There are approximately five million Americans living with fibromyalgia and yet it’s a disorder that’s extremely difficult to diagnose. Fibromyalgia is characterized by widespread muscle pain and tenderness and fatigue. Symptoms can include muscle spasms and tightness, TMJ, sleep difficulties, and headaches and migraines. Although misunderstood by many, the pain that fibromyalgia patients experience is very real.
BlackDoctor.org recently spoke with Dr. Kyrin Dunston, a board-certified medical doctor with more than 20 years of experience, who used to suffer from fibromyalgia, about this debilitating disorder. She says that fibromyalgia is something she sees frequently. Here’s what she had to say about it:
BDO: Do you have to have widespread pain in the body in order to have fibromyalgia?
Dr. Kyrin Dunston: Yes you do. Fibromyalgia means pain (myalgia) in the fibers (fibro) of the body, which are muscles and tissues that hold the body together. Although it’s a recognized diagnosis by the American Medical Association and most all health insurance carriers, it’s really a description of a constellation of symptoms and does not define what is causing the symptoms.
The 1990 American College of Rheumatology criteria identifies fibromyalgia patients with an 88 percent accuracy. The requirements to be diagnosed with fibromyalgia include two criteria that must be met:
- There must be widespread pain in all four quadrants of the body for a minimum of three months (four quadrants are defined by dividing the body in four parts with a cross, so the four quadrants are right upper, right lower, left upper and left lower).
- At least 11 out of 18 specified sites must be painful for the past three months and tender on examination. A tender myofascial point is called a trigger point and generally is a firm nodule present in a tight muscle that hurts when pressed and often radiates or shoots pain into other more widespread areas. A simply tender area is different from a trigger point in that the pain from pressure there generally does not radiate elsewhere and the painful area can often be relieved with local measures like massage and warm baths and does not persist. Also, trigger points can decrease your ability to move normally. The 18 sites used for the fibromyalgia diagnosis cluster around the neck, shoulder, chest, hip, knee, and elbow regions. A positive trigger point is noted when the clinician presses a finger on the spot firmly enough so that her nail bed turns white or blanches.
BDO: What if the pain only occurs on one side of the body?
Dr. Dunston: By the traditional definition, above pain on only one side of the body would not qualify as pain in all four quadrants is required. However, the more relaxed and inclusive clinically used diagnostic criteria above would include pain on one side of the body. It’s not uncommon to see unilateral pain in fibromyalgia patients often due to handed dominance. However, a full evaluation to rule out other causes of the syndrome should be undertaken.BDO: What causes the pain associated with fibromyalgia?
Dr. Dunston: There are myriad causes for the pain associated with fibromyalgia and includes hormonal imbalance, toxicity and nutritional deficiency. Toxicity includes infections. All of these issues trigger the pain cascade that includes production of inflammatory cytokines like interleukin 10 and NF kappa B. Nerve endings are stimulated and transmit or conduct information regarding pain using neurotransmitters to the brain, which recognizes the stimulants as pain. Nociceptors are the nerve endings that transmit a sensation of pain to the brain. They can be stimulated by nutritional deficiencies, toxicities and hormonal disruptions and transmit a pain signal.
BDO: How is fibromyalgia diagnosed? I heard that it is very difficult to diagnose.
Dr. Dunston: Yes, the diagnostic criteria as above can be very confusing because there are so many different criteria. Basically, if someone has widespread chronic intractable pain present fairly often and has any of the other associated symptoms, then the diagnosis is fibromyalgia. This really just means pain in the body and describes symptomatology ad not a disease process. As you can see the causes are myriad and in reality comprehensive Functional Medicine diagnostic tests must be completed to a certain the true diagnosis and underlying causative factor. As this is not the standard of care currently, it requires patients to seek out qualified practitioners who can correctly assess the cause of the fibromyalgia and treat it.
BDO: What is the best form of treatment for fibromyalgia?
Dr. Dunston: The standard of care for treating fibromyalgia includes medications. However, they typically just control symptoms and must be used long term. They do not address the underlying cause of the symptoms. There are better options.
