(FM) is a disorder that includes widespread musculoskeletal pain along with
fatigue, sleep disturbance, memory changes, mood changes and more. Studies show
that FM amplifies or increases painful sensations by changing the way the brain
processes pain signals. FM is NOT a psychological disorder that only people
with a troubled past or present acquire. Nor is it due to being inactive or
lazy. If ANY doctor suggests that, PLEASE find a different doctor who
understands the pathogenesis of FM. Unfortunately, this can be a challenge!
FM symptoms can begin after a
physical trauma, surgery, an infection and/or after a significant stress
experience. It can also just gradually appear over time without an obvious
triggering event. Women are more vulnerable to acquire FM than men. Many FM
patients have other conditions that may be associated with FM including (but
not limited to) headache, TMJ, irritable bowel syndrome, anxiety, depression,
thyroid/hormonal imbalances, endometriosis, and more.
Though the cause of FM may not
be clearly identified, studies suggest there are a variety of factors that work
together resulting in FM. Some of these include genetics, infections and
physical and/or emotional trauma. Because FM tends to run in families, there
may be certain genes or genetic mutations (changes that occur to genes) that
make one more susceptible to developing FM. Infections appear to be a trigger for
developing or aggravating FM. Post-traumatic stress disorder and less obvious
physical or psychological trauma has been linked to the development of FM. The amplified or heightened pain response has
been termed, “central sensitization,” meaning, increased sensitivity to normal
pain stimulation in the central nervous system (brain and spinal cord). Because
of this heightened nervous system response, what normally isn’t processed as
pain in the non-FM person, does reach and exceed the pain threshold in the FM
patient (sort of like when amputation of a limb occurs and the brain still
“thinks” there is a limb and “phantom pain” is felt). Studies show that
repeated pain signals result in an abnormal increase in certain brain chemicals
(called neurotransmitters). As a result, the brain’s pain receptors seem to develop
a “memory” of the pain and become “sensitized” or they overreact to the pain
signal input and pain is felt at an increased intensity. Certain risk factors
come into play with developing FM, some of which include: your sex (female),
family history (increased risk if other family members have FM), and rheumatic
diseases such as rheumatoid arthritis and lupus.
Tests to establish the diagnosis
of FM are few. In 1990, the American
College of Rheumatology
established 2 criteria for diagnosing FM. The first is widespread pain lasting
at least 3 months, and the second is the presence of at least 11 out of 18
positive tender points. Since then, less emphasis has been placed on the exact
number of tender points, while ruling out other possible underlying conditions
that might be causing the pain is now utilized. There is no lab test to confirm
a diagnosis of FM, but blood tests including a complete blood count, an ESR,
and thyroid function tests are commonly done to rule out other conditions that
have similar symptoms. Treatment is best approached by a “team effort”
combining the skills from multiple disciplines including a primary care doctor
who “believes in FM” and is willing to work with chiropractors, and others.
Exercising, pacing yourself, accepting your limitations, yoga, psychological
counseling, nutritional counseling, and having strong family/friend support are
all important in the management of FM.
If you, a friend or family
member requires care for FM, we sincerely appreciate the trust and confidence
shown by choosing our services!
To schedule an appointment with a Fibromyalgia Doctor in San Francisco call 415-392-2225.