Fibromyalgia and Chronic Pain

Fibromyalgia, Back Pain, Neck Pain and Headaches are often related to treatable sleep problems.

What is Fribromyalgia?

Fibromyalgia is a condition of chronic pain, located in the muscles and soft tissues rather than the joints (it is not an arthritis). It is characterized by tender points that occur in typical locations and that are painful when pressure is applied to them.

Where are tender points typically located?

Common locations include:

  • The base of the skull and back of the neck
  • The soft tissues over the shoulders
  • The chest wall, just below the clavicles (over the pectoralis muscles)
  • Along the lateral aspect of the legs, both above and sometimes below the knees

What do tender points look like under a microscope?

Normal tissue! While tender points can be “broken up” and eliminated temporarily by skilled therapeutic massage, using techniques such as accupressure. However, unless aggravating factors are eliminated, they tend to recur.

What other symptoms tend to accompany the pain of Fibromyalgia?

  • Persistent fatigue and unrefreshing sleep
  • Generalized stiffness

What other problems occur frequently in patients with Fibromyalgia?

  • Headaches; TM joint syndrome
  • Chronic fatigue
  • Irritable bowel syndrome
  • Cold sensitivity
  • Exercise intolerance
  • Complaints of weakness

What are some factors that worsen Fibromyalgia?

  • Poor sleep
  • Stress
  • Inactivity
  • Repetitive motion, excessive exercise and poor posture
  • Anxiety and depression

How common is Fibromyalgia, and in whom does it tend to occur?

  • It has been called the most common cause of chronic, widespread musculoskeletal pain.
  • It is more common in women and tends to “run in families”.

What is the relationship between sleep and Fibromyalgia?

  • It was found years ago that patients with fibromyalgia tend to have poor quality sleep.
  • Early studies noted excessive amounts of alpha activity (the normal waking EEG rhythm of the brain) persisting during sleep: making the person appear as if they were awake and asleep at the same time! Since many patients who sleep lightly and poorly state that they are very aware of everything around them, even during sleep, this finding seems consistent with how they feel! However, this finding of persistent alpha activity is not always present, and it has been noted in patients without fibromyalgia.
  • Fibromyalgia sufferers tend to lack normal amounts of slow wave sleep (stages 3 and 4 of non-REM sleep, also called delta sleep). These stages are the deepest, soundest stages of sleep. They have been felt important for the restoration of the body during sleep.
  • It also was found that if one deprives normal people of slow wave sleep, they develop fibromyalgia symptoms! Thus, one can imagine a vicious circle being established. The more pain, the worse the sleep quality, with less stage 3 and 4 sleep–which then makes the pain even worse.
  • And a recent investigation found SLEEP APNEA in 80% of fibromyalgia victims. Sleep apnea fragments sleep, thereby reducing slow wave sleep. Sleep apnea is extremely common–potentially serious if severe, with such complications as heart attack, high blood pressure, stroke, heart failure and sleep-related highway crashes–and eminently treatable!
  • Other studies have shown an association between UPPER AIRWAY RESISTANCE SYNDROME (UARS) which is frequently not detected by conventional sleep center monitoring techniques. Hence, even if you or a loved one suffer from fibromyalgia and have been told that sleep studies ruled out sleep apnea or other problems, it is important to pursue the problem further and obtain evaluation at a good quality sleep center that can monitor for UARS: particularly since fibromyalgia does not respond well to medications.

What does this sleep connection mean for treatment of Fibromyalgia?

It is vital to ensure the best quality sleep possible. This involves three key steps:

  • Detect any sleep disorders that could be rendering sleep less than optimally refreshing, then ensure their effective treatment. For example, controlling SLEEP APNEA often causes a dramatic improvement in fibromyalgia symptoms: with complete elimination of pain even reported by some patients!
  • Practice good sleep hygiene and ensure that nothing is being done that would render sleep inadequate in either quantity or quality. This involves such “common sense measures” as getting adequate amounts of sleep and avoiding caffeine before bedtime.
  • Ensure an optimally comfortable sleeping environment with attention to room temperature, elimination of disruptive light and sound, and a maximally comfortable bed and pillow. For example, pain medications will not undo the adverse effects of sleeping on a surface that would make anyone hurt the next day!–but this simple principle is often overlooked, since mattresses and pillows wear out gradually, and most traditional mattresses no longer provide proper support after 7-10 years.
We offer free screening for sleep disorders with brief questionnaires, which can be obtained from our center. We review all submitted questionnaires promptly after we receive them and contact the person with a written summary of our impressions. We also provide comprehensive diagnostic and treatment services for the entire spectrum of sleep disorders.

What other measures, unrelated to sleep, may reduce Fibromyalgia symptoms?

Exclude other illnesses and contributing disorders. Consult with your physician or a rheumatologist. Good relaxation/ stress management training and therapeutic massage or skilled physical therapy can be invaluable. Medications are sometimes helpful but they tend to be of limited benefit. Ensuring refreshing, restful sleep and other measures, such as described above, typically are at least as important as pills.

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