What is FM?

Fibromyalgia (FM) is a chronic, complex disorder of wide-spread pain throughout the body, profound fatigue, non-restorative sleep and including many other symptoms.  A person with FM suffers from a wide variety of symptoms, which can fluctuate in degree of severity or remain constant.  The condition may be mild, moderate or severe.  FM can be very debilitating, affecting all aspects of a person’s daily life, often leading to significant disability.

FM is a common disorder that seems to affect more women than men, although men, women and children of all ages are diagnosed with the condition.  456,000 people with FM were identified in the 2010 Canadian Community Health Survey.

Although the cause of FM is not yet understood, the onset of the disorder has been often associated with some form of physical trauma and most often related to a whiplash-type injury.  Research has strongly suggested the involvement of the neurological system in the development of FM along with a suspected genetic disposition.  At present, there is no definitive cause and no known cure for FM, a fact which challenges patients and health care professionals alike.

Currently there are no diagnostic tests to confirm a diagnosis of FM, although FM is actively diagnosed by examination of specific tender points throughout the body in correlation with a patient’s symptomatology and history.  It is important for patients and their doctors to distinguish FM symptoms from other medical conditions a patient many also have in order to receive appropriate treatment and health care.

What are the Signs and Symptoms of FM?

Widespread Pain

The widespread pain of FM is often described as aching, burning, throbbing, gnawing, shooting and tingling.  It can be localized, generalized, can feel like muscle spasms and can be scattered throughout the body.  It may be migratory, with pain presenting in one or more areas on one day and other areas on another day.

Fatigue

The fatigue of FM is much more than just being tired.  People with FM have described it as feeling like all their energy has been drained away.  It can be so profound that it interferes with even the simplest of daily tasks and activities.  Sometimes the fatigue can come on suddenly for no apparent reason and be very debilitating.  After short periods of exertion, a person may require long periods of rest to recuperate.

Non- Restorative Sleep

Sleep difficulties may be described as not being able to fall asleep, frequent night awakenings, unrefreshing sleep or waking up feeling as if you haven’t sleep at all.  Sleep studies show a deep-sleep anomaly in patients with FM.

Besides widespread pain, severe fatigue and non-restorative sleep, FM symptoms often include:

  • Cognitive and memory problems – includes memory lapses, problems with concentration and comprehension;
  • Morning stiffness, often lasting for hours;
  • Irritable bowel syndrome – frequent diarrhea and/or constipation, abdominal pain, gas and nausea;
  • Chronic headaches and jaw and head pain related to the muscles and ligaments surrounding the Temporomandibular Joint (TMJ).

Some other symptoms that are often reported include muscle spasms and weakness, restless legs, disequilibrium, sensitivity to noise or other stimuli, light cold and drafts; itching skin, numbness or tingling in the hands or feet, irritable bladder, clumsiness, non-cardiac chest pains and multiple chemical sensitivities.

Symptoms may be aggravated by changes in the weather, stress and either too much or too little activity. Flare-ups frequently occur a day or two after an activity and may take several weeks to settle down again.  It is often difficult to determine what causes the symptoms to flare, which makes the condition so unpredictable and difficult to regulate.

How is FM Diagnosed?

FM is not a new condition, but it is often difficult to diagnose.  There is no lab test or x-ray that “proves” someone has Fibromyalgia.  Once other medical conditions have been ruled out through various tests and by taking a thorough patient history, a complete physical exam will assist the doctor in diagnosing FM.

The main diagnostic criteria using the Canadian Consensus Criteria are:

  1. History of widespread pain in all four body quadrants for a minimum of three months;
  2. Pain in 11 of 18 specified tender points when they are pressed;
  3. Other clinical symptoms including fatigue, sleep disturbance, neurocognitive manifestations and/or neurological manifestations.

Physicians accept a diagnosis of FM with fewer than 11 tender points if several associated symptoms are present along with a definitive history.  An addition of positive tender points when palpitated can indicate a severe degree of the condition.

What Treatment is Available for FM?

