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We offer understanding for those with the severe pain and the exhaustion of fibromyalgia and chronic fatigue syndrome. In WHAT & WHY we explain the symptoms, and how the nervous, endocrine and immune systems contribute to them. Things that help include exercise, cognitive therapy, Lyrica, Ultram, Cymbalta and other treatments.
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FIBROMYALGIA and CHRONIC FATIGUE: INTRODUCTION and OVERVIEW
Hippocrates wrote about “those lighter pains which have no evident association with podagra and do not cause swelling.” Dr. Roxann Powers wrote an engaging paper that describes the history of fibromyalgia, going back to the time 500 years before Christ when Hippocrates was a student of medicine. She wrote that Hippocrates observed that these pains have imprecise localization and character, tend to be weather sensitive, and are associated with stiffness, tenderness and fatigue that are like that experienced by untrained athletes after unaccustomed exercise.
The tender points of fibromyalgia were first described by Balfour in 1824. The observation of tender nodules in the muscles led to a burst of medical literature in German during the nineteenth century. The term “fibrositis” was coined by Dr. W. R. Gowers in 1907. Muscle biopsies were reported in 1919 and 1921. They revealed only normal muscle. The first description of the distribution pattern of tender points is credited to Doctors Lange in 1931 and Reichert in 1938. Another criterion they described is the finding of a palpable “rope” in the muscle at the site of tenderness. This too remains a major characteristic of this disease. While the tender points may overlie bone, tendon, ligament or muscle, when the palpable “rope” or lump is present, it is consistently found in the muscle. Bursal swelling is different anatomically but it can look the same. When the lump is injected with a local anesthetic relief usually follows. Localized cramping of the involved muscle bundle is the only plausible explanation. Muscle testing by recording electromyograms with a precisely placed needle into the lump showed increased electrical activity: Spasm. Another study in patients with low back pain revealed increased EMG Electromyographic activity, suggesting muscle spasm.
The clinical finding of a palpable lump in a muscle that is associated with the tenderness typical of this disease is impressive. That it is reversible--it goes away when an injection of anesthetic relieves the pain is also impressive. There is no inflammation in the site and no abnormal tissue is present on biopsy. These argue strongly for a localized reversible phenomenon—spasm. Muscle responds to pain by contracting. A persistent full muscle contraction is a cramp. In the palpable tender point lumps of fibromyalgia the cramp is limited to a localized group of muscle fibers. Fatigue, sleep disturbance and morning stiffness are significant too Fatigue associated with non-restorative sleep is as typical of this disease as are the tenderness and pain. But how does the Chronic Fatigue Syndrome fit in?
Fibromyalgia can occur at any age, even in children. Spouses of fibromyalgic patients are secondary victims. So are the children. When the wife and mother is wiped out with fatigue and aching pain, the whole family suffers. Why does fibromyalgia happen? What can we do about it? And when will it END?
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