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Fibromyalgia Definition and Incidence |
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The Book of Aching & Fatigue
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The Problem
Musculoskeletal and rheumatic complaints account for approximately 15% of the patients seen by primary care physicians. These complaints include muscle pain and weakness, regional pain syndrome such as back or neck pain, rheumatoid arthritis, gout, ankylosing spondylitis and lupus erythematosus. More aggressive muscle pain associated with muscle inflammatory activity is less common and occurs in patients with the autoimmune disorders, polymyalgia rheumatica and polymyositis. Norman J. Marcus, M.D. (American Medical Association media briefing on pain NEW YORK -- July 17, 1997 ) stated that "we need to recognize that pain is an epidemic of sorts and that we are not adequately handling patients with pain." He estimated that headaches disrupt productivity in 40-million Americans each year, while back pain interferes with work in 36-million people, muscle pain affects 24-million people and neck pain affects 20-million people. For persistent pain in general, the cost estimates are around $100 billion per year. For back pain in particular, estimates are $16-20 billion per year. He stated: "Back pain is a problem of fitness…if we made weight loss and exercise a national priority, the result would filter down in tremendous savings for our beleaguered health care system…Even something as simple as walking the equivalent of two miles per day could reduce utilization and cost of medical services. Generalized Aching and Stiffness In many patients, pain, stiffness and loss of function occur without demonstrable inflammation. Their diagnoses include chronic low-back pain, fibrositis, fibromyalgia, fibromyositis, myofacial pain syndrome and idiopathic myalgia. The pain seems to originate from muscles and connective tissue with little or no evidence of tissue changes. Blood tests are normal, even when the disability from pain, weakness, and stiffness is severe. Aching is often associated with fatigue and other symptoms. Gastrointestinal Tract symptoms are especially common. Patients with these diagnoses are usually offered drugs by their physicians. Pain-relievers, NSAIDs, muscle relaxants, tranquilizers and anti-depressant drugs are all popular, but none are particularly helpful Fibromyalgia patients often sleep poorly and may experience some relief by taking the antidepressant, amitriptyline, at bedtime. Fibromyalgia is often associated with or indistinguishable from the "chronic fatigue syndrome" . These symptom complexes should be viewed in the wider context of hypersensitivity disorders and food-related disease. Fibromyalgia & Chronic Fatigue - Little Boxes in a Bigger Box Fibromyalgia and Chronic Fatigue Syndrome (CFS) and related disorders are not discrete diseases in the usual sense, but patterns of maladaptive responses to food and the environment. We believe that fibromyalgia is one expression of non-specific hypersensitivity disease and should be treated with diet revision as the first and most essential form of therapy. People with chronic pain describe a variety of patterns - a generalized aching associated with pressure sensitivity over some muscle groups is common. People say " feel like I am 90 years old". Stiffness after sitting or lying down is common. The stiffness and pain will improve with mild activities. The pain seems to originate from the surface of muscles and from the areas where muscle and bone connect. Mild exercise, stretching, and free movement can be helpful. However, many people complain that if they exercise more vigorously, the pain is increased and sometimes a flu-like illness lasting hours to days follows too vigorous exertion. As the problem progresses, physical activities are curtailed and physical work may become impossible. There are often sore spots that come and go and "trigger points" have become a diagnostic feature of FM. Joint pain is not a feature of FM, although it is common for patients with inflammatory arthritis to have generalized aching.The pain does not respond well to common analgesics such as ASA and the NSAIDs. Acetominophen is a poor pain reliever and offers little benefit. Hot showers and baths are helpful and gentle massage may be soothing although sore spots can be aggravated by unskilled touching and vigorous massage will make the problem worse. Some people are helped by taking low doses of antidepressants such as amitripylene. Often, associated problems are as or more important than the aching disorder. In most patients, other primary diagnoses such as irritable bowel syndrome, migraine, chronic fatigue are more appropriate. Often the diagnosis of fibromyalgia and chronic fatigue can be made together, although some people remain energetic but are stopped by pain. Seldom have we seen a patient who just has generalized aching with no other health problems. Associated Disorders Once you have the concept that people fit into boxes like "Fibromyalgia", you artificially separate people from the causes and connections that link their disease with other diseases. People with fibromyalgia said to have associated symptoms. They, in fact have a multisystem, polysymptomatic disease. You have to consider that fibromyalgia is a little box inside a much bigger box. You then ask: "what is the common cause or common mechanism of all the conditions in the bigger box? About 60 % of patients diagnosed with fibromyalgia have chronic digestive disorders and half have symptoms suggestive of allergy to food and airborne allergens. Many are overweight and some are destined to develop diabetes as they age. If you link conditions such as irritable bowel, with migraine headaches, with depression and allergies - you get one very plausible answer - delayed pattern food allergy. Commonly associated problems include:
In one study, reported lifetime associated conditions included
When you look at these statistics you have to consider that fibromyalgia is a little box inside a much bigger box. You then ask: "what is the common cause or common mechanism of all the conditions in the bigger box? If you link irritable bowel, with migraine headaches, with depression and allergies - you get one very plausible answer - delayed pattern food allergy. Diagnostic Criteria After years of waffling, many physicians are now ready to diagnose a non-specific aching disorder. The term fibromyalgia has emerged as the most popular diagnosis and replaces a number of older diagnoses such as fibrositis and muscle-fascia pain syndrome. According to the American College of Rheumatology, 1990 to be diagnosed with fibromyalgia you must have:
There are no tests for fibromyalgia and nothing shows on X-ray or Cat scan. The diagnosis often depends on the physician being convinced that you have 11 "trigger points". The idea of trigger points is flawed and leads to some ridiculous conclusions. What if you have only 10 trigger points on a good day? Obviously, fibromyalgia is an easy condition to fake or exaggerate and as more insurance and disability claims hinge on the diagnosis, more conflicts between patients, MDs and insurers will arise. Often, attempts to focus on a specific set of symptoms ( aching and stiffness) is counterproductive - you can't see the forest for the trees. Aching and stiffness are symptoms of a pervasive life-problem that you have to solve at its source. A trial of diet revision, using the Alpha Nutrition Program, is always indicated to probe the probability that wrong food choices are responsible for the suffering. |
