Where Does It Hurt?

fibromyalgia widespread pain

Are you among the millions of people who suffer from daily bouts of pain which seemingly travels all over your body?  

Do you lie awake at night, tossing and turning in an effort to ease the pain so you can sleep?  

Are you so tired all of the time that you wonder how you’ve managed to find the energy to breathe all day, or so depressed that you wonder why you even tried?  

If you have answered yes to any of these questions, there is a possibility that you may be joining the ranks of millions of people all across this country who suffer from the discomforts and pain of fibromyalgia .  

Where does it hurt?

I’ll bet you wish you could truly answer that question with a simple “my knees” or “my back” or “my neck”.  The truth is, you could hurt in all of these places as well as other places, oftentimes simultaneously.  

Fibromyalgia is a condition in which those afflicted commonly suffer from pain and tenderness which is pretty widespread — commonly affecting the soft tissues of the neck, upper shoulders, chest, rib cage, lower back, thighs, arms and basically any area around joints, though not the joints themselves.  

Less often, those afflicted patients will cite lower legs, hands and feet as being painful and stiff.

Can you describe the pain?

Many of those afflicted with this condition describe the pain and discomfort from fibromyalgia as “feeling like I have the flu all of the time”.  

This represents the generalized achiness, stiffness and pain that characterizes the condition. While the exact cause of fibromyalgia is not known at this time, it is known that any soft tissue (i.e. ligaments, muscles and tendons) can potentially be affected, and this can occur intermittently or as a constant source of discomfort.

Some patients describe the pain as deep inside the tissue, citing a widespread burning, stiffness and aching kind of pain which radiates out from a central point to surrounding areas.  

The intensity can vary, waxing and waning with the time of day, changes in weather, levels of activity, exercise or inactivity and stress levels.  

The pain is further described as “exhausting”, and is especially intense when sleep is interrupted.

Tender points

Those who suffer from fibromyalgia have “tender points” which are described as specific spots on the muscles which, when firm pressure is applied with a fingertip, will elicit pain or tenderness, sometimes causing the patient to wince or jump in response.  

There are a total of eighteen (18) fibromyalgia tender points in the body and, historically, one must have tested positively for eleven (11) of them for fibromyalgia to be a diagnostic consideration.  

This medical opinion is changing, however, focusing instead on the presence of symptoms and widespread pain more than the number of tender points.

When flare ups occur, the muscles can actually tighten and spasm, causing the pain and discomfort associated with this condition.   

Patients who suffer from this malady will attest to the fact that these pain and discomfort symptoms tend to increase and get worse with fatigue, straining and overuse.  

Heightened pain sensitivity

People who suffer from fibromyalgia tend to have an increased sensitivity to pain. This means that their “pain sensors” in the brain are really much more sensitive to that stimuli, making the pain seem even worse.  

Add to that the fact that stress seems to increase that sensitivity even more and the result is even more pain and discomfort for the host.  But, there are other conditions which tend to contribute to the suffering from this condition:

  • Poor sleep
  • Repetitive muscle strains
  • Repeated dampness and cold exposure
  • Mental stress – not so much the stress itself but rather the way the host responds to it – i.e. perfectionists and type A personalities
  • Other connective tissue diseases like lupus or rheumatoid arthritis
  • Infections or viruses – i.e. Lyme disease
  • Traumatic event

Other areas of pain

Because the soft tissue is affected, there are other areas of the body and conditions which may also add to the level of discomfort for the fibromyalgia sufferer:

  • Poor sleep and anxiety generally lead to depression and tiredness
  • Migraine and tension type headaches
  • Interstitial cystitis – defined as a type of bladder inflammation that results in pain with urination
  • Irritable bowel syndrome – defined as a combination of diarrhea, constipation, abdominal discomfort and bloating
  • Painful menstrual periods
  • Dry mouth
  • Dizziness
  • Balance problems
  • Numbness or tingling in hands and feet

As you can  see, the pain from the soft tissue involvement creates a multi-layered network of more pain and more discomfort as it weaves its web throughout the body of the host.

Additionally, some of the contributors to the development of the condition also can work toward worsening the symptoms – i.e. the added stress from worrying about the possibility of serious diseases due to the symptoms.  And, the cycle continues….

How is it diagnosed?

Like so many of the symptoms we experience can suggest many maladies of the human, the characteristic generalized pain and discomfort of fibromyalgia can signal a variety of other diseases and conditions in the human body.  

