The Life and Times of Fibromyalgia

In my last post I joked that given the commonality of some of the symptoms of fibromyalgia, we all have it.  Actually it’s estimated that 1-2% of the population has it which would be millions and millions of Americans. 

The history of the disease is interesting.  Years ago, I can remember when I first started medicine, it was a huge question of whether this was just malingering or what this was.  That may have something to do with the fact that most of the primary doctors back then were male and most of the people who get this are female.  Women were widely told “This is all in your head.  Go home.  You’re just depressed.  Take an anti-depressant.”  We blew them off.  That was not a good period of time in the medical field.  We needed to recognize that there was an honest problem.  We may not know what to do about it, but giving people recognition that, yes, there’s an actual problem here has some benefit in and of itself.

It was ignored by medicine for a lot more years because we didn’t really have anything to do for it and still don’t have a lot to do for it today.  Doctors don’t like to admit they can’t help people with their problems.  Patients don’t like to be told there is no help.  Still, today, there is some denial or a lot of ignoring. Because of its insidious and slow onset, it is frequently not even recognized.  A person might be coming in complaining of TMJ (temporal mandibular joint) pain and not have read an article or put the rest of the pieces together.  The doctor is rushing from one patient to the next and he doesn’t ask questions.  It can go unrecognized for long periods of time.  It’s frequently under-diagnosed and misdiagnosed.  There are a lot of pitfalls there from the medical side of things.   

It’s also interesting that people in Africa or India or other places don’t seem to get fibromyalgia.  It’s kind of a European/American disease.  What is it? What causes it?  Is it stress?  Is it microwaves in the air?  Is it fluoride in the water?  We don’t really know what causes it or where it comes from.  We do know that there is disturbance of sleep patterns.  We do know that there are different alterations of neuro-hormones in the brain.  There is low growth hormone.  There is a derangement of things in the brain.  We know that some of those things can be diagnosed, but part of the diagnosis is that all of your blood tests and X-rays will be normal even if you do have fibromyalgia.  It’s important for us to have a diagnosis in case it’s something else medically that we can treat.  

But it’s very interesting to note that there is a continuum of fibromyalgia.  That continuum is directly related to the amount of stress the patient is in.  The more stress they have the worse their fibromyalgia is.  

The one thing that we can universally prescribe that we know that helps is not a drug.  It is not a pill that medicine knows to prescribe; it is simply exercise.  That’s a hard thing to get somebody to do who is stiff in the morning and hurts all over.  But that’s the one thing that we can consistently encourage patients to do is exercise.  

In the alternative medical field there are certain things we’ve tried:  alpha lipoic acid, B12, and magnesium certainly should be tried. Also acetylcysteine, glutathione, and Omega-3’s are always important and particularly important for fibromyalgia because of it’s anti-inflammatory needs.  It is an inflammation of sorts.  L-arginine can be beneficial because it increases nitrous-oxide and that helps control pain out there. 

Medically things that doctors try are P3, thyroid supplements; doxaphene as kind of an anti-depressant; and oxytocin shots can be beneficial.  Testosterone may be of some benefit.  There are some things to try medically. 

The huge thing, the real take-home note here is the continuum of stress and it’s relationship to fibromyalgia.  The more stress, categorically, the more pain and the more significant a problem this is going to be on a daily basis.  And that's the skinny on fibromyalgia.

Fibromyalgia: Pain With No Cause

Fibromyalgia is an interesting, intriguing problem which I have personally experienced.  My case is actually quite unusual because I’ve read articles that said that around 90% of the people who have this are women.  I guess that makes me fairly unique as a man having personally experienced fibromyalgia.

It’s kind of interesting what medicine does with it and where they place it and it’s treatment. It is included medically as an arthritis, in the arthralgias.  In fact, the most common one, only after osteoarthritis.  Yet it doesn’t have anything to do with joints.   It’s related to muscles and tendons and pain.  

Fibromyalgia defined, is pain bilateral all over the body that lasts greater than 3 months.  Doctors have 18 specific sites that they test and you have to have 11 of those 18 to qualify officially for having fibromyalgia.   It’s characterized by aching, by pain in these spots, and by disturbed sleep patterns.  People rarely get good stage 4 sleep and that causes some other problems.

Fatigue is a major symptom.  Morning stiffness and depression are other symptoms, but not primary depression, only secondary depression.  You don’t have depression and then get this as a result of it. The depression comes because you’re in pain and there doesn’t appear to be any hope because there aren’t any good medicines, because it is going on for a long period of time, and because it actually changes neuro-transmitter levels of good feeling things in the brain; oxytocin and dopamine and different brain chemicals that help us to feel good.

Recurrent headaches are another of the symptoms.  It’s not migraines, you can actually get worse headaches than that, muscle tension headaches, usually of the occipital nerves in the back of the head.  

