Fibromyalgia, the condition that has baffled the medical community since being identified, is beginning to step into the light. The condition is characterized by fatigue, musculoskeletal pain, mood issues, sleep disturbance and, sometimes, memory issues. The pain and fatigue of fibromyalgia are often spread throughout the whole body, complicating efforts to locate a source.
People with fibromyalgia experience muscular pain, often in the form of a constant or semi-constant ache, both above and below the waist. There are 18 identified points on the body, named “tender points,” that hurt when pressure is applied to them if you have fibromyalgia. Some of these tender points are found on the back of the head, the upper chest, the tops and sides of the hips, the inner knee and between the shoulder blades. Fatigue, sleep disorders, depression, headaches and irritable bowel syndrome often accompany fibromyalgia.
Diagnosing fibromyalgia is generally done by process of elimination. If blood tests and X-rays indicate no other reasonable cause, then fibromyalgia is considered. To officially diagnose the condition, doctors should confirm at least three months of widespread pain above and below the waste and, usually, 11 out of the 18 tender points causing pain for the individual. Some doctors have dispensed with tender point testing, being uncertain of how much pressure to apply during the examination. You may need to see a number of doctors before a diagnosis is reached.
What Causes Fibromyalgia?
The exact mechanisms through which fibromyalgia causes pain and other symptoms are not scientifically proven, but researchers are making important inroads that have allowed them to begin shaping a theory. The current theory states that abnormalities in pain processing centers of the brain and in biochemistry are responsible for the widespread pain that characterizes fibromyalgia. The brain of a person with this condition senses pain when there should be none, and so the individual feels pain. This altered biochemical state can be triggered by an injury, infection, or traumatic event. It can also arise with no identifiable trigger.
The above is not at all the same as saying that fibromyalgia pain is psychological. Mental or emotional states are not postulated as the cause of the abnormalities described in this theory; rather, the abnormalities are physiological.
UpToDate, a website featuring quality information on research into medical conditions, published an article entitled “Pathogenesis of fibromyalgia” that highlights some of the specific biochemical abnormalities that shape the budding theory. Studies of people with fibromyalgia show that they have:
1) fewer opioid receptors in the brain,
2) higher-than-normal levels of Substance P in their cerebrospinal fluid, and
3) increased blood flow in areas of the brain that sense pain.
Opioid receptors are needed to cope with pain. Endorphins, the body’s natural pain-killers, lock into these receptors to reduce pain and create feelings of pleasure. Fewer opioid receptors means that your brain has a diminished defense against pain.
Substance P is a substance in the body that determines when a sensation begins being interpreted as painful. This is also called the pain threshold. Heightened levels of Substance P means that pain is experienced earlier than normal in people with fibromyalgia.
Finally, increased blood flow in areas of the brain that process pain signals indicates increased activity. This shows that either an unusually high number of pain signals are being sent to the brain or that the brain is processing a normal number of signals in an abnormal way.
Also significant is the lower level of serotonin some fibromyalgia patients exhibit, reports the Shore Health System of the University of Maryland. This neurotransmitter is a key player in the feeling of well-being and in pain modulation. Decreased serotonin levels are also linked to irritable bowel syndrome, migraine and depression, three conditions often present in those with fibromyalgia.
Some research has also shown that fibromyalgia patients may have low levels of phosphocreatine and adenosine, chemicals that regulate the amount of calcium in muscle cells. An insufficient amount of calcium in muscle cells reduces the muscle’s ability to relax, causing it to become tight and inflamed.
Women are significantly more likely to develop fibromyalgia than men. This is likely due to hormonal and biochemical differences between men and women. Women have less testosterone than men, for example. Testosterone is important in preventing muscle fatigue. Cortisol, a stress hormone that helps to defend the body against damage from stress, is also generally lower in women than in men.
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