While there is no specific blood test or imaging modality which can precisely identify fibromyalgia, there are many blood tests which can identify what it is not.  

When your doctor is evaluating your various pain and discomfort complaints, other possible illnesses will need to be ruled out before treatments can be considered and initiated.  

Blood testing and perhaps some imaging modalities will likely be needed to rule out as many of these other diseases and conditions as possible.

It may be known by other names…but still there is pain

There are several other names by which fibromyalgia has been referred:  fibrositis, fibromyositis and myofascial pain syndrome.  

These terms have been used to describe or refer to fibromyalgia, but though the name may be different, it still means pain for those who are afflicted.  

Did you know that it can take as long as five (5) years for a diagnosis of fibromyalgia to be rendered for the average person suffering from the symptoms?  

Additionally, statistics reveal that probably three (3) out of every four (4) fibromyalgia sufferers never get the diagnosis!  It is certainly NOT a disease which is easily diagnosed!

One of the saddest comments to hear from a fibromyalgia patient refers to their inability to enjoy their lives, citing the difficulty getting to sleep and staying asleep causes them to feel unrested when they awaken.  

They often say that the distress that is caused by the lack of rest can sometimes outweigh the distress from the pain.  The relationship between fibromyalgia and sleep continues to be researched across the globe.

Experts believe…

As noted above, there is no specific testing process which can definitively diagnosis this condition. There is a belief among many experts that fibromyalgia is not a disease but rather is a condition of chronic pain that is brought on by the body’s abnormal stress responses.

It is felt that the areas in the brain which react to pain behave differently in those afflicted with fibromyalgia than those who are otherwise healthy.  

They believe this occurs as a result of an imbalance of various hormonal, metabolic and brain chemicals, though no exact pattern has yet been established.  

Of particular interest is serotonin  — with the feelings of well-being, the manipulation of pain levels and its effect on deeper sleep, and research showing that serotonin levels are lower in some patients with fibromyalgia — and stress hormones — the balance of which affect the hypothalamus-pituitary-adrenal gland axis (HPA), known to control sleep, stress reactions and depression, with lower levels of norepinephrine and cortisol are being found in some fibromyalgia patients.

Fibromyalgia is considered a rheumatic disease mostly due to its inflammatory component. Some experts choose to place it in the arthritic category but not because it causes any actual damage to joints or bones, with its inflammatory component being confined to the soft tissue only in the joint areas which are commonly afflicted.  

Most medical professionals have historically agreed that a diagnosis of fibromyalgia can be given if certain criteria are met:

  • Widespread pain and discomfort for a minimum of 3 months
  • Must be on both sides of the body
  • Must be both above the waist and below the waist
  • Must be along the length of the spine
  • If at least eleven (11) out of the eighteen (18) tender points are identified

New guidelines and criteria proposed by the American College of Rheumatology would change:

  • The number of tender point examinations to a widespread pain index (WPI) which will include any of the areas in which the patient has had pain in the past week
  • It adds a symptom severity scale (SSS) which allows for a rating  (0 to 3) for fatigue, unrefreshing sleep and cognitive symptoms
  • It also allows some points in the SSS for some of the other symptoms like numbness, dizziness, nausea, irritable bowel syndrome and depression

The total of the WPI and SSS of a value between 0 and 12 with seven or more pain areas noted and a severity score of 5 or more or the patient would need 3 to 6 pain areas and a severity score of 9 or more to be diagnosed with fibromyalgia.  

The symptoms must still be present for a minimum of 3 months to qualify for this diagnosis.

It is our hope that this article has given you more information about the condition from which you or a  loved one are suffering.  

Armed with good information and perhaps a better understanding, you can forge ahead in your attempts to control and mediate your pain, fatigue and other symptoms of fibromyalgia.

Bibliography:

http://www.merckmanuals.com/home/bone,-joint,-and-muscle-disorders/muscle,-bursa,-and-tendon-disorders/fibromyalgia

http://www.webmd.com/fibromyalgia/guide/fibromyalgia-tender-points-trigger-points#1

http://www.webmd.com/fibromyalgia/news/19991116/malfunctions-key-systems-contribute-fibromyalgia

https://www.niams.nih.gov/health_info/fibromyalgia/

http://www.umm.edu/health/medical/reports/articles/fibromyalgia

https://www.uptodate.com/contents/fibromyalgia-beyond-the-basics

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