If your doctor doesn’t believe in FMS, you are going to the wrong doctor.

If your doctor doesn’t believe in FMS, you are going to the wrong doctor

May 7, '07 7:49 AM

 
"Fibromyalgia (FM) is the commonest cause of widespread pain (Bennett,1995), yet it may remain undiagnosed for a long time. Uncertainty and frequent misdiagnosis can cause considerable havoc in the lives of patients. Every expert in the field seems to have his or her own estimate of how many people actually have FMS. This confusion will remain until doctors are trained in comprehensive differential diagnosis. Most FM patients are female, but again, experts disagree on the percentage.
Fibromyalgia is pronounced fie-bro-my-al-jia sind-rome. The word "fibromyalgia" is a combination of the Latin roots fibro (connective tissue fibers), my (muscle), al (pain), and gia (condition of). Fibromyalgia is not a new "fad disease". For many years the medical profession called it by many different names, including "chronic rheumatism" and "fibrositis".  

Most physicians still lack the skills to diagnose and treat it effectively. FMS, like many other conditions, is not curable right now, but it is very treatable, and there are many ways in which you can considerably improve your health and quality of life. You may come to your doctor with symptoms that seem unrelated. They can run the gamut from mental confusion to burning feet, but are usually accompanied by an over-all flu-like feeling that impacts every aspect of your life. Each chapter in "Fibromyalgia and Chronic Myofascial Pain: A Survival Manual, edition 2" has its own medical journal reference section at the end of the chapter. There is also instruction in how to obtain these reference materials.
The American College of Rheumatology, American Medical Association, The World Health Organization, and the National Institutes of Health have all accepted FMS as a legitimate clinical entity. If your doctor "doesn’t believe in FMS", you are going to the wrong doctor. At the Travell Focus on Pain Seminar 2000, I. Jon Russell MD, editor of the Journal of Musculoskeletal Pain, mentioned the use of the Functional MRI, which shows the brain in action. In a healthy individual, when you pressed on a tender point, there is minimal response, but in a patient with FMS, "...the result was wild. The whole brain went crazy." Something is happening in the FMS central nervous system that doesn’t happen to healthy people. 

Fibromyalgia can be a source of substantial disability (Kaplan, Schmidt and Cronan, 2000). This is especially true if you have had it for a long period of time without adequate medical support. Nearly everyone with FMS exhibits reduced coordination skills and decreased endurance abilities, although some of this may be due to co-existing chronic myofascial pain (CMP).
Fibromyalgia is a complex syndrome characterized by pain amplification, musculoskeletal discomfort, and systemic symptoms. In FMS, there is a generalized disturbance of the way pain is processed by the body (Morris, Cruwys and Kidd, 1998). I think the definition of FMS as widespread allodynia and hyperalgesia (Russell, 1998) describes it well. Allodynia means nonpainful sensations are translated into pain sensations. Hyperalgesia means that your pain sensations are amplified. These changes in the way your central nervous system processes pain seem to be worse if there is a physically traumatic initiating event.
You may be sensitive to odors, sounds, lights, and vibrations that others don’t even notice. The noise emitted by fluorescent lights might drive you to distraction. Your body may at times interpret touch, light, or even sound as pain. Sleep, or the lack thereof, plays a crucial role in FMS. Sleep disturbances, a swollen feeling, and exercise intolerance are significantly related to FMS (Jacobsen, Petersen and Danneskiold-Samsoe, 1993).
Besides specific tender points, the essential symptom of FMS is pain, except in the case of older patients. Seniors are more troubled by fatigue, soft-tissue swelling and depression (Yunus, Holt, Masi et al. 1988) In younger people, discomfort after minimal exercise, low-grade fever or below-normal temperature, and skin sensitivity are also common (Reiffenberger and L. H. Amundson, 1996). 

