“It's all in your head” or “just learn to live with it” - these are the two most common phrases, from the medical profession, suffering from fibromyalgia syndrome or FMS.
Most of us have an understanding, especially nowadays, that research in the field of medicine is happening and is emerging at a fast and violent pace. Most people also understand that not every doctor can or should even be responsible for keeping up with each new discovery. Without special need or interest in this area, many of what they have learned never get on the table of most doctors. This is one explanation of how such a large number of medical specialists are still not aware of whether a widespread disorder such as fibromyalgia is misinformed or completely denies the existence of such a disorder.
Far from a new discovery, the symptoms of FMS were first recorded in the 18th century and recognized as a specific set of symptoms in 1860. It took more than 100 years, in the late 1980s, before the official name of Fibromyalgia Syndrome was appointed the American Foundation for Arthritis and the National Center for Disease Control. Until that time, the FMS was known for at least 100 different names, including fibromyositis, fibrositis, and the old character familiar to rheumatism.
Despite familiarity with this disorder, many doctors remain attached to the FMS diagnosis. Maria Shriver reported the presentation of Dr. Thomas Bohr on January 4, 2000 on NBC Dateline. In this report, a neurologist from Loma Linda Medical Center in California, Dr. Bor, said: "... there is a part of a medical institution that claims that fibromyalgia is not just repurposed, it does not exist at all." His opinion does not seem to be reflected by most doctors. Nevertheless, people like him are enough, which sometimes makes it difficult to find a diagnosis and treatment. Even with doctors familiar with FMS, the diagnostic process often takes five years.
Literally defined, fibromas reflect fibrous or connective tissue. Myalgia means pain in one or more muscles. Therefore, fibromyalgia means pain in the connective tissues and muscles. It is often called the conditions of the musculoskeletal system with soft tissues.
Although it may be literal, it is strictly descriptive. It is often described as the feeling that a person has eternal flu. This is not enough. Today, it is the second most common rheumatic disease and ten million people, only in the United States, share the plight of this highly painful disorder. Among 1.5-6% of the world's population with a positive diagnosis of fibromyalgia, there is a wide range of descriptions.
This is true for FMS symptoms. They are as diverse and individual as people. The most common symptoms are insomnia, excessive exhaustion and / or fatigue, hormonal dysfunction, irritable bowel and bladder, blurred vision, dysfunction of heat regulation, dysmenorrhea, TMJ, food and environmental allergies, unheated sleep, mitral valve prolapse, muscle pain and spasms , joint pain, myofascial pain, depression, anxiety, craving for sugar, excessive thirst, confusion, memory loss, chest pain, irritability, acne, diarrhea, gum disease, oral infection and headaches. The list goes on and on, however, comparing one patient with another will produce two completely different sets of symptoms. This in itself can interfere with the diagnostic process, as numerous diseases and disorders share these symptoms.
In 1990, the American College of Rheumatology established diagnostic criteria that help distinguish FMS from other diseases. This criterion should include, but is not limited to:
Widespread pain in muscles / joints, not explained by inflammatory or degenerative musculoskeletal disorder, for 3 months or more
Current fatigue over the same time period
Tenderness in at least 11 of 18 tender points, with digital palpation.
This diagnostic criterion is useful, but the FMS continues to be mistakenly diagnosed and mixed with diseases such as chronic fatigue syndrome, myofacial pain syndrome, lupus, Epstein-barre and many others. The chronic nature of each of these demographic and similar therapies adds to the confusion.
In the early 1990s, comparative studies were conducted by researchers to distinguish between multiple chemical sensitivities, fibromyalgia, and chronic fatigue using patient questions to evaluate symptoms. The results showed that 70% of patients previously diagnosed with FMS and 30% of patients diagnosed with MCS met the CFS criteria set by the Center for Disease Control.
Many of the symptoms that mimic such diseases and the initial diagnosis are usually something other than FMS, until visualization studies, blood tests and other clinical trials are excluded. To date, there are no tests for positive identification of FMS, although the February 1999 news release cited an anti-polymer antibody assay suitable for FMS testing based on what researchers found anti-polymer antibodies in the blood of FMS patients.
Recent reports on completed tests begin to identify specific clinical factors. However, they have yet to be grouped into a single package of identifying factors. Another problem is to deal with the desks of doctors with this information. The diagnosis of the elimination process in combination with the established criteria remains the general course of events.
