McGovern Physical Therapy Associates - The Personal Care Professionals

FIBROMYALGIA

What is fibromyalgia?

Fibromyalgia means pain in the fibrous tissues in the body. Fibromyalgia is a chronic condition causing pain, stiffness, and tenderness of the muscles, tendons, and joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, fatigue, anxiety, depression and disturbances in bowel function. People with fibromyalgia have "tender points" on the body. "Tender points" are localized tender areas of the body that can bring on widespread pain and muscle spasm when touched. Tender points are commonly found around the elbows, shoulders, knees, hips, back of the head, and the sides of the breast bone.

What causes fibromyalgia?

The cause of fibromyalgia is not known. Patients experience pain in response to stimuli that are normally not perceived as painful. Researchers have found elevated levels of a nerve chemical signal, called substance P, and nerve growth factor in the spinal fluid of fibromyalgia patients. The brain nerve chemical serotonin is also relatively low in patients with fibromyalgia. Studies of pain in fibromyalgia have suggested that the central nervous system (brain) may be somehow supersensitive. Scientists note that there seems to be a diffuse disturbance of pain perception in patients with fibromyalgia.

Also, patients with fibromyalgia have impaired non-Rapid-Eye-Movement, or non-REM, sleep phase (which likely explains the common feature of waking up fatigued and unrefreshed in these patients).

The onset of fibromyalgia has been linked to, stressful or traumatic events, such as car accidents; repetitive injuries, illness and certain diseases. However, fibromyalgia can also occur on its own.

Who does fibromyalgia affect?

Fibromyalgia affects predominantly women (over 80 percent) between the ages of 35 and 55. Rarely, fibromyalgia can also affect men, children, and the elderly. It can occur independently, or can be associated with another disease, such as systemic lupus or rheumatoid arthritis. In the United States, approximately 2 percent of the population have fibromyalgia, or 1 in 50 people.

What are symptoms of fibromyalgia?

The universal symptom of fibromyalgia is pain; however the pain in fibromyalgia is not caused by tissue inflammation. Instead, these patients seem to have an increased sensitivity to many different sensory stimuli, and an unusually low pain threshold. Minor sensory stimuli that ordinarily would not cause pain in individuals can cause disabling pain in patients with fibromyalgia. The body pain of fibromyalgia can be aggravated by noise, weather change and emotional stress.

The pain of fibromyalgia is generally widespread, involving both sides of the body. Pain usually affects the neck, buttocks, shoulders, arms, the upper back, and the chest. "Tender points" are localized tender areas of the body that can bring on widespread pain and muscle spasm when touched. Tender points are commonly found around the elbows, shoulders, knees, hips, back of the head, and the sides of the breast bone.

Fatigue occurs in 90 percent of patients. Fatigue may be related to abnormal sleep patterns commonly observed in these patients. Normally, there are several levels of depth of sleep. Getting enough of the deeper levels of sleep may be more important in refreshing a person than the total number of hours of sleep. Patients with fibromyalgia lack the deep, restorative level of sleep, called "non-rapid-eye-movement" (non-REM) sleep. Consequently, patients with fibromyalgia often awaken in the morning without feeling fully rested. Some patients awaken with muscle aches or a sensation of muscle fatigue as if they had been "working out" all night!

Mental and/or emotional disturbances occur in over half of fibromyalgia patients. These symptoms include poor concentration, forgetfulness, mood changes, irritability, depression and anxiety. Since a firm diagnosis of fibromyalgia is difficult, and no confirmatory laboratory tests are available, patients with fibromyalgia are often misdiagnosed as having depression as their primary underlying problem.

Other symptoms of fibromyalgia include migraine and tension headaches, numbness or tingling of different parts of the body, abdominal pain related to irritable bowel syndrome and irritable bladder, causing painful and frequent urination.

Each patient with fibromyalgia is unique. Any of the above symptoms can occur intermittently and in different combinations.

How is fibromyalgia diagnosed?

There is no blood or x-ray test to help the doctor determine whether someone has fibromyalgia. Therefore, the diagnosis of fibromyalgia is made purely on clinical grounds based on the doctor's history and physical examination. In patients with widespread body pain, the diagnosis of fibromyalgia can be made by identifying point tenderness areas (typically, patients will have at least 11 of the 18 classic tender points), by finding no accompanying tissue swelling or inflammation, and by excluding other medical conditions that can mimic fibromyalgia.

Fibromyalgia can occur alone, or in association with other systemic rheumatic conditions. Systemic rheumatic conditions refer to diseases that can cause inflammation and damage to numerous different tissues and organs in the body. Systemic rheumatic conditions associated with fibromyalgia include systemic lupus erythematosus, rheumatoid arthritis, polymyositis, and polymyalgia rheumatica.

What is the treatment for fibromyalgia?

Since the symptoms of fibromyalgia are diverse and vary among patients, treatment programs must be individualized for each patient. Fibromyalgia treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise and medications. Recent studies have verified that the best outcome for each patient results from a combination of approaches that involves the patient in customization of the treatment plan.

Exercise and Physical Therapy

There is increasing evidence that a regular exercise routine and a program of stretching is essential for all fibromyalgia patients. This is easier said than done because increased pain and fatigue caused by repetitive exertion can make regular exercise quite difficult. However, those patients who do get into an exercise regimen experience worthwhile improvement. In general, fibromyalgia patients must avoid impact-loading exertion such as jogging, basketball, aerobics, etc. Regular walking, the use of a stationary exercise cycle and pool therapy seem to be the most suitable activities for fibromyalgia patients to pursue. Supervision by a licensed physical therapist is necessary to develop an appropriate, healthy program. In general, 20 minutes of physical activity, 3 times a week at 70% of maximum heart rate is required to maintain a reasonable level of aerobic fitness. The key is to start slowly and increase your exercise time and level carefully.

All physical therapists are not the same. To improve the odds that you are getting effective treatment, take an active role in the selection of your therapist. McGovern Physical Therapy Associates emphasizes teaching you techniques to manage your pain. Although muscle mobilization, massage and other techniques may be provided for a short period - especially to help you get relief during a fibromyalgia "flare"- we do not believe that therapy which requires you to continue to see the therapist for relief is very effective over the long-term. Our roles as therapists are to provide you with the information you need to manage your pain, fatigue and other issues. We emphasize teaching you techniques, exercise programs and activity modifications which you then apply in your home and work settings. Together, we analyze the equipment you use at home and work and come up with recommendations for new office equipment, home seating, alternative positioning and other recommendations. If possible, we help connect you with resources to purchase appropriate equipment. The goals of therapy are to help people with fibromyalgia learn to reduce pain, manage pain and maintain the activities, which are important to them.

McGovern Physical Therapy Associates, the personal care professionals, is a multi-specialty provider of outpatient physical therapy care. Voted “Best PT Practice 2004” by ADVANCE for Directors in Rehabilitation magazine, our clinicians offer personalized manual therapy and exercise expertise, including a variety of customized treatment options. Combining innovation, experience and excellence, our staff of clinicians, as well as dedicated office personnel, work as a team to provide caring, convenient and professional service for total patient recovery.