Term Paper: Fibromyalgia Syndrome (Fms)

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[. . .] Some scientists believe that central nervous system dysfunction could be the cause of these unexplained conditions. Muhammad Yunus referred to these comorbid conditions as "central sensitivity syndromes." (Facts of Life, 2002).

Present Understanding of FM: (Again General Concept for the Concept Paper)

The diagnostic criteria for classifying fibromyalgia were finally established and published in 1990 by the American College of Rheumatology (ACR). These criteria were widely accepted because they reflected the results of research published by 20 clinical investigators throughout the United States and Canada.

The ACR criteria for the classification of FM are:

History of widespread pain (must be present for at least 3 months)

Pain is considered widespread when all of the following are present:

1. Pain in the left and right side of the body

2. Pain above and below the waist

3. Axial skeletal pain (cervical spine, anterior chest, thoracic spine, or low back)

Pain in 11 of the 18 tender point sites on digital palpation

1. Occiput bilateral, at the suboccipital muscle insertions

2. Low cervical bilateral, at the anterior aspects of the intertransverse spaces at C5-C7

3. Trapezius bilateral, at the midpoint of the upper border

4. Supraspinatus bilateral, at origins, above the scapular spine near the medial border

5. Second rib bilateral, at the second costochondral junctions, just lateral to the junctions on upper surfaces

6. Lateral epicondyle bilateral, 2 cm distal to the epicondyles

7. Gluteal bilateral, in upper outer quadrants of buttocks in anterior fold of muscle

8. Greater trochanter bilateral, posterior to the trochanteric prominence

9. Knees bilateral, at the medial fat pad proximal to the joint line

For a tender point to be considered positive, the subject must state that the palpation was painful." (De Blecourt & Knipping, 2002).

The ACR criteria assume that the symptoms associated with FM are: pain, sleep disturbance, fatigue, headaches, irritable bowel syndrome, numbness and tingling sensations, joint pain, chest wall pain, sensitivity to cold, memory and concentration difficulties, and anxiety and/or depression, and interstitial cystitis -an inflammatory disorder affecting the walls of the bladder. (De Blecourt & Knipping, 2002).

Role of Collagen in fibomyalgia

Collagen is a structural protein, constituting about one quarter of all of the protein in the body. Collagen provides structure to our bodies, and also protects and supports the softer tissues, connecting them with the skeleton. Collagen is a relatively simple protein, composed of three chains, wound together in the form of a tight triple helix, somewhat akin to the double helix of the DNA molecule. It occurs in the form of resilient sheets that support the skin and internal organs. Bones and teeth consist essentially of collagen impregnated with mineral crystals.

The role of collagen in fibromyalgia has been the subject of many research studies. Musculoskeletal pain caused by continuous and repetitive work has been found to occur frequently in people engaged for long hours in work involving repetitive motions e.g. polishing, cleaning, weaving, mail sorting, working for extended periods on the computer, etc. The same muscle fibres are constantly being used and activated during such repetitive work. Therefore these muscle fibres are most prone to overloading disorders. However it is not fully clear whether this localized overloading actually results in changed metabolism, inflammatory changes in the collagenous tissue, affecting afferent nociception.

Twenty people, who had been suffering from fibromyalgia for two to over fifteen years, participated in a 90-day evaluation to determine effects of collagen hydrolysat on symptoms of chronic fibromyalgia. Twelve of the participants had concurrant temporomandibular joint pain. Collagen hydrolysat is a food supplement with no known side effects. Participants were evaluated initially and then at 30-, 60-, and 90-day periods. Pain complaint levels decreased significantly in an overall group average, and dramatically with some individuals. It was concluded that patients with fibromyalgia and concurrent temporomandibular joint problems might experience significant improvement in their symptoms with the use of collagen hydrolysat." (Olson, Savage & Olson, 2002). In one case, high doses of a collagen product, helped relieve a patient suffering from musculoskeletal pain, within a few days. This led to the theory that pain is caused by damage to the myelin sheath of the nerve fiber. The theory ties in with the general belief that people with autoimmune diseases have difficulty digesting protein and cannot therefore repair cells efficiently. In this case, the body was able to repair the myelin sheath using the easily digestible collagen protein.

