Fibromyalgia: An Environmental Scan
Table of Contents
The symptoms of fibromyalgia commonly vary in intensity throughout the day and are influenced by numerous factors such as weather, stress, level of exertion, exercise and various other environmental and personal characteristics. In terms of managing symptoms, they are often aggravated by unrelated illness. Additionally, symptoms can occur continuously or in stages over time. Many people with fibromyalgia experience symptoms that prevent them from performing normal activities such as driving a car or walking up stairs. The most frequently occurring symptom shared by an overwhelming majority of individuals with fibromyalgia is widespread body pain. Patients often describe the pain as an aching, stinging or burning. The discomfort is common in many areas of the body including the neck, jaw, back, chest and legs. Pain may be found in both the joints and nerves, specifically referred to as musculoskeletal and neuropathic pain respectively. For some patients, pain is also reported as localized. Widespread musculoskeletal pain, stiffness, fatigue, non-restorative sleep, cognitive dysfunction and diminished physical function are all recurring complaints. (Baldursdottir, S. 2008). It is not uncommon for fibromyalgia patients to experience muscle tension and spasms along with, allodynia and hyperalgesia (see page 13 of this report for definitions). Individuals with fibromyalgia commonly state they have pervasive tenderness. Patients report abnormal soreness and tenderness throughout their body including thigh area, buttocks, elbows and knees along with the upper back, neck and shoulder areas. Additionally, patients also suffer from stiffness, which is common first thing in the morning and stiffness often improves but returns again upon arising after periods of inactivity (Arnold, Lesley M. 2000).
Many patients experience chronic sleep disturbances where their inability to gain deep sleep; therefore, sleep is impaired (Perrot, S., Dickenson, AH., and Robert Bennett n.d.). This is particularly important among individuals, who suffer with fibromyalgia as it is precisely during deep sleep or stage 4 where muscles recover and the body restores itself. Patients describe difficulty going to sleep, staying asleep or feeling rested upon waking (Bernard Bannwarth et al. 2009). Both physically and psychologically, scientists demonstrate that physiological aspects of the nervous, cardiovascular and immune systems along with metabolic function all require proper sleep. Restorative sleep is necessary for cognitive processing, physical endurance and for proper healing of the physical body. There are two types of sleep, Rapid Eye Movement (REM) associated with psychological rest and recover and Non-Rapid Eye Movement (NREM), which is comprised of stages. Importantly, the delta or a deep stage 4 is crucial for physical recovery of the body. During stages of sleep, there is an increase in hormone releasing activity. The majority of individuals with fibromyalgia report poor sleep. As such levels of necessary hormones were found in lower amounts compared to their healthy counterparts (Millea and Holloway 2000). During the delta sleep stage, the growth hormone somatomedin C is released and is responsible for restoration of muscles. All adults have micro-trauma to their muscles from moving around during the day. Muscle is normally restored with the help of somatomedin C released in the proper amounts. Studies performed using sleep electroencephalograms show that up to 90% of the individuals studied, who had fibromyalgia do not enter NREM sleep stages. Additionally, other research verifies that once an individual’s sleep quality improves there is a decrease in the amount of pain and fatigue (Perrot, Dickenson, and Bennett 2008).
Numerous fibromyalgia patients report cognitive difficulties also referred to as ‘brain fog’ that is described as difficulty thinking, concentrating or problems with short term memory tasks. Brain fog is substantiated by abnormally slow brain wave patterns among individuals with fibromyalgia and commonly reported cognitive deficits. Many experts feel that ’brain fog’ is directly related to the sleep disturbances experienced by those with fibromyalgia. Finally, some individuals also experience perceptual disturbances such as difficulty surrounding the ability to make figure/ground distinctions, loss of depth perception and an inability to focus vision and attention (Glabus, Simpson, and Patterson 2009). A number of neurological symptoms are associated with fibromyalgia such as poor balance, weakness, tingling, short-term memory impairment, confusion, directional disorientation and sensitivities. A number of patients state they experience sensitivity to particular stimuli such as temperature changes, humidity levels, medications or even certain foods or smells. Such sensitivity may cause a flare up in symptoms of fibromyalgia or a more general feeling of un-wellness. Furthermore, a feeling of swelling, numbness and/or tingling is common in the face, arms, hands, legs and feet.
Patients with chronic pain conditions including fibromyalgia often report psychological distress and mood disorders. Often patients suffer from depression and/or anxiety, night sweats, panic attacks and unaccountable irritability. Depression is found more often among people who also have conditions involving soft tissue damage without having typical articular disease e.g., rheumatoid arthritis. Thus, depression and anxiety is common but not absolute in patients with chronic pain syndromes such as fibromyalgia (Nampiaparampil and Shmerling 2004). Along with psychological distress there exists severe physical fatigue. Fibromyalgia is characteristic of mild to severe fatigue and in many instances, patients with fibromyalgia also fit the diagnostic criteria for chronic fatigue syndrome.
Researchers have found that people with fibromyalgia either tend to run at a slightly higher than normal level of stress or may take a longer time to recover in stressful responses. Reacting and recovering from the human stress response involves the specific part of the central nervous system known as the autonomic nervous system (ANS) (Martinez-Lavin, M. 2007) . The ANS regulates heart rate, breathing, blood pressure and digestion, well known for the ‘flight or fight’ reaction. During the stress response adrenaline and cortisol neurochemicals cause increased heart rate, fast and shallow breathing, increased thermoregulation and decreased gastrointestinal reactions to name a few. Both acute onset and chronic stress influence how pain signals are processed in the brain which can lead to increased sensitivity mediating symptoms of fibromyalgia. Finally, other symptoms include: headaches, dermatological conditions, myoclonic twitches, irritable bowels, bladder irritation, pelvic pain, hypoglycermia, bruxism (teeth grinding), menstrual difficulties, loss of libido and impotence. Overall, the symptoms of fibromyalgia are complex and most frequently, patients do not experience all of the symptoms associated with the disorder.