FIBROMYALGIA (FIBROSITIS)
WHAT IS FIBROMYALGIA?
Fibromyalgia (also referred to as fibromyalgia syndrome, myofibrositis, myofascial pain syndrome, or fibrositis) is a form of rheumatic disease. Like many other forms of rheumatic diseases, fibromyalgia is a chronic syndrome of pain that can come and go. It can affect a person?s work habits and life style.
Many of the 100 or so kinds of rheumatic diseases are characterized by arthritis, which causes pain and swelling in the joints. With fibromyalgia, the pain is in the ligaments, tendons, and muscles. This can affect the way your joints function, and that?s why you might think that fibromyalgia is in your joints.
However, fibromyalgia is not a form of arthritis. You need not worry about fibromyalgia causing deformities or permanent crippling.
WHO GETS FIBROMYALGIA?*
Physicians are finding that fibromyalgia is a very common ailment. There are currently millions of Americans who have been diagnosed with it. Although anyone can get fibromyalgia, many more women have fibromyalgia than men?and most are between the ages of 20 and 50.
There is also increasing evidence that fibromyalgia can start in the teenage years. Some teenagers have symptoms just as severe as their middle-aged counterparts, but many people experience only occasional symptoms in their younger years that become more troublesome in later years.
WHAT CAUSES FIBROMYALGIA?*
Although medical researchers and physicians don?t know the exact causes of fibromyalgia, they have recognized a number of different conditions that are associated with it. These conditions are described in the following paragraphs.
Physically Unfit Muscles
There is increasing evidence that people with fibromyalgia have unfit or poorly developed muscles. (It is not yet known whether unfit muscles are the cause or the result of fibromyalgia.) Nonetheless, this theory does provide an important clue about treatment because people who are able to engage in a regular exercise program usually have the most improvement in their symptoms.
The reason exercise is so beneficial is that your muscles are remarkable in their ability to adapt to specific training programs. On the other hand, underuse of your muscles leads to a ?negative, detraining? effect, which results in unfit muscles. ?Detrained,? or unfit, muscles are more likely to become injured or damaged from exercise. This sort of muscle damage is commonly called ?microtrauma.?
All of us have probably experienced the effects of muscle microtrauma after exercising too vigorously. When microtrauma occurs, you experience delayed muscle pain that may not appear until 48 hours after exercising and may last 7 days. In addition to the pain, increased fatigue occurs, resulting in a lack of desire to participate in further physical activity until energy has been restored.
It is common for anyone to experience the effects of microtrauma after too vigorous physical activity. Yet for people who have unfit muscles, these problems may develop after only slight exertion, such as routine day-to-day activities. Microtrauma may also result from overuse, or abuse, of certain muscles? such as poor posture or damage caused by a blow or fall.
Sleep Disturbances
Another interesting clue as to the cause of fibromyalgia comes from sleep laboratory studies. Tests of people with fibromyalgia often show a sleep disorder in which the deepest, or most restful, stage of sleep (stage IV) is disturbed or interrupted. Physicians refer to this disturbance as ?alpha intrusion of stage IV sleep.?
Sleep disturbances may be responsible, in part, for the low energy levels experienced by people with fibromyalgia. There is also evidence that continued sleep problems can lead to muscle pain. This combination of pain and fatigue often limits physical activity and endurance. The resulting lack of physical exercise can contribute to the overall symptoms of fibromyalgia. Current research indicates that stage IV sleep is also important in repairing tissue damage and feeling psychologically rested after sleep. As you can see, when this stage of sleep is reduced, it can contribute to other symptoms of fibromyalgia.
In fact, the inability to get a good night?s sleep is considered by some to be a major factor contributing to the symptoms of fibromyalgia. In one study, volunteers who did not have fibromyalgia were subjected to artificial disturbance of their stage IV sleep. They developed pain and soreness in their muscles, which were very similar to those of fibromyalgia.
Although pain itself and the psychological stress it may cause seem to be the most common causes of sleep disturbances in people with fibromyalgia, alcohol, caffeine, and nicotine can also contribute to sleep disturbances.

