelona[iii] found that the fibers were indeed less prevalent in the skin of patients with fibromyalgia and that the nerve presentation can be interpreted as systemic nerve damage that causes deep pain that patients experience in their muscles, tendons and joints.
Dr. Sommer, professor of neurology (U Clinic of Wurzburg-Germany), focused on small nerve function seeing that it occurs at least in some fibromyalgia patients. This simlar finding has been replicated elsewhere in the U.S..
- There could be an adverse life event or triggering factors that lead to inflammation and changes in pain processing.
- The patients with fibromyalgia clearly had increased thresholds to temperature-warm and cold.
It is interesting that her study included a sub-sample of patients with unipolar depression and they had different reactions than those with just fibromyalgia alone. This clearly suggests that: FIBROMYALGIA IS REAL!
We found another study[iv] looking at the thyroid’s relationship to fibromyalgia, specifically hyperthyroidism. It showed that nearly all the patients who had primary hyperparathyroidism (too much calcium in the presence of elevated parathyroid hormone PTH) which affects .5% of the US population with a preexisting condition of fibromyalgia, Experienced improvement in fibromyalgia symptoms following parathyroid surgery and 20% got off their fibromyalgia medicines.
This indicates that screening for this endocrine issue of hyperthyroidism must be included in the workup for fibromyalgia.
Both hyperthyroidism and fibromyalgia conditions include fatigue, musculoskeletal pain, headache, cognitive dysfunction and mood disturbance and both are more prevalent in women and increase with age.
A smaller study at The American College of Rheumatology Oct 2013, showed this thyroid issue was found in 10% of patients who had fibromyalgia compared to .1% of the population at large. Of the 2,184 patients treated for hyperparathyroidism, 4% or 80 patients had a prior fibromyalgia diagnosis. This is a significant finding and gives even more credence to fibromyalgia being a condition all it's own.
We can choose! Get the proper diagnosis and manage this painful condition!
[i] The psychiatrist confronted with a fibromyalgia patient. Hum Psychopharmacol. 2009 Jun; 24 Suppl 1:S25-30. doi
[ii] The Journal of Family Practice 2004,April;53(4):280-291. Exercise and Antidepressent Improve Fibromyalgia Anna Quisel MD, et al.
[iii] Fibromyalgia patients may harbor fewer small nerve fibers by Mitchel L. Zoler Clinical Psychiatry Digital Network November 4, 2013
[iv] Fibromyalgia Symptoms Respond to Parathyroidectomy in some Miriam E. Tucker. May 1, 2014