Sleep disturbance

Sleep disturbance is a key feature of FMS. (Chaitow, L., 2003). "A survey of over 1000 patients with fibromyalgia syndrome (FMS) and Chronic Fatigue Syndrome (CFS) showed that prior to their illness fewer than 1% had disturbed sleep, whereas during their illness this rose to over 90%. The findings reveal that muscular aches and pains in a patient having fibromyalgia are frequently the result of the same processes, which disturb their sleep. The same biochemical or hormonal imbalances that cause sleep disturbances also create muscular symptoms." (Chaitow, L., 2003). The lack of deep sleep again impacts the pain symptoms, setting off a chain reaction.

In order to gain an insight into how sleep disturbances affect individuals suffering from fibromyalgia syndrome, it is important to understand the sleep process. Normal sleep occurs in cycles of 90 minutes, covering four stages. During the first stage of light sleep, an individual has alpha brain-wave patterns. This is followed by stages 2 (beta), 3 (gamma), and 3 (delta), which are progressively deeper stages of sleep. These three stages are also known as non-REM sleep, given that the rapid eye movements (REM) which occur during dreaming is absent in these stages of sleep. Various studies have shown that nearly half of all people with fibromyalgia experience disturbed delta stages - caused by intrusive alpha wave periods - and wake up feeling as tired as they did when they went to bed. Stage 4 sleep is the deepest level of sleep and is the one that fibromyalgia sufferers cannot enjoy. That sleep disturbance may be a possible cause of fibromyalgia was indicated in a study in which fibromyalgia-like symptoms were induced in normal volunteers by depriving them of deep sleep. It was concluded, therefore, that sleep disorders accompanying fibromyalgia may actually be an underlying cause of the syndrome.

Hormones

It has been observed that people with FMS exhibit alpha-delta anomaly during sleep. A patient with fibromyalgia suffers from chronic sleep deprivation, and never enjoys delta level sleep. When he reaches the stage of delta sleep, alpha waves intrude and bring him back to shallow sleep or to a wide-awake state. During stage 4 sleep, a hormone called somatomedin C, which is essential for the body to rebuild itself, is released into the system. Fibromyalgia sufferers, who do not get enough deep sleep, show abnormally low levels of this hormone. Lack of somatomedin C. may be actually causing the muscle pain and fatigue commonly seen in fibromyalgia patients. Also, release of growth hormone occurs essentially during stage 3 and stage 4 of non-REM sleep. Thus disturbed sleep will affect the release of this hormone, causing abnormalities in the body. Further, a significant proportion of fibromyalgia sufferers have low insulin growth factor (IGF) levels, which indicates that there is depressed growth hormone secretion. "Growth hormone has a powerful effect on the connective tissue, and directly stimulates the production of fibroblasts and mast cells, ground substance and collagen fibers. It plays a significant role in wound healing, where rapid production of collagen fibers by many fibroblasts is necessary for repair. Delta-level sleep is impaired in fibromyalgia patients, and this negatively impacts the release of Growth hormone." (What Causes Fibromyalgia?, 2002).

Neurotransmitters

The central nervous system transmits pain signals along 3 separate pathways, viz., via the peripheral nerves, the spinal and, and the brain. The peripheral areas of the body are first exposed to painful stimuli, and certain chemicals called neurotransmitters are released into the spinal cord in response to these stimuli. These neurotransmitters ultimately activate various receptors in the brain, depending upon the intensity and duration of the stimuli. Severe or persistent pain from any source (e.g. injuries, arthritis, surgery, etc.) can result in a heightened sensitivity to pain itself. What was formerly being perceived as non-painful stimuli now becomes painful, and the sense of pain spreads beyond the original site of injury. Substance P (SP), a neurotransmitter released in the spinal cord, plays an important role in the spread of chronic pain. It is composed of 11 amino acids, and when levels of substance P. increase significantly in the cerebrospinal fluid, this neurotransmitter diffuses to neighboring neurons. The diffusion in turn causes neighboring neurons to become sensitized, resulting in the perception of pain, even in uninjured tissue. The concentration of SP is elevated threefold in the cerebrospinal fluid of FMS patients compared to normal control subjects. Patients with severe cases of FMS have a reduced pain threshold, an increased sensitivity to painful stimuli, and an increase in the duration of pain after… [END OF PREVIEW]

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