Fibromyalgia Neck Pain
Fibromyalgia, formerly known as fibrositis, is a condition that leads sufferers to experience chronic pain in their muscles and ligaments. It is increasingly prevalent, perhaps through better diagnosis and recognition of the disease, and affects approximately 2% of people in the US, and 1% in the UK, although population differences may be due to under-reporting of the condition. Fibromyalgia primarily affects women in their mid-30s to late 50s although men, the elderly, and children may also be affected. The condition is linked to abnormal pain responses by the body which prevent the muscles from relaxing properly and lead to fatigue, poor sleep, depression, and issues with concentration and memory. Headaches, dizziness, nervousness, numbness, and digestive problems are also common symptoms of fibromyalgia.
Recognition of Fibromyalgia
For many years the disease has been overlooked, discredited, and dismissed by many, including some in the medical profession. Now that there are working theories on the mechanism behind the disorder, it is beginning to be more widely recognized and patients are more likely to receive assistance with the condition. It appears that fibromyalgia sufferers have higher levels of a chemical called substance P in the cerebrospinal fluid. Substance P transmits pain impulses to the brain, and the higher levels lead to more intense and chronic pain in fibromyalgia.
CFS, Fibromyalgia, and Sleep
The condition is also connected to lack of deep sleep and its restorative capacity. This may be an independent aspect of the disease or may itself be caused by chronic pain leading to disturbed and shallow sleep patterns. On waking the pain is often excruciating, and is generally felt in the neck, shoulders, back, and hips. In some it can cause problems with walking, and with most patients it prevents them from engaging in normal activities due to the pain and fatigue. Some physicians suspect that chronic fatigue syndrome and fibromyalgia are actually the same disease as they symptoms coincide and overlap in a large number of cases.
Fibromyalgia – Recent Research
More recent research indicates that exercise is often the best way to treat fibromyalgia, although studies also continue into new medications, such as cyclobenzaprine for fibromyalgia to reduce the chronic pain associated with the disease. Fibromyalgia and neck pain may also be connected through stress and so stress-relief techniques can ameliorate symptoms. It is not the case, however, that simply telling a patient to avoid stress will reduce their fibromyalgia and neck pain symptoms; the opposite may in fact be true as patients then believe themselves to blame for their suffering.
The diagram above presents a typical progression of fibromyalgia and neck pain misdiagnosis and confusion. Not all cases need be this way; find out more about how neck pain can be an early sign of fibromyalgia, or a new symptom years after diagnosis. If your doctor simply dismisses acute neck pain as part of your fibromyalgia then consider getting a second opinion.
Neck Pain and Fibromyalgia
Any new occurrence of neck pain warrants investigation as the causes of neck pain are diverse. Rather than suffering in silence consider any new stressors, be they at work or at home, and think about your fibromyalgia medications and whether they may have inadvertently triggered neck pain. Also, look at your sleeping position as many fibromyalgia sufferers have fitful sleep and may end up napping on an unsupportive couch during the day, possibly triggering neck pain. Whiplash may also trigger both neck pain and fibromyalgia symptoms but the management of one could adversely affect the other.
As you can see, the connections between fibromyalgia and neck pain are far from straightforward but sometimes neck pain can have a simple cause that is easily remedied, leaving you with one less fibromyalgia symptom to contend with.
Causes of Fibromyalgia
Unfortunately, the medical profession has yet to establish the cause of fibromyalgia, making fibromyalgia treatment strategies difficult to devise. Research has recently found a significant disparity in the levels of a pain-transmitting chemical, substance P, in the cerebrospinal fluid of fibromyalgia sufferers, with three times as much activity in some patients. Intense pain, both chronic and acute in nature, is a major feature of fibromyalgia. Patients are also thought to have low levels of the brain chemical serotonin, which has an effect on regulating sleep, mood, and the digestive system due to the presence of the enteric nervous system in the gut. Some scientists are working with the theory that an infection triggers the disease, and it this organism is found then a definitive blood test should be possible to diagnose fibromyalgia. A particular area of interest is a specific part of the brain known as the insula which may hold the key to understanding the symptomology of fibromyalgia.