Central Sensitization "It is now firmly established that a central nervous system (CNS) dysfunction is primarily responsible for the increased pain sensitivity of fibromyalgia" (Simons, Travell and Simons, 1999 p 17). There is a generalized CNS- mediated deep tissue sensitivity in FMS includes the muscles, which is why so many people mistakenly believe that it is a muscular condition. Anything that results in tissue injury, whether from more obvious physical trauma such as an auto accident or from subtler biochemical damage, can cause hypersensitivity at the site of the injury. If there is repeated or continued trauma, other areas may develop the hypersensitivity (Yaksh, Hua,. Kalcheva et al. 1999). This can lead to a state of "central sensitization", as your nervous system reacts to chronic, long-term pain in several ways.
The tendency to develop FMS may be inherited. Many mothers with FMS have children with FMS. Because psychological and familial factors were not different in children with or without FMS, this may be due to genetics (Yunus, Kahn, Rawlings, et al.1999). In 1989, Pellegrino, Waylonis and Sommer found that FMS might be inherited on an autosomal dominant basis, with a variable latent phase. This means that approximately half of the children of an FMS parent will eventually develop FMS. The sooner FMS is recognized and treated the more easily symptoms can be controlled. In Fibromyalgia and Chronic Myofascial Pain: A Survival Manual, edition 2, there is a chapter dealing with age-related issues, infant to senior citizen, later in the book.

What Fibromyalgia Isn’t.
Fibromyalgia is not musculoskeletal disorder (Simms, 1998). It should have been called "Central Nervous System-myalgia" (New Research). That is where the dysfunction is. It has nothing to do with the fibers of your muscles. In FMS, muscle fibers are not causing the problem, although there may be cellular changes caused by biochemical FMS dysfunction. Fibromyalgia is a biochemical disorder, and these biochemicals affect the whole body. You can’t have FMS only in your back or your hands. You either have it all over or you don’t have it at all. If you have localized complaints, they are probably not caused by FMS, although FMS may be amplifying the local symptoms.
Fibromyalgia is not progressive (Wolfe, Anderson, Harkness et al.1997). If your illness is getting significantly worse with time, there is some perpetuating or aggravating factor or a co-existing condition that has not been addressed. If you identify it and deal with it thoroughly and promptly, your symptoms should ease considerably. Fibromyalgia is not a diagnosis of exclusivity. You may have co-existing conditions, such as MS, arthritis, and/or myofascial pain, and still have FMS amplification. 

Fibromyalgia is not a catchall, wastebasket diagnosis. It is a specific, chronic non-degenerative, non-inflammatory syndrome. It is not a disease. Diseases have known causes and well-understood mechanisms for producing symptoms. A syndrome is a specific set of signs and symptoms that occur together are also classified as syndromes. Rheumatoid arthritis, lupus, and many other serious conditions are also syndromes. 

Fibromyalgia is not the same as chronic myofascial pain (Gerwin, 1999). It is fundamentally different in an important way (Simons, Travell and Simons, 1999 p 18.) There is no such thing as a fibromyalgia trigger point. Mention of "FMS trigger points" by your doctor or physical therapist should wave a warning flag that there is a serious lack of understanding here. Trigger points (TrPs) are part of myofascial pain, not FMS, and your care provider must understand this.
Fibromyalgia is not the same as CFIDS, although they may be part of the same family of central nervous system dysfunctions. In one study, levels of substance P were determined in the cerebrospinal fluid in 15 patients with CFIDS. All values were within normal. Most patients with FM have increased substance P in the cerebrospinal fluid. The results of this study support the notion that FMS and CFIDS are different disorders in spite of overlapping symptoms (Evengard, Nilsson, Lindh, et al. 1998). Another study points out that "In FMS, there is a condition of physiological hyperarousal. In CFIDS, a blunted response, the exact opposite, occurs" (Crofford, 1998).
Fibromyalgia is not just widespread pain or achy muscles. In the general population, adults who meet the ACR definition of FMS appear to have distinct features compared to those with chronic widespread pain that do not meet those criteria (White, Speechley, Harth et al. 1999a). There are many conditions, which cause widespread pain besides FMS. CMP can cause widespread pain due to trigger point cascades, for example. Side effects of some medications can do the same. Widespread pain is also common in Lyme disease, HIV, hypothyroid and other endocrine abnormalities, and some genetic diseases (Soppi M. and E. Beneforti, 1999). 

Fibromyalgia is not homogenous. The cause of muscle pain and allodynia may not be the same in all persons fulfilling the American College of Rheumatology (ACR) criteria for FMS (Henriksson, 1999). Fibromyalgia seems to include patients with different pain processing mechanisms (Sorensen, Bengtsson, Ahlner, et al.1997). There are many subsets of FMS. One study has separated some subsets into meaningful categories (Eisinger, Starlanyl, Blatman, 2000), and this separation may help decide which treatment regimens are more likely to help specific patients. 

