Term Paper: Fibromyalgia

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[. . .] In terms of coping with these symptoms, one has to be able to trace the progress of symptoms of FMS. Most aver that these symptoms do not decrease. The good news is that they do not increase either. They remain the same. Without truly finding a cure, patients felt more vitalized with passing time because they had learned to carry on their lives despite the discomfort and were used to living with the problems. A study of people who had been part of a clinical trial over six years ago involved measuring the symptoms over time. Most of the respondents to this study reported that they had better control over the symptoms. (Baumgartner, Finckh, Cedraschi, & Vischer, 2002) The parameters measured were "sleep quality, morning stiffness, amount of medications used per week, functional ability, anxiety, or perceived severity of overall symptoms" These parameters were qualitatively assessed and patients did not report any exacerbation except in instances of certain pains.

Understanding Pain

Since pain is an important component of fibromyalgia, it is necessary within the context of this work to understand the mechanisms in pain and the natural responses of the body to it. There is a journal that is dedicated to the subject of pain -- Pain. This is an important aspect of life because it is the mechanism by which the body protects itself. The capacity to monitor the integrity of our bodies and to be made immediately aware of injury through the experience of pain is critical for our survival. International Association for the Study of Pain defines pain "... An unpleasant sensory and emotional experience associated with actual or potential tissue damage." (Merskey, 1979) Margaret McCaffrey, a social scientist and registered nurse, was quoted in cancer-pain.org as saying: "Pain is whatever the experiencing person says it is, and exists whenever he says it does."

There are different types of pain. Chronic pain persists for a period of a month or more beyond the normal recovery time of an illness. Chronic pain can range from dull and nagging to intense and severe. Acute pain is a short-lived condition. This pain is experienced with injury or acute illness. Another kind of pain is called breakthrough pain. It lasts for a short time. Breakthrough pain is of moderate to severe intensity occurs over already existing or controlled pain.

While it is difficult to quantify pain, clinicians frequently use methods to make effective diagnosis based on the level of discomfort experienced by the patient. These are McGill Pain Questionnaire, which consists of a questionnaire answered by the patient in a descriptive fashion. The Submaximal Effort Tourniquet Test is a physical test. The Visual Analogue Scale measures the range between two extremes of pain. The 101-point Numerical Rating Scale (NRS-101) - a progressive numerical scaling method from 1-100. When these methods are compared, the NRS-101 scale rating is generally considered optimal for clinicians to measure a patient's pain. (Jensen, Karoly, O'Riordan, Bland, & Burns, 1989) PET and MRI studies and autoradiography in animals help identify the neurological mechanisms in the brain and the nervous system following a pain stimulus.

There are several millions receptors in the body. Some of these receptors carry impulses related to temperature, organ status. Nerves carry these impulses from the receptors to the brain. The nerves consist of bundles of fibers. Large bundles are associated with the sense of touch and the smaller bundles carry the pain impulse. The smaller bundles project their impulses slower that the larger bundles. These bundles meet at the spinal cord. The central nervous system serves the primary function of processing stimulus. The information is processed across different brain regions and transmitted via parallel pathways. This enables the mechanism of pain to function even if one pathway becomes somehow damaged. The structures that are important in the processes of pain and pain relief are sensory receptors and their afferent nerve fibers, the dorsal horns, ascending and descending pathways, the reticular formation in the midbrain and medulla, the thalamus, the limbic system and the cerebral cortex.

Melzack and Wall (Melzack & Wall, 1965) developed their now-famous theory on pain mechanisms called the gate theory. The model depicts a mechanism of a gate opening and closing which allows pain to flow or retards the pain impulse into the spinal cord. This is the first step of pain before it is processed in the brain. The science of acupuncture is associated with "pricking" those points in the system where the gates are likely to be. Acupuncture decreases pain by causing the gates to close to the pain impulse. A previous theory of pain was called the Specificity Theory. This theory held that pain was a separate system in the body that had its own neurons and pathways that were separate from other impulse and sensory mechanisms. Yet another theory was called the Pattern theory. This theory held that pain receptors were just like other receptors. (Baldry, 1993)

Pain in fibromyalgia is often reported as originating from the muscles -- though others report that it originates from the joints.