The onset of the disease often coincides with trauma, physical or psychological stress, or infection. Researchers have also found that fibromyalgia patients do not experience deep sleep (stage 4 sleep) in the same way as those without the condition. This stage of sleep is the time where the muscles recuperate from the stresses and strains of daily activities leading to a refreshed state on waking. Fibromyalgia patients, however, remain in a lighter form of sleep and do not experience this restorative state meaning that they wake with muscle pain and ligament pain after even the gentlest of activity the day before. So, although fibromyalgia patients may sleep for a long time, just as in chronic fatigue syndrome, this sleep may not constitute the recuperative deep sleep needed for bodily repair.
Stages of Fibromyalgia
Fibromyalgia does not appear to be a progressive disease, nor is it fatal. Sufferers, therefore, can lead productive and happy lives with the implementation of successful coping strategies, pain management, appropriate medication, and adequate rest.
Symptoms of Fibromyalgia
The experience of intense, chronic neck pain, neck pain shoulders, back pain, and pain in the hips primarily, and chronic fatigue are the key symptoms of fibromyalgia, formerly known as fibrositis. Areas of tenderness can lead to widespread, systemic, pain when touched, with muscles going into spasm. Specific tender points are commonly found in the shoulders, knees, hips, back of the head, sides of the breastbone, and the elbows. Patients generally feel worse when first waking, with muscle stiffness, neck stiffness and pain, and may struggle with mobility. Some sufferers require the use of a walking stick or frame to get around, and many are confined to a chair or their bed for a large part of the day. Some patients with a milder form of the condition remain active and are simply watchful of their known limits; not engaging in energetic sports for instance, going on long hikes, or lifting heavy objects for example. Pain may be aggravated by changes in the weather, emotional stress, and noise.
Fibromyalgia is Different
The condition differs from arthritis in that the pain is in the ligaments and muscles rather than the joints of the body. It can be experienced as a burning neck pain, throbbing, aching pain, similar to that experienced as a symptom of influenza. Body temperature scans of fibromyalgia patients reveal intense heat in the back, neck, shoulders, and hips which is where the pain is most frequently felt. The condition is not normally connected to inflammation of the tissues, however, meaning that permanent damage is not occurring in the majority of cases.
Fibrofog is another symptom of fibromyalgia and is reported as a haziness similar to dementia, with patients losing the ability to concentrate, suffering memory loss, and depression in some cases. Headaches, dizziness, numbness, and problems with the digestive system all occur in this condition.
Diagnosis of Fibromyalgia
Even in cases where a patient has their diagnosis it is important to report any worsening of pain, or new fibromyalgia symptoms that occur. New treatments may have become available, and the symptoms may not necessarily be connected to the fibromyalgia, indicating another pathology at work. Fibromyalgia does not generally cause inflammation of the tissues in the body, such as occurs in rheumatic conditions such as rheumatoid arthritis, polymositis, and systemic lupus. This means that it does not lead to deformity and damage to the body, including the internal organs, rather just the intense pain and associated symptoms are experienced.
Fibromyalgia Tender Points Exam
In general the diagnosis of fibromyalgia is one of exclusion. Ruling out conditions such as arthritis, systemic lupus, depression, thyroid disease, and Epstein Barr, amongst others, means that the physician must then rely on taking an exhaustive case history and conduct a thorough physical exam checking for tender points. There are eighteen common tender points used to determine a diagnosis of fibromyalgia, with most patients experiencing at least eleven of them. These tender points may also be connected to other diseases, although in fibromyalgia there will be no accompanying inflammation, just pain. Muscle pain must be present for three months or more before a physician is likely to consider fibromyalgia as a differential diagnosis.
Thyroid problems, bone diseases, cancer, AIDS, parathyroid disease, muscle disease such as polmyositis, and hepatitis can all mimic the symptoms of fibromyalgia making diagnosis often highly complicated with tests ordered to rule out these conditions. Tests to exclude these conditions include blood calcium levels, complete blood count, levels of CPK (a muscle enzyme), alkaline phosphatase (a bone enzyme), and liver tests. There are many other tests that may be conducted making the diagnostic process particularly lengthy and fatiguing for those with fibromyalgia.
New Tests for Fibromyalgia
Due to recent research, testing the patient’s cerebrospinal fluid for substance P may now form part of the diagnosis of fibromyalgia, as this has been found to be
up to three times higher in fibromyalgia patients than in the general population. Levels of nerve growth factor have also been found to be higher in sufferers, which may play a role in the finding of supersensitivity to pain stimuli observed by researchers of the condition. Conducting sleep studies can highlight problems with REM sleep in some patients, meaning that stage 4 restorative sleep is not occurring, decreasing the body’s ability to heal and repair itself.