Also, you can get tender lymph nodes.  There can be bowel and bladder disturbances, and in fact irritable bowel syndrome is one of the things that characterize fibromyalgia.  Finally, some lesser symptoms include sensitivity to heat and cold, anxiousness, dizziness, occasional palpitations of the heart and even decreased coordination.  Sounds like that wrapped all of us up in there together.  I guess we’ve all got fibromyalgia.  

In my next post I'll talk a little about the history of fibromyalgia in the medical community and the possible causes of fibromyalgia. 

Achy Bones: Gout

Last week we talked about osteoarthritis because it affects the biggest group of arthritis sufferers.  About 20 million people in the U.S. have doctor-diagnosed arthritis.  If you look at statistics 5 years ago more people had arthritis than they do today.  You have to scratch your head over that.  Well, the CDC changed the criteria.  Back then it was people reporting joint pain and arthritis.  Today it has to be physician-diagnosed.  All of a sudden the numbers when way down from 50-60 million people to 20 million people. If you’re looking at numbers, according to what vintage your numbers, they will vary dramatically. 

This week and next we’re talking about the next two most prominent types of arthritis: gout and rheumatoid.  Rheumatoid gets our attention more because it’s so chronic and debilitating.  There are actually twice as many people who have gouty arthritis than rheumatoid.  I guess it’s a good thing since gout is more treatable.

Then there’s another group of people, nearly as many as have gout, and twice as many as have rheumatoid.  These are people that have fibromyalgia.  That’s been now kind of included in the arthritic “family” if you would.  By the way  90% of fibromyalgia patients are women.  Doctors were telling women just a few years back that they were hypochondriac or that it didn’t exist.  But we were, as a group of physicians, disrespecting women and ignoring their symptoms.  Much worse than that, impugning them by suggesting that it was only in their minds.  I ask forgiveness but I can’t speak for the rest of the medical community

Today we’re going to talk specifically about gouty arthritis.  Gouty arthritis is a situation in which uric acid builds up in the system and it forms crystals.  The solution becomes super-saturated with uric acid and so it crystallizes.  If you put too much sugar in your tea and keep putting more and more sugar in until it’s in solution while the tea is warm, when you put it in a refrigerator it can actually precipitate out.  The same reason honey goes to sugar after a while if it just sits there on your shelf.  It will crystallize.  That’s the type of situation we have here: crystallization.  

When there is too much uric acid in your system, your kidneys aren’t clearing enough.  That can be a genetic predisposition and can also be a situation where it’s environmental to some degree, in the sense of what we’re eating.  If we’re eating to many rich foods, too much meat with fat in it that can contribute to gout. Alcohol can also precipitate gout.  In the past it was known as the rich man’s disease, back as early as the 1500’s.  These were people who were able to afford lots of wine and ducks, fatty foods and things like that to eat.  

Gout is crystals that form in the joint space.  These little crystals are just like if you’ve ever gotten into fiberglass.  It itches.  It irritates.  This is kind of like fiberglass in your joints.  These pointy little crystals just irritate the heck out of the synovial lining.  As a result it becomes inflamed. 

Gouty arthritis usually occurs in one joint to begin with.  If you’ve got one joint that’s inflamed and hurting then the first question in your mind should be whether it’s gout.  The body demographics have changed over the years.  First-time attacks occurred 70-80% of the time in the great toe.  But in recent years that’s decreased.  We’re getting much more in the knees and elbows and hips these days than we did in times past.  It’s interesting to see that for centuries it stayed the same with the great toe being the fist joint to show up and then it’s changed a little bit.

Standard medical treatment for gout is non-steroidal anti-inflammatories that we talked about the other day.  Then some treatment drugs are Probenecid and sulfuric tyroione,  Allopurinol and things like that.  They do a fairly effective job of taking care of gout and keeping the uric acid out of the body.  Natural treatments include curamin, MSM, and digestive enzymes.  Digestive enzymes are interesting because if you put them in the bowel with food, they help digest food.  But if you take them on an empty stomach they go into the blood stream and are very anti-inflammatory there.  Black cherries as an old-wive’s treatment are known to help gouty patients.  We don’t know the mechanism because none of the big labs are going to put a couple million dollars into research in that.  It’s probably not patentable.  

Then just recently in the last year I’ve heard of a gentleman who stumbled across, just by the power of association with his own personal experience, that baking soda helped his gouty arthritis.  He mentioned it to other people who had gout.  They used it and so this has become another “ma and pa” treatment.  I just personally treated four or five patients with bicarbonate.  It’s worked on every one of them.  It’s an intriguing, new, alternative, very inexpensive treatment which you can find in any grocery store, probably in your own cabinet in the kitchen.  That’s interesting to see how that’s going to turn out and what percentage of people are benefiting over time. 

I'll talk early next week about a third type of arthritis: rheumatoid arthritis.