Definable causes are hard to come by primarily because the symptoms are widespread and varying in intensity. At best, causes can be attributed to hormonal imbalances. One way would be to identify the causes would be identifying the triggering mechanism. For example, if the root cause of sleep impairment would be able to help with muscle stiffness, pain and depression that comes from a lack of sleep. While rennin-angiostensis-aldosterone levels in both normal and FMS women were the same, FMS test subjects showed an impaired metabolism to angiotensin resulting in decreased blood pressure. This decrease in "intravascular volume" resulted in dizziness, one of the common symptoms of FMS. (Maliszewski, Goldenberg, Hurwitz, & Adler, 2002)

Sleep impairment is one of the most discernible symptoms of fibromyalgia. In identifying triggering mechanisms therefore studies have implicated the growth hormone. This is simply because secretions of the growth hormone is secreted (perhaps to aid in slow metabolism and body repair during sleep) during the third and fourth stages of non-REM (rapid eye movement sleep). The study included IGF-1 level measurements in 500 patients with FMS and one hundred and fifty-two patients without FMS. (Valcavi, Valente, Dieguez, Zini, Procopio, Portioli, & Ghigo, 1993) The normal response of elevated growth hormone secretions was absent. When patients were treated with pyridostigmine, growth hormone secretions resumed to normal levels. Pyridostigmine is known to suppress hypothalamic somatostatin secretions.

Mengshoel and co-workers studied the hormonal responses after a typical work out involving training the quadriceps muscles. The researchers found that most physiological responses were comparable between the test and the healthy patients. The only statistically significant difference was between the levels of the catecholamine secretions. Runners' high is a term that is described as a feel-good sensation after a particularly strenuous work out. Clinicians aver that seeking this high might result in people working out at levels that are dangerous to their bodies. One of the theories advanced was catecholamine release. This was associated not only with runners' high but also with the second wind. The depressed release of this chemical might cause symptoms of depression. (Mengshoel, Saugen, Forre, & Vollestad, 1995)

Another ideation that makes the rounds is the beta-endorphin theory. Beta-endorphin secretions have, like catecholamine been implicated in the feeling of runner's high. (Colt, Wardlaw, & Frantz, 1981) These endorphins have are also the first respondents in the study of pain. They are also implicated in helping with mood disorders and in the response to stress. A study was conducted in Italy that measured the ?-endorphin levels in patients with depression, FMS, CFS and a healthy control. A total of forty subjects participated in the study and the differentiation of subjects in each subgroup was not uniform. Seventeen subjects of the patients suffering from CFS formed the highest sub-group. Only five patients suffered from FMS. This study showed that ?-endorphins levels in those suffering from CFS and FMS were significantly lower. Interestingly, depressed test subjects without FMS or CFS had elevated endorphin levels when compared to the healthy subjects. Since ?-endorphins are created in the brain, this study pointed to a possibility that fibromyalgia might find its origins in the central nervous system. This test will also prove useful. In making an effective diagnosis for FMS, the symptoms caused by other disease often confound truly identifying the condition as FMS. A test of beta-endorphins will allow patients to differentiate between FMS patients and those suffering from non-FMS related depression.

The above studies sought to find physiological changes that caused FMS -- namely, the triggering mechanism. There is another view of identifying causes, which are more qualitative in nature. These have to do with triggering events. Many FMS patients have identifying a defining event from where symptoms of FMS started manifesting. An acute work related or athletic injury is often the primary cause. A study in Israel listed twenty-two percent of FMS sufferers blaming an automobile accident and… [END OF PREVIEW]

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