To further complicate matters, there is often a comorbid diagnosis of one or more diseases that mimic the FMS. Frequent concomitant morbidity exists with irritable bowel syndrome, migraine headaches, osteoarthritis and rheumatoid arthritis, as well as others. In a review of FMS in April 1999, Dr. Don L. Goldenberg of the Department of Rheumatology at Newton-Wellesley Hospital in Massachusetts claims that FMS is present in 10-40% of patients with systemic lupus erythematosus and from 10% to 30% of patients with rheumatoid arthritis. He also claims that 25-50% of all patients mentioned for the treatment of Systemic Lyme disease have never had Lyme, but rather FMS. On the other hand, than systemic diseases, Dr. Goldenberg feels that there is no use in trying to differentiate between FMS or other syndromes, since the overlap of symptoms is so extensive.
Many skeptics look as if they would like us to believe that FMS is completely a psychiatric illness. Antidepressants are often prescribed for FMS patients and are often found to be helpful in relieving some of the symptoms. There is a link between FMS and major depression. However, is this the old, “who was the first, the chicken or the egg?” Argument. Relentless, often disabling pain from FMS, can certainly lead to depression. On the other hand, classical psychosomatic theory asserts depression as a cause, not a result.
It has been shown that patients with a simultaneous diagnosis of irritable bowel syndrome are more common in the past and present diagnosis of depression. There is a higher incidence of comorbid conditions with depression and IBS in women who have been physically and / or sexually abused as children.
Stress plays an important role in stimulating and / or exacerbating the main symptoms of many of these crossover disorders. However, most of those who work with FMS are not suppressed. Only one third of patients with FMS share the simultaneous diagnosis of major depression, eliminating the likelihood that it is the cause of FMS.
Fibromyalgia syndrome crosses all boundaries, socio-economic, age, racial or gender. Women are diagnosed between five and twenty times more often than men. It has been shown that women have lower pain tolerance and threshold, and tend to exhibit healthier behaviors than men. Diagnostic indicators for both sexes increase as the age at the time of diagnosis increases above fifty.
No identifying causes of fibromyalgia were found. Over 100 years of research has only recently begun to detect any permanent disruption of soft tissue or muscles. Electrical stimulation caused a significantly higher level of pain in the upper limbs in patients with FMS in contrast to normal control. Patients with PMS have hypersensitivity to pain and auditory stimuli, and there is some evidence that these people have a real altered perception and response to these stimuli. It is assumed that one of the main causes of the manifestation of extreme physical symptoms is a high level of destruction of muscle tissue.
Studies conducted in 1999 and so far in 2000 showed a decrease in serotonin levels, elevated levels of substance P (neuropeptide) and abnormal antinociceptive (pain-relieving) peptides in the cerebral spinal fluid. Nearly a quarter of patients who studied with cervical spine injuries developed FMS, while a much smaller number developed it after a leg injury. With the FMS, many believe that they can track the sunset to a certain emotional or physically traumatic event in their lives. Studies of the visualization of the brain of women with FMS revealed a decrease in cerebral blood flow in the thalamus and the caudate nucleus (1 of 4 basal ganglia). The caudate nucleus and the thalamus are responsible for transmitting the signal of toxic stimuli to the brain. Reduced blood flow to these areas has also been identified with other chronic pain.
A study conducted at the University of Washington Medical Center in the early 1990s tried to clarify whether FMS patients are more susceptible to actual muscle damage than to actions than to non-FMS people. The results showed that there was no more damage to one group than another. However, the researchers then questioned whether pain was an indicative measure of muscle damage. Magnetic resonance spectroscopy showed that patients with PMS had a higher amount of phosphodiester than healthy people, indicating abnormalities in the thin transparent membrane of striated muscles.
Subsequent studies in this vein followed, with a conclusion in one of 1998, which stated that "P-31 MRS provides objective evidence of metabolic disorders with fatigue and fatigue in patients with FM."
Studies published in March 2000 show that the basal automatic state of persons with FMS "is characterized by increased sympathetic and diminished parasympathetic tones." The physical, symptomatic, and psychological health of these patients entails automatic disregulation. Other test reports in 2000 show that there is a significant difference in how FMS patients respond to pain compared to controls.
Sleep disorders are present in most, if not all, sufferers. Men tend to suffer from sleep apnea. Both men and women may experience anomalies in the cycles of slow sleep and non-fast eye movement.
There is also evidence that the tendency to develop this disorder can occur in families, suggesting a genetic causative factor. Anomalies in various neurohormones, microcirculation disorders, low phosphate and magnesium, insufficient synthesis of adenosine triphosphate, exaggerated response to certain hormones, sympathetic and parasympathetic imbalances and interference with the release of growth hormone, have recently been clinically identified in the FMS.
Viral factors, especially the Epstein-Barr virus, have been consistently proposed by patients and researchers as a causative factor. The theory is that the concomitant infectious state has depleted the immunological response, creating inflammation that increases the levels of nitrous oxide, increasing the level of homocysteine in the cerebral spinal fluid. One quarter of all Lyme sufferers developed the FMS after the completion of Lyme treatment, also presenting the possibility of a viral causative agent. However, there is no concrete evidence supporting this as a fact.
