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The following is a common type of case presentation that I see in my office:
An adult between the ages of 20-50, usually a woman, with pain (usually described as aching, or tender, or burning) – but not just pain localized to one area of the body, but rather pain that seems to be all over the body. They may also describe feeling stiff most of the time, often most noticeably in the morning. They are sometimes unable to describe any particular event/occurrence that caused the pain. They often describe feeling tired a lot of the time and have difficulty concentrating. Sleep disturbances as well as feeling down or depressed may be reported. There is usually a lack of desire to exercise (due to the pain and fatigue). Stress, anxiety, and possibly certain weather conditions (cold, or damp) may seem to worsen the pain. There may or may not be a history of headaches, and or irritable bowel syndrome (IBS).
Does this sound familiar to you? Many of us may know someone who fits this profile. One possible diagnosis in this scenario (and certainly there are other possible diagnoses) is that of the condition called fibromyalgia.
An estimated one million Canadians suffer from fibromyalgia.
But, just what is fibromyalgia? In a nutshell, fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain. (By the way – “chronic” for our purposes, means that you’ve suffered with the condition for 3 or more months). Researchers don’t exactly know what causes it, but there are theories that certain events (either recent or from years previous) can trigger its symptoms, such as car accidents, viral or bacterial infections, or the onset of other disorders (for example, rheumatoid arthritis, or lupus). There is some research that suggests a possible connection between emotional stress/trauma (and, in particular, post-traumatic stress disorder) and fibromyalgia. For now, the exact cause remains elusive.
When I perform a physical examination on fibromyalgia sufferers, a pattern emerges. Testing of the mobility of different joints in the body often does not show any large reduction of mobility (although the patient may report feeling stiff). Likewise, strength testing often does not reveal any obvious, significant weaknesses. Neurological testing is usually normal. However, palpatory findings (simply touching different joints and muscles) commonly reveals marked tenderness and soreness. Affected areas may include the upper back, lower back, hips, thighs, rib cage, shoulders, elbows, chest, knees….you get the point. This does not mean that the fibromyalgia sufferer has tenderness in all of these areas, but some of them anyway. The force that I use to touch an affected area of the body is not even close to being enough to harm anyone, yet the patient feels pain or discomfort.
This highlights the difference between hurt and harm. The fibromyalgia sufferer will often feel pain with non-harmful stimuli – such as light touch, or upon performing simple daily tasks. The pain is real – there is no doubt about that point in the scientific literature, and certainly there is no doubt to the patient. However, in these cases, feeling hurt does not accurately indicate that any harm is being done to the musculoskeletal system. Normally, we will experience pain only when some sort of damage is being done to the body – this is the body’s way of alerting us to trouble so that we may attend to it immediately (for example: if you accidentally touch a hot stove, you will very quickly experience pain, which then forces us to respond by quickly removing your hand from danger). The fibromyalgia sufferer will also react to touching a hot stove, but they also react to stimuli and activities that are not harmful to the body (such as light touch).
So why does it hurt then? This question encapsulates the frustration that fibromyalgia suffers experience. To answer that question, I have to get a bit technical. Researchers believe that fibromyalgia sufferers have developed a lower threshold for pain due to increased sensitivity in the brain to pain signals. This is called “central sensitization”. In other words, areas in the brain that are responsible for pain seem to react differently in fibromyalgia patients. Certain chemicals in the brain (called neurotransmitters), as well as the brain’s pain receptors change in these patients, ultimately creating a sort of overreaction to stimuli to the body.
If you feel that you, or someone you know, fit the profile of a fibromyalgia case, it is a good idea to see your health care provider so that he or she can rule out other potential reasons for your pain. They may wish to have blood work, or a urinalysis performed to help eliminate these other potential pain sources. In the case of fibromyalgia, these tests are often found to be normal.
After a diagnosis is made, a plan of management is needed. There is no quick fix in this case, but there is most definitely strategies that can significantly help manage and improve pain and quality of life. In my next entry, we will discuss your varying treatment and self-help options.
Of course, if you have any questions about anything that has been discussed, please do not hesitate to contact me.
Towards good health,
Dr. Michael Carney
B.Sc. (Hons. Kin), D.C., D.Ac., C.S.C.S
