What is fibromyalgia syndrome (FMS) and myofascial pain syndrome (MPS)? FMS is a "chronic invisible illnesses". It isn't just a form of muscular rheumatism. It's actually a type of neurotransmitter dysfunction. (Neurotransmitters are what the brain uses to tell the body what to do.) We think 4% or more of all people have FM. It often occurs with chronic myofascial pain syndrome, which is a neuromuscular chronic pain condition with Trigger Points that refer pain, and also can cause symptoms such as extreme dizziness, migraines, buckling knee, and calf cramps. Specific regional pain is a s ymptom of MPS. Diffuse, body-wide pain is a symptom of FMS. One symptom of FMS is a type of dysfunctional sleep called the alpha-delt a sleep anomaly. As soon as people with FMS reach the deep level sleep, alpha brain waves intrude and can jolt them back to shallow sleep or wake them entirely. Not only are they denied refreshing sleep, but delta level is when the body does its repair work and chemical replenishment. If people with MPS are immobile at any time, such as during travel, or sitting in a meeting, their muscles get rigid and painful. Morning stiffness with both of these conditions can be severe. FMS/MPS symptoms can occur body-wide over, and yet the usual medical tests come back negative. Symptoms can fluctuate from hour to hour and day to day, and often worsen with changes in barometric pressure. FMS and chronic MPS are two of the most undiagnosed illnesses. Doctors often refer patients to psychologists or psychiatrists, and yet recent studies show that psych ologically, these chronic patients have about the same amount of abnormal psychology as Rheumatoid Arthritis patients. People with FMS and MPS ar e misunderstood and doubted, and this, in addition to the chronic pain an d other symptoms, could cause anyone to feel depressed. Research is showing that people with FMS have low growth hormone, which i s involved with muscle repair. Some researchers think that the key probl em is a CNS abnormality upstream of the spinal cord. The FMS body is an engine idling at 35% power, rather than a normal 5%. Most FMS patients have memory and cognitive impairments, and many with MPS have difficulty with depth perception and weight perception. In FMS there is an abnormal production of neurotransmitters such as serotonin, melatonin, norepinephrine, dopamine, and other chemicals which help control pain, mood, sleep and the immune system. It looks like there is a genetic predisposition. Often there has been a trigger event, such as accident. An American College of Rheumatology study in 1992 found that the impact of FMS on your life is as bad, or worse, than Rheumatoid Arthritis. They listed one major factor in this as "clinician bias". FMS patients don't look sick, so they are often victimized by clinicians, family , and friends, leaving them with self-doubt, guilt, and loss of self-esteem. FMS patients are hypersensitive to everything--sort of like the "Princess and the Pea" in nursery stories. Little things that others take for granted, like wringing out a wash cloth, or writing a letter, become pain endurance sessions. Many of these symptoms are actually due to MPS. A comparative analysis in the "Journal of Rheumatology" this year found t hat the quality of life for women with FMS is worse than for those who ha ve Rheumatoid Arthritis, osteoarthritis, chronic obstructive pulmonary disease, or insulin-dependent diabetes.
How can someone know if they have FMS and/or MPS? Suspect it if you have a history of widespread pain, and wake up every mo rning feeling like you've been run over by a truck. You may have headach es and loss of balance. Looking both ways when going into traffic can cause dizziness. You can't always find your car in a parking lot. On your best days you feel like you have the flu. You usually develop esophageal reflux. You put on weight, and can't get it off. There is a "fat pad" over your belly. Some common signs are ridges on the fingernails, goosebumps behind the upper arms and thighs, and mottling of the skin. Sometimes you get muscle twitches. You are electromagnetically sensitive. Technically, for FMS, you will have syndrome, grinding of teeth at night, pain when you put your hands in c old water, dizziness, chronic inversion sprains of the ankle, weak knees, weak ankles, pelvic pain, dysmenorrhea and painful intercourse, impotence, and a great many more disruptive symptoms. The tightened and spasming of the myofascia surrounding the muscles can entrap nerves, blood vessels, and ducts. You can have blurring of the eyes, double vision, leg cramps, hypoglycemic-like symptoms, food intolerance, sciatica, hives and rashes, numbness or tingling, mood swings, confusional states--the list goes on and on.
What can we do for someone who has FMS and/or MPS? There is no cure for FMS/MPS, although you can reverse TrPs if you also deal with perpetuating factors. There are medications that help some of the symptoms. Trigger points can be relieved by some types of physical therapy. It takes a commitment on the part of the patient to practice good nutrition, a program of gentle stretching and moderate exercise, and a recognition of both the patient and her/his companions in life that there are real limitations for people with fibro myalgia. It isn't easy to find the right balance to optimize the quality of life. Be kind. Be patient. Be compassionate. Listen. And ask if there is something you can to help.