In a January report by Dr. Garth L. Nicholson for January 1999, Dr. Nicholson claims that up to 70% of patients with a positive diagnosis of FMS can react to mycoplasmas and other bacteria and / or subject them to "chemical or other insults" that can suppress immune function. He does not believe that this is the actual cause of the FMS, but rather that they exacerbate the symptoms and the progress of the disease. The studies that he publishes in his report and the results of his own research state that most of the patients surveyed confirm the presence of pathogenic species, such as M. fermentans, M. penetrans, M. pneumoniae, M. genitalium, M. pirum and M. hominis . The report further states that the use of blood tests specific for the identification of mycoplasma infections, as well as the polymerase chain reaction and tracking of nucleoprotein genes as an effective check.
Lilia G Casura reports in a release of the Townsend Newsletter, released in January 2000, that patients said they felt they were being "driven by a Mack truck." There are moments, even full days, when it seems that there is not a single part of the body that does not experience severe pain. It affects daily activities, mood, ability to digest foods, sleep and body parts, and actions that most people cannot even identify. Mental confusion and short-term memory loss are often overwhelming and embarrassing. Even a loving hug can bring an episode of excruciating pain that can last several days.
Fibromyalgia treatment varies as a diagnosis and the corresponding cause. Since there is no particular biophysiological reason, how can there be a drug or a single treatment protocol? Although researchers continue to ponder their findings, the medical profession and alternative health care providers continue to discuss the best course of action. Each of these sects has plenty of medical and alternative alternatives. It must be decided that everyone agrees to restore proper sleep patterns, treat depressive states, and that increased exercise is of great benefit.
The medical profession is divided into treatment in several ways. Those who believe only in the psycho-factor tend to be treated with antidepressants and sleep medications and some more. Others will add narcotic pain killers. Some people believe that nonsteroidal painkillers are effective, while some conclude that no one type works. Dr. Goldberg said: "Medicines that affect the perception of pain, sleep, and mood were useful and should be integrated with activities, exercises, and educational programs." Dr. Devin J. Starlanil believes that gifenezin, a common expectorant in cough syrup, is effective at certain doses. She also follows training and education guidelines.
Here there is another split regarding which type of exercise is appropriate. Some recommend intensive aerobic, cardiovascular exercises, some believe in strength training or slow stretching, such as Tai chi or yoga.
Several enlightened medical professionals, such as Dr. Kristin Fritsch, MD from North Kaiser-Pernania, Dr. Bill Sieber from CorText Research in California, or chiropractors, such as Dr. Harvey Eckhart from Santa Rosa, California, have a preventive health clinic finding value in additions to the charter. Dr. Fritch recommends bromelain and chondroitin to reduce inflammation and maintain joint integrity. Dr. Eckhart studies the effect of the enzyme's activation formula for the digestion of proteins and the antioxidant formula, based on the fact that many people believe that the ability to properly digest proteins and damage to free radicals are two significant factors for FMS.
Dr. Sieber recommends using omega-3 fatty acids, using a high-protein, low-carbohydrate diet and adding supplements of vitamin C and magnesium. Low doses of antidepressants can be helpful in controlling pain and melatonin for better sleep. Dr. Sieber also briefly talks about the National Institutes of Health (NIH), which no longer protects the use of cortisone injections in CFS or FMS, when tested using Epogen, a drug commonly used to treat kidney failure and anemia of anemia in HIV patients, и об использовании солодки травы в то время, но не признает из первых рук знания о ее использовании. В травяных сообществах солодка известна своими тоническими свойствами, характерными для боли, энергии и пищеварения.
Доктор Дэвид Дарбо, доктор медицинских наук в Медицинском центре Индианаполиса, имеет компанию в своем убеждении, что магнитная терапия выгодна девяти из десяти человек среди населения в целом. Считается, что магниты поддерживают общий оздоровительный эффект, поддерживая естественные процессы релаксации и стимуляции организма и позволяя клеткам организма функционировать на оптимальных уровнях. Претензия, что они работают особенно в отношении случаев хронической усталости, боли и бессонницы, делает обращение к больным FMS отличным.
Доктор Сэмюэль К. Юэ, доктор медицины и директор Центра Миннесоты в Санкт-Петербурге. Пол, испытывал влияние гормона релаксина как лечение. Его предсказание заключается в том, что начало FMS связано либо с системным дефицитом гормона, либо с телом неспособность использовать существующий гормон из-за аутоиммунных антител или дефектного клеточного приема. Известно, что Relaxin влияет на целостность мышечной ткани и соединительной ткани, но тесты до сих пор были неубедительными.
Ó2000Thorp, E., CNE, CDC, CLPT
