Thursday, September 26, 2013

The Mystery of Fibromyalgia...


The medical terminology of the word "fibromyalgia" derives from Latin, fibro-, prefix meaning "fibrous tissues", Greek myo-, "muscle", and Greek algos-, suffix meaning "pain"; therefore, the term literally means muscle and connective tissue pain.  Along with arthritis, low back or muscle pain, fibromyalgia affects “nearly a third of the U.S. population every year” (Kerns, 345).  The psychological and social toll of chronic pain is enormous, and pain specialists estimate its cost in medical expenses and lost income and productivity to be “between $50 billion and $100 billion annually.” (Carpenter, 61).  What is unique about fibromyalgia is that its exact cause is unknown.  Most medical experts agree that psychological, genetic, neurobiological and environmental factors lead to the development of this condition.



It is interesting to note that researchers have found that pain is as individual as the people who have it, and that subjective assessments of pain do not necessarily match the degree of actual bodily damage.  Therefore, it is not unusual for a patient to also be suffering from psychiatric issues such as depression and anxiety.  Patients with fibromyalgia often live their lives with “emotional distress, lost productivity or inability to work, and high medical costs.” (Kerns, 345).    As per chapter two, page 30 of our textbook, “Emotions can affect physiological responses such as blood pressure, heart rate, respiration and threshold of pain and tolerance.”  Studied have found that “Patients who are "interpersonally distressed"--about 20 to 35 percent--experience severe pain and feel they get little support from those around them”. (Carpenter, 61).  The most fortunate of chronic pain patients are the "adaptive copers,"--20 to 35 percent--who experience “significant pain but are reasonably well-adjusted and feel in control of their pain” (Carpenter, 61).  With this in mind, it is important for health care providers to treat patients with fibromyalgia in a multidimensional nature and with continuous comprehensive assessments.

One such assessment is the West Haven Multidimensional Pain Inventory, developed by Dr. Kerns.  This assessment helped initiate dialog between psychologists, physiotherapists and physicians, and initiated research on cognitive and behavioral aspects of pain.  This same research has emphasized the importance of looking at the whole “person with pain” instead of isolating the pain as just one problem that needs treatment.  Most recent advances in the treatment of fibromyalgia have helped people feel better and cope better with their pain, but they have also reduced dependency on potentially addictive pain medications and lowered the burden on the health-care system.

According to the course textbook in chapter two, page 34, the diathesis-stress model indicates that individuals inherit tendencies to express certain traits or behaviors, which may then be activated under conditions of stress.  Research has shown evidence that environmental factors and certain genes increase the risk of developing fibromyalgia.  These same genes are also associated with other psychosomatic syndromes and major depressive disorder.  According to the NIH, people with depression have “higher than normal levels of proteins called cytokines” (Depression and Chronic Pain, 1) which results in abnormalities in pain processing.  In addition, some research suggests that these brain abnormalities may be the “result of childhood stress, or prolonged or severe stress”. (Schweinhardt, 415).  While the cause of fibromyalgia is officially unknown, there is little doubt that the diathesis is stress.

Serotonin is a neurotransmitter that regulates sleep patterns, mood, concentration and pain.  The treatment of fibromyalgia with SSRIs has been relatively unsuccessful, as the results have been inconsistent.  SNRIs have appeared to work better in more patients.  However, the NIH suggests that people living with chronic pain may be able to manage their symptoms through lifestyle changes. Such changes could include “regular aerobic exercise, talk therapy, quitting smoking, and eating healthier” (Depression and Chronic Pain, 2).

Whichever methods a patient and their physician decide to use, it is important for the patient to remember fibromyalgia is a multidimensional condition, and not everyone responds to treatments in the same way.  Medications can take several weeks to work, may need to have combined with cognitive behavioral therapy or may need to be changed or adjusted to minimize side effects and improve the quality of the patients’ life in the best possible way.




Works Cited

American Psychological Association (2006). Pain, Pain, Go Away. http://www.apa.org/research/action/pain.aspx

Carpenter, S.  (2002).  Hope on the Horizon.  http://www.apa.org/monitor/apr02/hope.aspx  Page 61

Kerns, R.D., Turk, D.C., & Rudy, T.E. (1985). The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). http://www.tac.vic.gov.au/files-to-move/media/upload/west_haven_yale_multidimensional_pain_inventory.pdf

NIMH (2010).
http://www.nimh.nih.gov/health/publications/depression-and-chronic-pain/index.shtml.  Depression and Chronic Pain.  Pages 1-2.

Schweinhardt P, Sauro KM, Bushnell MC. (October 2008). "Fibromyalgia: a disorder of the brain?”. Neuroscientist.
Pages 415-21.


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