A major feature of fibromyalgia is a disturbance of stage IV sleep?the most restful phase of sleep. This figure identifies conditions that may contribute to this sleep disturbance and thereby contribute to fibromyalgia.

Stress
It was originally thought that the symptoms of fibromyalgia were caused by stress and worry, which caused additional muscle tension. Although recent studies of people with fibromyalgia do not prove that stress itself causes fibromyalgia, stress, anxiety, and fatigue can make your condition worse. In fact, the pain and fatigue of fibromyalgia often cause stress and anxiety, which in turn can increase the pain and fatigue, thus creating a vicious cycle.
WHAT ARE THE SYMPTOMS OF FIBROMYALGIA?*
Since fibromyalgia is not completely understood and symptoms often seem vague, it is sometimes difficult to describe symptoms to your friends and relatives. Even your physician may have some initial difficulty getting a useful history. All people with fibromyalgia have two major problems: pain and fatigue.
Pain
The major symptom of fibromyalgia is pain. Most people feel the pain of fibromyalgia as aching, stiffness, and tenderness around joints, muscles, tendons, and ligaments. Pain may appear in one or more locations at the same time and also in many different parts of your body.

The dots in this figure indicate the various locations of ?tender points.? People who have fibromyalgia experience undue tenderness when the physician applies pressure over many of these locations.

The pain is located within the muscles themselves, as well as at the points where ligaments attach muscles to bones. For reasons that are still unknown, if you have fibromyalgia, you will feel extreme tenderness over many of these locations. These sites of tenderness are called tender points (sometimes referred to as trigger points). The location of tender points is similar in all people with fibromyalgia and are, therefore, an important part of the diagnosis.
Sometimes, you?ll notice that the symptoms of fibromyalgia are worse when you first wake up. But in most cases, the discomfort increases as the day goes on. The type of activities you do may be a factor. For example, if you sit slumped over a desk all day long, by the end of the day the pain may have gotten worse because of poor posture.
Fatigue
Fatigue is sometimes the most debilitating aspect of fibromyalgia. Some people experience fatigue as a lack of muscle endurance, and others describe the fatigue as an overall sense of lack of energy. Much of the fatigue is thought to result from a lack of restful sleep.
You may find it helpfu Ito schedule a rest period during your day if possible. A nap or time spent relaxing in bed may help you face your activities more efficiently.
There?s been much recent interest in the ?chronic fatigue syndrome.? This was once thought to be due to a persistent infection with the Epstein-Barr virus (the cause of infectious mononucleosis). This theory,
?. however, has now been disproven, and many people who had previously been diagnosed as having ?chronic fatigue syndrome? are now known to have fibromyalgia.
Other Symptoms
Many people with fibromyalgia have other problems, which often cause some confusion to their physician. These include Raynaud?s phenomenon (poor circulation to the hands or toes), tension headaches, migraine headaches, dizziness, tingling and numbness, an irritable bowel (abdominal bloating with alternating diarrhea and constipation), muscle tremors, bladder spasms, and blurred vision. Although most instances of fibromyalgia-related blurred vision cause no permanent damage to eyesight, an ophthalmologist should be consulted if this symptom occurs.
CHIROPRACTIC AND FIBROMYALGIA**
Most chiropractors can provide a number of soft tissue procedures, exercises, and manipulations that may help reduce myofascial pain, reduce spasm, promote pain-free movement, and relax the tight muscles often associated with this condition. In addition, there may be changes in diet, posture, daily activities, and sleeping habits that can be of great benefit to fibromyalgia sufferers.
*Soir: Adapted from ?Fibromyalgia,? 1989 by the Arthritis Foundation. Permission granted.
**Soce: Robert D. Mootz, DC, Professor, Palmer College of Chiropractic?West.

