News & Events: Member Articles

The Conundrum of Fibromyalgia
By Lora Thaxton, M.D.

Karla awakes at 6:30 AM to start her day feeling exhausted. She was in bed attempting to sleep at 10:00PM and readily fell asleep only to awaken several hours later due to pain in her hips and back. She woke up three other times during the night because of being uncomfortable and having pain in various parts of her body. This is nothing new for her. She has suffered from widespread pain as well as a multitude of other symptoms for many of her 42 years.

She has sought treatment with at least 6 or 7 doctors all of whom have run various tests only to reveal normal results. She has been told that she has pain related to depression and had suggestions to see a psychiatrist and counselor on a regular basis. She faithfully followed those instructions for about 2 years with no significant benefits in regards to her pain.

She has also been told that she will just have to live with the pain because there is nothing really wrong with her as documented by the testing. This is Karla’s life: wake up in pain, drudge through the day and try to sleep every night in pain.

Karla suffers from a condition known as Fibromyalgia or Myofascial pain syndrome. She is but one of millions of patients in the United States and throughout the world who have a multitude of symptoms but have completely normal laboratory and radiological test results.

How is it possible to be afflicted with widespread muscular and joint pain, subjective soft tissue swelling, headaches, fatigue, paresthesia (an abnormal sensation, as burning, prickling etc), irritable bowel and bladder syndromes, and a long list of others including difficulties with memory and concentration, without having a medical disease or illness?

This is the conundrum of Fibromyalgia!

An American neurologist named Beard seems to be the first to describe and record widespread muscular pain as well as fatigue and psychological disturbance as early as 1880. He used the phrase “neurasthenia” and suggested these symptoms were the result of daily life stressors.

The term “fibrositis” was coined by the British physician Sir William Gowers in 1904 in an article on lumbago (lower back pain). He felt there was an inflammatory component to the condition with associated complaints of fatigue, poor sleep, worsening of symptoms with cold weather and muscular strain, and sensitivity to mechanical pressure.

Many studies ensued over the following years to prove or disprove the inflammatory component of the syndrome. In 1952, Travell and Rinzler published their work on “myofascial pain” and the theory of injecting “trigger points” for treatment of these complaints. Their work is widely published and referenced for treatment of “myofascial pain syndromes”.

A modern description provided by Eugene Traut M.D. of the University of Illinois: widespread musculoskeletal pain and stiffness with all-over aching, fatigue, poor sleep, headache, anxiety, and widespread tender points on palpation. He noted that almost all patients were women between the ages of 20-50 years.

The very nature of fibromyalgia as a valid clinical entity remains in doubt to this day. The term “fibromyalgia” was officially “accepted” by the American College of Rheumatology in 1990 when they published a paper on the criteria for the diagnosis of the condition. This paper is widely referenced in the medical community.

There is much ongoing research related to fibromyalgia and other associated conditions such as Chronic Fatigue Syndrome. This research continues to be undertaken by physicians, academic institutions, and patient support and education groups. Such organizations include the National Fibromyalgia Association, National Institute of Health, and the Arthritis Foundation, among others.

There is a wide array of accepted treatment regimens for the conditions and its associated symptomology. The following should be considered to formulate a plan of care:

  1. Diet and Nutrition - These are considered key to one’s basic health and wellbeing. The digestive system is extremely important to the optimal efficiency of one’s immune system.
  2. Exercise and Weight control - Also considered integral to overall wellness and optimal organ system function.
  3. Restorative and Recuperative sleep - Sleep efficacy and quality is imperative for individuals who experience chronic pain.
  4. Pharmaceutical and prescription medications - A vast array of medications, are available to assist with pain and sleep, as well as other symptoms associated with fibromyalgia and myofascial pain syndrome.
    1. Alternative medicine and Complementary Medicine
    2. Acupuncture, Trigger/Tender Point injections
    3. Massage, Reiki, Biofeedback etc.
    4. Homeopathic Medications
    5. Yoga, Pilates etc.

There are a myriad of alternative techniques and treatments that many patients find helpful for the symptoms associated with fibromyalgia as well as other conditions and disease processes.

Lora Thaxton, M.D.
Academy of Medicine of Toledo and Lucas County