Neurotransmitter: any specific chemical agent released by a presynaptic cell when activated, that causes the synapse to stimulate or inhibit the postsynaptic cell. Mostly regulated in delta level sleep.
Serotonin: vasoconstrictor (constricts blood vessels) liberated by blood platelets, inhibits gastric secretions and stimulates smooth muscle. Present in large amounts in some areas of the Central Nervous System .
Myofascia: thin layer of connective tissue that covers, supports and connects muscles. Support network that gives the body its shape, determines flexibility. Neurotransmitter superhighway. It is the center of the Trigger Point and tender point problems.
Neurotransmitter activity determines the plasticity of the tissues. Body processes rely on the appropriate movement of fluids through the system. In FMS/MPS, connective tissues become stiffened, shortened and tightened. Growth hormone also has a powerful effect on the connective tissue, directly stimulating production of fibroblasts and mast cells, ground substance and collagen fibers. It's significant in wound healing, where rapid production of collagen fibers by many fibroblasts is necessary for repair. Growth hormone is released during delta-level sleep. People with FMS often have the alpha-delta sleep anomaly, and never enjoy uninterrupted delta level sleep. As soon as it's reached, alpha waves can intrude and jolt us awake or to shallow sleep.
FMS patients have very low levels of growth hormone. The body can't repair itself. Connective tissue is the major repair mechanism of body. Its chemistry monitors inflammatory response, and its fluids deliver antibodies and wbc to fight infection. These are disrupted in FMS.
So much of the psychological and physical sense of continuity and security depends upon our ability to repeat appropriate and predictable actions. Spindle reflex arcs keep muscles constantly informed as to what they"re doing, so that the action can be modified. In FMS, most of the required muscle tension of the body is improperly controlled by the higher brain centers. Others think nothing of picking up a glass of water, and bringing it to the lips. They know how much contractile effort and speed it will take to do this smoothly. FMers have muscular "incompetence in the absence of proper sensory feedback". The thumb grasps with too little pressure. The wrist muscle lets go when flexed. The economy of effort is not there. To sit, walk, and stand, the entire musculature must feel its own activity.
FMS patients are usually burdened with a long history of undiagnosed illness. They suffer from loss of self-esteem. Their condition is invisible, so friends and family don"t believe them when they say they hurt. Yet FMS amplifies the slightest pain. Sin tissue scars and tears easily.
Fibromyalgia can trigger Myofascial Pain Syndrome. Acute pain from FMS creates a muscle contraction,"guarding" around the tender points. This impairs circulation and neural transmission through the area. This effects not only the muscles, but the surrounding organs. A muscle in a state of sustained tension is working, thus its need for nutrition and oxygen is high. At the same time, the sustained contraction reduces circulation in the area by squeezing the small arteries and capillaries which give the working cells fuel and oxygen. Chronic muscle tension and contracture creates an area of heightened metabolism and ischemia and buildup of toxic waste--a Trigger Point. The contracting muscles produce increased waste products and demand increased nutrients from capillaries that are less and less able to handle them. This causes more contraction. This results in rigid muscles until the Trigger Points are defused and the perpetuating factors resolved.
11 of 18 specific "tender points". If these spots are pressed, you will have pain. If you also have MPS, you have Trigger Points. These TrPs are incredibly painful areas that often feel like knots, hard lumps, or taut ropy bands of fibers in the muscles. The TrPs refer pain to other areas. They can trigger gastritis, irritable bowel syndrome, grinding of teeth at night, pain when you put your hands in c old water, dizziness, chronic inversion sprains of the ankle, weak knees, weak ankles, pelvic pain, dysmenorrhea and painful intercourse, impotence, and a great many more disruptive symptoms. The tightened and spasming of the myofascia surrounding the muscles can entrap nerves, blood vessels, and ducts. You can have blurring of the eyes, double vision, leg cramps, hypoglycemic-like symptoms, food intolerance, sciatica, hives and rashes, numbness or tingling, mood swings, confusional states--the list goes on and on.
What can we do for someone who has FMS and/or MPS? There is no cure for FMS/MPS, although you can reverse TrPs if you also deal with perpetuating factors. There are medications that help some of the symptoms. Trigger points can be relieved by some types of physical therapy. It takes a commitment on the part of the patient to practice good nutrition, a program of gentle stretching and moderate exercise, and a recognition of both the patient and her/his companions in life that there are real limitations for people with fibro myalgia. It isn't easy to find the right balance to optimize the quality of life. Be kind. Be patient. Be compassionate. Listen. And ask if there is something you can to help.
Devin Starlanyl M.D. devstar@empath.win.net