Fibromyalgia is not autoimmune (Wittrup, Wiik, Danneskiold-Samsoe, 1999). The presence of antinuclear antibodies and other connective tissue disease features is similar in patients with fibromyalgia and healthy controls (Yunus, Hussey and Aldag, 1993). Some FMS patients may develop co-existing autoimmune conditions, and patients with immune conditions may develop FMS, but this does not show a causal relationship. There is a subset of people with FMS who test positive for antinuclear antibodies (Smart, Waylonis and Hackinshaw, 1997). We don’t yet know what this means. A response to antipolymer antibodies is associated with a subset of patients with FMS (Wilson, Gluck, Tesser et al. 1999). 

Fibromyalgia is not a mental illness, and must not be categorized as such. Some people with FMS also have mental illness. Some people with sniffles have mental illness too, but that doesn’t mean that sniffles are caused by mental illness. Studies have shown that the incidence of mental problems is no higher with FMS patients than with any other type of chronic pain syndrome (Goldenberg, 1989; Merskey, 1989 ). "There is now clinical evidence that FMS represents a distinct rheumatic disorder and should not be regarded as a somatic illness secondary to psychiatric disorder" (Dunne and Dunne 1995). "Psychiatric Diagnostic Interview data failed to discriminate in any major way between primary fibromyalgia syndrome (a disorder with no known organic etiology) and rheumatoid arthritis (a disorder with a known organic etiology). Therefore, these data do not support a psychopathology model as a primary explanation of the symptoms of primary fibromyalgia syndrome" (Ahles, Khan, Yunus et al. 1991).

Fibromyalgia is not infectious. Infection from many causes can start the neurochemical cascade of FMS. This does not mean that FMS itself is infectious. Both FMS and CMP can be brought on by triggers, such as stress, infections, pollution, and diet. There is a great deal of financial and other stress in dealing with a chronic illness, so it is not surprising that some partners of patients with FMS develop the same illness.
Tender points hurt where pressed, but they do not refer pain. In other words, pressing a tender point does not cause pain in some other part of the body. The examiner must use enough pressure to whiten the thumbnail, which is about 4 kg pressure. The official definition further requires that tender points must be present in all four quadrants of the body, that is, the upper right and left and lower right and left parts of your body. Tender points occur in pairs, so the pain is usually distributed equally on both sides of the body.

Fibromyalgia Tender Points
On the back of your body, tender points are present in the following places:Along the spine in the neck, where the head and neck meet;On the upper line of the shoulder, a little less than halfway from the shoulder to the neck; about three finger widths, on a diagonal, inward from the last points;On the back fairly close to the dimples above the buttocks, a little less than halfway in toward the spine;
Below the buttocks, very close to the outside edge of the thigh, about three finger widths.On the front of your body, tender points are present in the following places:
On the neck, just above inner edge of the collarbone;On the neck, a little further out from the last points, about four finger widths down;On the inner (palm) side of the lower arm, about three finger widths below the elbow crease;On the inner side of the knee, in the fat pad.
The tender point count may decrease with proper medical treatment and self-care, but that doesn’t mean that the FMS has been cured. It simply means that you have learned to deal with the perpetuating factors and co-existing conditions and have them under control.
In FMS, we believe that there is often an initiating event that activates biochemical changes, causing a cascade of symptoms. For example, unremitting grief of six months or longer can trigger FMS. In many ways, FMS is sort of like a Survivor’s Syndrome. Cumulative trauma, protracted labor in pregnancy, open-heart surgery, and even inguinal hernia repair have all been initiating events for FMS. The start of each case of FMS probably has multiple causes (Bennett and Jacobsen,1994. Not all cases of FMS cases have a known triggering event that initiates the first obvious flare. During a flare, current symptoms become more intense, and new symptoms frequently develop.
Fibromyalgia seems to be the result of many neurotransmitter cascades (Fibromyalgia Advocate, Chapter 2). A neurotransmitter cascade is like a waterfall that starts at the top and bounces off rocks and ridges on the way down, wearing down rock, moving gravel, and changing the river as it goes. The neurotransmitter cascade can cause changes throughout your body, and many of these changes start cascades of their own. Once they get going, a combination of peripheral and central factors join in to make the changes chronic, and the result is what we call fibromyalgia. Every patient may have different "informational substances" disrupted in different ways".

We the people, dont take any more shit from your ignorant doctors!!!