BDO: If medication is the best treatment, what kind and how long must you take it? I’ve heard that medications that treat other illnesses, such as depression, fatigue, sleep disorders, and Lyme disease are effective in treating fibromyalgia. How effective are they? What are the side effects of these types of medications, since they do not directly treat fibromyalgia itself?
Dr. Dunston: Standard of care treatment for fibromyalgia includes pharmaceutical agents designed to decrease pain and inflammation in the body or to decrease the perception of pain in the brain. The only drug approved by the FDA for use in fibromyalgia patients is Lyrica.
Typical treatments include NSAIDS (non-steroidal anti-inflammatory agents), such as Aleve, Ibuprofen, Tylenol and narcotic medications, such as codeine or even morphine.
Antidepressants help to decrease the sensation of pain in the brain by increasing serotonin levels. Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), and Sertraline (Zoloft) are often used at low doses to decrease fatigue and pain in fibromyalgia patients. Benzodiazapines like Xanax and Valium can be useful for relaxing tense and painful muscles and improve sleep in fibromyalgia patients.
There are concerns, however, for chemical dependence with Benzodiazipines and narcotics and none of these listed treatments actually addresses the underlying cause of fibromyalgia. They just address the symptoms and can have serious side effects, which include addiction and less serious but difficult symptoms, such as gastrointestinal distress (nausea, vomiting and diarrhea), sexual disturbance (decreased libido and difficulty achieving orgasm or erection), nervousness, agitation or restlessness, dizziness, sleep and energy disturbance, weight gain, and headaches.
Physical therapy and treatment can also help patients emotionally cope with pain. Most patients who do not have a proper and comprehensive evaluation need continued medication support to alleviate their symptoms.BDO: Are there other options? What are the alternatives for taking medication to treat fibromyalgia?
Dr. Dunston: Evaluation for causation is another option to controlling symptoms with drugs. Testing for hormonal imbalances, such as cortisol, thyroid, insulin and sex hormones is a start. Cortisol imbalances frequently contribute to pain in the body. An evaluation for toxicity, which includes functional stool testing and testing for chronic viral and bacterial infections and heavy metal toxicity, as well as other tests, is also indicated. Nutritional evaluation that checks urine and blood for 250 nutritional parameters is very useful in fibromyalgia patients as deficiencies are commonly found.
Natural treatments aimed at correcting the identified imbalances in then indicated with vitamins, minerals and herbs. Lifestyle modification is usually indicated as well and includes aerobic exercise, stretching and body work like massage and acupuncture. Adequate and restful sleep promotion assists with recovery and can be obtained with natural measures as well. Relaxation techniques such as meditation, pranayamas (breath work and gentle or yin yoga are also helpful). Therapy that includes cognitive behavior components assists with coping with the chronic symptoms that can exist in patients with fibromyalgia.
Natural anti-inflammatory agents like cur cumin, bosweillia and quercetin and ginger can greatly ease symptoms. These are found in some foods and natural supplements. Magnesium is one of the most prevalent minerals in the body and is important for muscle relaxation. Most people are deficient in this and use of higher doses can significantly improve muscle tension in fibromyalgia patients. Omega 3 fatty acids have a beneficial anti-inflammatory effect as well and moderate doses may improve pain symptoms with this condition.
BDO: How would you describe the pain associated with fibromyalgia?
Dr. Dunston: The pain experienced with fibromyalgia is most often described as a chronic dull to intense localized aching in specific places in the body that may be intermittent but really never resolves. In my personal experience, this is truly the case. It’s chronic, nagging pain that occurs in the same places over and over again and few interventions alleviate it. It’s also pain in the viscera (abdomen), the head and sometimes the jaw.
BDO: Does fibromyalgia ever go away permanently?
Dr. Dunston: Absolutely, fibromyalgia can go away permanently if the causative factors and identified and corrected. Unfortunately, the majority of patients never receive the appropriate testing to identify the underlying causes of their pain and symptoms. This precludes correction of the issues with the appropriate measures. Hence, the majority of patients suffer needlessly their entire lives once diagnosed or are maintained on very strong and often harmful drugs whose side effects are often worse than the original symptoms.