Presently, treatment for Fibromyalgia aims to improve sleep and reduce pain. A few medications, for example Elavil (a tri-cyclic anti-depressant also called Amytriptilene) or Flexeril (a muscle relaxant) are known to be helpful for some people with FM when taken at very low doses (5 – 10 mg) nightly. These doses are below the usual therapeutic dose for the medication.  Either Elavil or Flexeril can help improve sleep quality and reduce pain over a period of time.  Consistent use of most “pain-killers” or “sleeping pills” have not shown long-term effectiveness in treating the symptoms of FM.  Often less medication is better.

Some patients find treatments such as therapeutic massage, physical therapy, acupuncture, or osteopathic manipulation helpful, especially when the therapist understands and treats FM and is able to adapt treatments to meet the needs of the individual.  Developing an individualized, gentle exercise program along with other management techniques may help to achieve and maintain a more functional lifestyle.

Becoming educated about FM and learning to self-manage the conditions seems, so far, to be the most successful way of dealing with its many effects.

Lifestyle modifications are helpful to conserve energy and minimize pain. Relaxation exercise can reduce physical and emotional stress.  Balancing rest with activity may reduce fluctuations in degree of symptoms.  Implementing dietary changes may also help to regulate bodily functions and support various systems in the body.

It is important to find a helpful and supportive medical professional who understands the myriad of issues that an FM patient deals with and can help with the appropriate prescription and monitoring of medications and their effects.  It is also important to seek professional help for any reactive depression that may result from dealing with a debilitating chronic illness.

The use of other medications or complementary medicines and therapies may help to reduce or relieve some specific symptoms that may be impacting on a person’s overall FM condition.

Support from family, friends and other people is extremely valuable to those who have FM.  Professional counselling may help some people to cope with the losses associated with this chronic condition and to assist with developing new coping strategies.

Self-help groups can plan important role in assisting people with FM to discover local resources that can access to help them manage their condition.

Please refer to our Support Group link for more information on finding a support group in your area.

What Causes FM?

Fibromyalgia often develops after some sort of trauma that seems to act as a trigger, such as a car accident or a fall, an infection (viral or bacterial), childbirth or an operation.  These triggers may awaken an underlying physiological disorder.  Sometimes the condition begins without any obvious trigger.  FM may sometimes co-exist with another chronic illness like Myalgic Encephalomyelitis, Multiple Sclerosis, Rheumatoid Arthritis, Osteoarthritis or Lupus.

The actual cause of FM has not been found, however, over the past several years increased research has opened the door to some new understandings. Evidence of muscle micro-trauma that my lead to central pain mechanism dysfunction has been found; altered levels of certain chemical neurotransmitters have been detected; and oxygen metabolism in muscles has been shown to be decreased.  Brain imaging shows neurobiological evidence of changes in the brains of people with FM. EEG studies have shown brain wave changes and certain abnormalities.

Further research is required to find out more.  Medical research has just begun to untangle the truths about this life-altering condition.

Diagnostic Criteria and Treatment Guidelines

The FM Consensus Documents

In 2003 Health Canada, in cooperation with the National MEFM Action Network, convened an expert panel to develop and publish a Canadian clinical case definition for the diagnosis and treatment of Fibromyalgia. The resulting full document was peer reviewed and published as:

Fibromyalgia Syndrome: Canadian Clinical Working Case Definition, Diagnostic and Treatment Protocols. A Consensus Document. Journal of Musculoskeletal Pain 11(4), 2003,  Jain AK and Carruthers BM, co-editors. van de Sande MI, Barron SR, Donaldson CCS, Dunne JV, Gingrich E, Heffez DS, Leung F Y-K, Malone DG, Romano TJ, Russell IJ, Saul D, Seibel DG. © Copyright 2003 Haworth Press Inc., Binghamton, NY.

The FMS Consensus Document was also published simultaneously as a book - Fibromyalgia Syndrome: A Clinical Definition for Practitioners. IJ Russell: editor. Haworth Medical Press © 2004.

In 2005, a summary of the above full definition was published in the form of an overview to assist physicians in applying the protocols to clinical practice. The summary is available as:

Fibromyalgia Syndrome:  A Clinical Case Definition and Guidelines for Medical Practitioners. An Overview of the Consensus Document. Bruce M Carruthers, Marjorie I van de Sande 2005  ISBN: 0-9739335-1-8