Misdiagnosis of Fibromyalgia
Due to the fact that many fibromyalgia sufferers experience emotional and cognitive symptoms, such as depression, anxiety, memory impairment, and poor concentration, their condition often goes undiagnosed, treated simply as depression, or anxiety disorder. The variety of symptoms experienced in fibromyalgia can frequently lead to an incorrect diagnosis such as irritable bowel syndrome, tension headaches, irritable bladder, and even premenstrual syndrome. In the case of irritable bowel syndrome, inflammation is usually present alongside the pain. In fibromyalgia the pain is the key indicator, with no inflammation observed.
Treatment of Fibromyalgia
Due to the diverse nature of the symptoms observed in fibromyalgia, the treatment strategy will be different for each patient. Effective therapeutic plans will include patient education, stress management, pain management, medication, and regular exercise. Involving the patient in the treatment decisions is likely to foster a successful outcome. Patients may be referred to specialist clinics for education about the condition as many general practitioners will not have the requisite knowledge of fibromyalgia to provide effective support after diagnosis. Support groups can be a considerable help for sufferers as they can learn and share coping strategies and experiences with those who understand and empathise with them.
Reducing Stress to Relieve Fibromyalgia
Reduction of stress can lead to a positive change in patients with symptoms of fibromyalgia. This may be through the use of relaxation activities such as yoga, deep breathing techniques and even the use of flotation tank therapy to mimic the restorative stage 4 sleep that can be lacking in the condition. Acupuncture and acupressure may provide relief for some patients, and biofeedback sessions may also assist with stress reduction and pain management. Talking therapies can help identify particular stress triggers and work on removing them or developing coping strategies. Regulating environmental factors can be beneficial, such as noise, temperature, and exposure to changes in the weather.
Patients are encouraged to maintain gentle aerobic exercise activities such as swimming, cycling, and walking. It appears that fibromyalgia sufferers achieve the most benefit from exercising every other day, in the morning, although the reasons for this are unknown. One theory is that exercise helps to promote deep sleep, it may also trigger the production of human growth hormone (as long as sugary foods and drinks are not consumed immediately after exercise) which also promotes muscle repair and recuperation.
Specific dietary changes may benefit fibromyalgia sufferers, including the removal of stimulants such as coffee so as to promote good quality sleep. Avoiding alcohol is also advisable for most patients. Sufferers may find that eating a small quantity of protein prior to going to bed can improve their sleep as it contains tryptophan, a chemical that is turned into serotonin and is connected to depression, anxiety, mood, hunger, and sleep. Serotonin precursors such as 5-hydroxytryptophan are also available and can be very helpful for fibromyalgia sufferers. Patients should consult their physician prior to trying these supplements, however, as too much serotonin can be very dangerous and leads to serotoninergic syndrome. If patients are taking certain antidepressant medications (such as SSRIs or tricyclics) they are advised not to use 5HTP supplements.
Tricyclic antidepressants may be helpful for sufferers of fibromyalgia, although they are usually taken at much lower doses than are used for depression, and taken before bedtime to reduce fatigue, alleviate muscular pain, and promote stage 4 sleep with fibromyalgia. Tricyclics commonly used include amitriptyline, and doxepin, which affect the levels of serotonin in the brain. Fluoxetine (commonly known as Prozac) may be added to these medications to further reduce muscle symptoms, and mood disorders. Taking the two together may cancel out some of the side-effects of each, such as fatigue from tricyclics being alleviated by the wakefulness some experience from fluoxetine. Lorazepam (Ativan) has also demonstrated effectiveness at relieving fibromyalgia symptoms.
Specific fibromyalgia medications include pregabalin (Lyrica) which can block the nerve pain that is the major symptom of the condition. Duloxetine (Cymbalta) and milnacipran (Savella) are two fairly new drugs used to regulate levels of serotonin and norepinephrine, and are now commonly advised for fibromyalgia patients. Injections of cortisone or analgesics can alleviate pain in tender points, and tramadol on its own or in combination with acetaminophen can also help. The use of NSAIDs is not indicated in fibromyalgia as it is not an inflammatory condition such as rheumatoid arthritis or systemic lupus. Narcotic medications are usually contraindicated in fibromyalgia patients as the condition is chronic and these drugs can promote dependency if used long term.