Friday, December 30, 2011

In a word – What we know about terms and fibromyalgia

Historical terms for what we know today as fibromyalgia:

fibromyocitis
muscular rheumatism
tension myalgia/ tension rheumatism
psychogenic rheumatism
neurasthenia
fibrositis
(Cooper and Miller, 2010)

Fibromyositis

Fibromyositis is still alive and we now know it is not interchangeable with FM. It is an inflammatory condition of muscle associated with overgrowth of the connective tissue.

Muscular rheumatism

Muscular rheumatism is today used to describe what we know as polymyalgia rheumatica.
Sneak Peek, Polymyalgia Rheumatica©…
Because muscle pain and stiffness are associated with PMR, it could be confused with FM, CFID, or CMP. However, it is a different condition all together. Polymyalgia rheumatica is inflammatory in nature. Because muscle pain and stiffness are associated with PMR, it could be
confused with FM, CFID, or CMP. However, it is a different condition all together….
(Cooper and Miller, 2010, pg 104)
Tension myalgia

Tension myalgia implies muscle pain from tense muscles, Mayo Clinic says, “Tension myalgia is a diagnosis that has been in use at the Mayo Clinic for more than 40 years. The term describes a common muscle pain disorder that is conceptually similar to other muscle pain disorders such as fibrositis, fibromyalgia, and myofascial pain syndrome. This article outlines the history of these disorders and proposes "tension myalgia" as a term that unifies these separate diagnoses under one conceptual framework. Because the diagnostic criteria for tension myalgia have been vague, the Department of Physical Medicine and Rehabilitation at the Mayo Clinic has developed specific criteria for generalized, regional, and localized forms of this disorder. The recommended treatment approach includes reassurance, elimination of contributing factors, physical therapy to restore normal neuromuscular function, conditioning, and medications.” (Thompson, 1990)

It is my opinion that tension myalgia may be related to what we know today as myofascial pain syndrome (MPS) referred to in our book as chronic myofascial pain (CMP). MPS/CMP is a prevalent peripheral pain generator to the centralization of pain found in FM. To learn more about CMP see my website.
http://www.thesethree.com/cmp/chronic-myofascial-pain.php


Psychogenic rheumatism

Psychogenic rheumatism is an old term that implies muscle pain is a psychiatric disease. Unfortunately, despite the overwhelming evidence to the contrary, there are still those that would like to put us in this category.

Neurasthenia

Neurasthenia is an old term that denoted what they thought was a psychological disorder manifested by chronic fatigue and weakness, loss of memory, and widespread pain, thought to be from an exhausted nervous system. This definition of an old term certainly does relate to what some of us still experience from our healthcare providers today. I would like to think our practitioners know that the breakdown in the central nervous system in FM is a biological problem that is caused by the presence peripheral pain generators called myofasical trigger points. Though they knew nothing of MPS/CMP in those days (long before the work of Travell and Simons), somehow I feel they would have embraced modern studies better than they are received in our healthcare delivery system today.

Fibrositis

Fibrositis is still used as a synonym for fibromyalgia by some who haven’t kept up with the research. Even though “itis” is the suffix for inflammation and we now know that fibromyalgia is not an inflammatory disorder. It is a syndrome that affects the central nervous system, perpetuated by peripheral nerve to muscle deregulation.


This blog is based on my original answer at ShareCare, Are fibromyositis or fibrositis related to fibromyalgia? View my other answered questions as fibromyalgia expert.


All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. http://www.thesethree.com


Resources:

Cooper C and Miller J, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection. Vermont: Healing Arts, 2010

Thomson, TM, Tension myalgia as a diagnosis at the Mayo Clinic and its relationship to fibrositis, fibromyalgia, and myofascial pain syndrome. Mayo Clin Proc. 1990 Sep;65(9):1237-48.

Monday, December 19, 2011

Ironic, the P in Substance P: The Relationship of Pain in Fibromyalgia

Substance P is one of two principle neurotransmitters (chemical messengers) in the central nervous system, the other being serotonin. Disturbance of these two important transmitters of information has an intense effect on pain perception. We know there is a chronic stress response in fibromyalgia and this constant strain on the body to reach well-being activates and causes hyperactivity of substance P.

Various neurotransmitters, including substance P, target cells across synaptic junctions between the cell’s axon and dendrite, binding to cellular receptors creating an action or electrical potential of the cell. These neurotransmitters create a union from a bounty of forerunners, such as amino acids, which are readily available from the diet. When neurotransmitters are disrupted, it can affect mood, sleep, cognitive function, and other symptoms present in fibromyalgia. These upsets also affect our modulation of the messaging system between the central nervous system and the peripheral and autonomic nervous systems.