Self-Care for Fibromyalgia
GETTING EXERCISE
Recent studies have shown that people can get a sustained benefit by participating in an aerobic exercise program. Aerobic exercise involves some form of activity that causes your pulse rate to increase and remain increased over an extended period of time. Usually, 20 to 30 minutes of aerobic exercise is recommended.
Most people with fibromyalgia are reluctant to exercise because it initially causes more pain. But if your physician or therapist works out an exercise program that starts out slowly and gradually becomes more challenging, the risk of muscle microtrauma will be significantly reduced and your body will eventually be able to accept more vigorous exercise routines.
Low or nonimpact aerobic exercises are generally recommended. These include brisk walking, swimming, and using an exercycle. Exercises such as jogging, aerobic dancing, weight training, and racquet sports should be avoided until you have reached a good overall level of physical fitness.
Remember to stretch all your major muscle groups gently for about 5 minutes both before and after you exercise. Stretching helps reduce the chance of muscle injury. Consult your physician before beginning any aerobic activities, and ask for a referral to a physical therapist who can teach you appropriate stretching exercises and help you get started on a nonimpact exercise program gradually. Then build up your routine as your body can tolerate more exercise.
CHANGING YOUR WORK OR HOME ENVIRONMENT
Changing certain habits or physical arrangements in your daily routine may make a difference, too. For example, pain in your arms, neck, or shoulders can be brought on by long hours of typing or entering data into a computer. If so, you may be able to relieve pain just by raising the height of your typewriter or computer table. A more comfortable mattress may help relieve aching muscles and reduce morning stiffness. If driving in heavy traffic causes your muscles to tighten, try using a backrest or try changing the way you sit in the car.
DEALING WITH EMOTIONAL FACTORS
Emotional factors may also affect your symptoms. Feelings are sometimes harder to pin down and understand than your physical symptoms, yet they may contribute to your symptoms.
It is important that your physician be aware of the special stresses in your life. He or she may want you to undergo some standard psychological tests that will provide more information about the ways you cope with stress. Do not be offended by this suggestion; everyone has stresses?including your physician? and everyone reacts to stress in different ways.
Souite: Adapted from ?Fibromyalgia,? ? 1989 by the Arthritis Foundation. Permission granted.

Trigger Points
HOW DOES TENSION AFFECT MUSCLES?*
A healthy muscle contracts when it?s in use and relaxes itself when the work is done. Muscles that are affected by stress, however, contract and stay tensed up. After a time in this tense condition, the muscles will go into spasm and be unable to relax at all. If you don?t exercise regularly, your body is probably more susceptible to the effects of stress than if you were active. Tension builds up faster in muscles that are weak and stiff from lack of exercise.
WHAT ARE ?TRIGGER POINTS?*
When a muscle is always knotted up, blood can?t circulate through the tissue to nourish it. Some of the tissue will eventually degenerate and form little nodules called trigger points. These little knots are a source of much of the severe referred pain associated with muscle-strain problems. Once the pain reference pattern of muscle is known, it can be used to locate the muscle that is the source of pain.
WHAT IS ?REFERRED PAIN?*
Trigger points can refer to other parts of the body far removed from its source. If you have a trigger point in your shoulders, for instance, it could be the cause of the pain in your temple. As a matter of fact, in examining a trigger point in the muscle, you can press it and feel the pain shooting up to the temple. You know, then, that your head pain is actually in the shoulder muscles. On the other hand, if you?re unaware of the trigger point, you might mistake the throbbing pain on one side of your head for migraine, a common misdiagnosis.
HOW SERIOUS ARE TRIGGER POINTS?*
Trigger points can occur anywhere in the body and cause diagnostic havoc wherever they appear. In the shoulders and neck, they cause pain mistaken for migraine headaches. In the buttocks, the discomfort they bring to the back is often confused with spinal disc disorders. Because they don?t show up on conventional diagnostic tests, and because most physicians don?t examine the muscles for these trigger points, they are perhaps the greatest factor in the misdiagnosis of chronic muscle-contraction pain. Without proper treatment, these knots continue to cause pain that, in turn, makes you more tense and causes the muscle to contract more tightly, leading to more trigger points and more pain.