BOOK EXCERPT - Chapter One Fibromyalgia Pain, Chronic Fatigue Immunodysfunction, and Chronic myofascial Pain from Trigger Points, subsection, Central Nervous System©

Substance P, which has been found in increased amounts in FM patients, is a peptide substance in spinal fluid (fluid that circulates in the central nervous system); its job is to regulate pain information. (Liu, et al, 2000).
Cooper and Miller, pg. 19 2010.
There are many types of neurotransmitters. Substance P is considered a nueropeptide and functions as a disseminator and interpreter of information, such as perception of pain. In response to pain the body engages in very specific interactions with opioid receptors in the central nervous system, and it can become quite complicated for us in this discussion, but suffice it to say, our body is constantly struggling to deal with painful impulses because our alarm system has become frayed with wear and tear. In chronic pain and widespread allodynia, this system is on perpetual high alert, sometimes called as wind-up, and eventually this exhausts the body’s ability to reach the balance it constantly strives to achieve.

The elevation of substance P in fibromyalgia patients leads many to the conclusion that FM is a disorder of heightened pain sensitivity. For those of us who have FM, we have pretty much already reached that conclusion.

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice.

This blog is based on my original answer at ShareCare, “What is substance P and how is related to fibromyalgia?”

View my other answered questions as fibromyalgia expert for Dr. Oz at Sharecare.


Other resources:

Khasar SG, Burkham J, Dina OA, Brown AS, Bogen O, Alessandri-Haber N, Green PG, Reichling DB, Levine JD. Stress induces a switch of intracellular signaling in sensory neurons in a model of generalized pain. J Neurosci. 2008 May 28;28(22):5721-30.

Z. Liu, M. Welin, B. Bragee, and F. Nyberg, “A high-recovery extraction procedure for quantitative analysis of substance P and opioid peptides in human cerebrospinal fluid,” Peptides 21, no. 6 (2000): 853–60.

Lyon P, Cohen M, Quintner J. An evolutionary stress-response hypothesis for chronic widespread pain (fibromyalgia syndrome). Pain Med. 2011 Aug;12(8):1167-78.

Stahl SM. Fibromyalgia--pathways and neurotransmitters. Hum Psychopharmacol. 2009 Jun;24 Suppl 1:S11-7.

Staud R, Spaeth M. Psychophysical and neurochemical abnormalities of pain processing in fibromyalgia. CNS Spectr. 2008 Mar;13(3 Suppl 5):12-7.

Monday, December 12, 2011

History the weapon for our arsenal in understanding fibromyalgia.

Understanding the history is of anything is important because we draw knowledge, from previous experiences. History has provided us a foundation for tying the advances of medical science to pain experienced as far back as documentation began. My own grandmother was diagnosed with “muscular rheumatism” in the 1960’s, a term once used to describe fibromyalgia as we know it today.

Fibromyalgia History

Symptoms of what we know as fibromyalgia today were first described in the 1700's. The disorder its self was first observed and documented by a British surgeon William Balfour in 1816. In 1904, another British doctor by the name of Sir William Gowers recognized the same collection of symptoms and described this chronic soft tissue syndrome as fibromyocitis.
Finally, in 1981 a connection was made between fibromyocitis and non-inflammatory systemic symptoms and led to the description of the syndrome formerly described as, fibromyocitis, muscular rheumatism, tension myalgia, psychogenic rheumatism, tension rheumatism, neurasthenia, and fibrocitis. Today it is called fibromyalgia.

Twenty years ago, fibromyalgia in its pure definition was unrecognized, but the continued symptoms of diffuse muscle pain and fatigue described by people with fibromyalgia (FM) led patients on a quest for help. Today, though still lacking in acknowledgment by some, it can no longer be denied and history has changed the course of the future for those of us who live with the symptoms of this disabling disorder.


We know today that fibromyalgia is a disorder caused by a loss of orchestration of our central nervous system symphony, which normally strives to find balance, feedback, and action to help the body function in all ways, and that it is affected by the presence of peripheral pain generators. Without the work of Travell and Simons, we never would be able to make this connection.

A more in-depth exploration of the history of fibromyalgia is detailed in our book.

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. http://www.thesethree.com

Wednesday, December 7, 2011

Ups and Downs; unpredictability of FM and CFID. How can I avoid a flare?

Identifying comorbid or co-existing illnesses is important. Whether other illnesses are comorbid to fibromyalgia (meaning they occur more frequently with FM or CFID) or co-existing, they are great aggravators to the symptoms of fibromyalgia and chronic fatigue immunodysfunction, AKA ME/CFS, and to each other. Identifying other contributors to pain and dysfunction are important too. The short list is posture, sleep disruption, anxiety, sedentary lifestyles, ignoring perpetuating factors or known emotional and physical stressors, etc.

Excerpt Chapter Two©
We are susceptible to a flare when we deviate in any way from our personally tailored, multidisciplinary treatment plan. This worsening of symptoms does not mean FM is progressing from one step to the next in the disease process. “Unpredictable” is the best way to describe the way symptoms occur. It is literally a 24/7 job for all of us, and varies in difficulty from one patient to another. (Cooper and Miller, pg 23-24, 2010)

It may not always be easy to define what your aggravating factors are, but you can certainly get a lot further through work and perseverance than by ignoring your symptoms or having a health care worker dismiss them. You may have to do a juggling act. For instance, when I treat resistant
TrPs while also dealing with unexpected FM symptoms, it can cause a serious flare of body-wide pain…This, in turn, results in a flare of CFID, lowering my resistance to infection and increasing general malaise. Sometimes the best thing to do is treat the condition that needs the most
attention. (Cooper and Miller, pg. 75)


There really is no short answer to this question. We discuss this at length in Chapter two Communicating Your Health Care Needs: Identifying Aggravating and Alleviating Factors and Coexisting Conditions. Also included in this chapter are Relating Your Symptoms and Health History, Communicating with Your Physician and Other Health Care Providers, Medication Log, Symptom Inventory Sheet, Anatomical Diagram of Pain, and Health History Log


Based on my answer as Share Care Fibromyalgia expert, How can I avoid flare-ups from fibromyalgia?

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. http://www.thesethree.com

Monday, December 5, 2011

Nerve to Muscle and the Role in Fibromyalgia

Research continues to tell us that fibromyalgia involves the breakdown of normal messaging in the brain, which is further sensitized by peripheral nervous system dysfunction, particularly in the muscle. This results in what is known as centralization of pain.

Chronic myofascial pain from myofascial trigger points which are caused by an excessive release of acetylcholine, a chemical neuro messenger, is prevalent in fibromyalgia and helps explain muscle pain and dysfunction. Myofascial trigger points are known as the great neurological imitators. When coupled with fibromyalgia this peripheral input further sensitizes the brain and it becomes a vicious cycle.

Learn more about chronic myofascial pain.

It is difficult to deny the brains ability to resurrect previous pain experiences or detach the emotional center from the physical response. Conditioning responses is important and why treatment takes a multidimensional approach. These various treatments, medication, stretching movement such as Yoga, gradual exercise after bringing myofascial trigger points under control, meditation, T’ai Chi for promoting balance input to the brain are all important for putting a tire tool in the spokes of this wheel spinning out of control between the brain and the periphery.


All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. Website


This blog is based on my original answer at ShareCare, What role do nerves play in fibromyalgia? View my other answered questions as fibromyalgia expert.


Resources

Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, Giamberardino MA.Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain. 2011 Jan;15(1):61-9.

Bazzichi L, Rossi A, Massimetti G, Giannaccini G, Giuliano T, De Feo F, Ciapparelli A, Dell'Osso L, Bombardieri S.Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clin Exp Rheumatol. 2007 Mar-Apr;25(2):225-30.

Bennett, R. Understanding Chronic Pain and Fibromyalgia: A Review of Recent Discoveries
National Fibromyalgia and Chronic Pain Association: The Science of Fibromyalgia http://fmcpaware.org/science-of-fm

Burgmer M, Gaubitz M, Konrad C, Wrenger M, Hilgart S, Heuft G, Pfleiderer B.
Decreased gray matter volumes in the cingulo-frontal cortex and the amygdala in patients with fibromyalgia. Psychosom Med. 2009 Jun;71(5):566-73. Epub 2009 May 4.

Carvalho LS, Correa H, Silva GC, Campos FS, Baião FR, Ribeiro LS, Faria AM, d'Avila Reis D.
May genetic factors in fibromyalgia help to identify patients with differentially altered frequencies of immune cells? Clin Exp Immunol. 2008 Dec;154(3):346-52.

Castro-Sanchez AM, Mataran-Penarrocha GA, Granero-Molina J et al. 2011. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011:561753.

Clauw DJ, Arnold LM, McCarberg BH; for the FibroCollaborative. The Science of Fibromyalgia Mayo Clin Proc. 2011 Sep;86(9):907-911.

Ge HY, Wang Y, Danneskiold-Samsøe B, Graven-Nielsen T, Arendt-Nielsen L. The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain. 2010 Jul;11(7):644-51. Epub 2009 Nov 14.

Hubbard JE. Myofascial Trigger Points: What Physicians Should Know about these Neurological Imitators Minn Med. 2010 May;93(5):42-5.

Lee YC, Nassikas NJ, Clauw DJ. The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia.
Arthritis Res Ther. 2011 Apr 28;13(2):211. [Epub ahead of print]

Lyon P, Cohen M, Quintner J. An evolutionary stress-response hypothesis for chronic widespread pain (fibromyalgia syndrome). Pain Med. 2011 Aug;12(8):1167-78. doi: 10.1111/j.1526-4637.2011.01168.x. Epub 2011 Jun 21.

Macedo JA, Hesse J, Turner JD, Ammerlaan W, Gierens A, Hellhammer DH, Muller CP.
Adhesion molecules and cytokine expression in fibromyalgia patients: increased L-selectin on monocytes and neutrophils. J Neuroimmunol. 2007 Aug;188(1-2):159-66. Epub 2007 Jun 28.

Petersel DL, Dror V, Cheung R. Central amplification and fibromyalgia: disorder of pain processing. J Neurosci Res. 2011 Jan;89(1):29-34.

Celeste's Website

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