Fibromyalgia Syndrome - Diagnostic Tools and Treatments
Fibromyalgia syndrome is a disease associated with general aches and pains throughout the body. Though the exact cause is unknown, pain is experienced because the nervous system overreacts to otherwise “normal” stimuli. As a “disease of exclusion,” other diseases must be ruled out before a diagnosis can be made. Five years is the average time people go without receiving an accurate diagnosis.
Chronic pain is the most common symptom reported with fibromyalgia. If you have fibromyalgia, you may experience aches and spasms in your muscles, joints, tendons, and ligaments. Sensitivity to touch is heightened and even mild pressure can be excruciating. It is not uncommon to experience neuropathic symptoms such as numbness and tingling – you may have even been “diagnosed” with restless leg syndrome. Sensations of swelling and inflammation may be felt, even if there is no visible swelling present.
Fatigue is another common symptom. Though problems with sleep are often reported, whether you get too much or too little seems to have no bearing on fatigue. Your energy is low and you just have that “blah” feeling throughout the day. A “foggy” sensation in your head may be felt and you may have cognitive difficulties such as poor memory and difficulty with concentration.
Problems with digestion such as nausea, heartburn, and irritable bowel syndrome are also experienced.
Stress levels are often elevated. Whether the cause is neurological or due to the frustration of living with these symptoms, people with fibromyalgia are often susceptible to emotional problems such as anxiety and depression.
New Diagnostic Criteria for Fibromyalgia Syndrome
Diagnostic criteria for fibromyalgia syndrome was established by the American College of Rheumatology in 1990. Before fibromyalgia can be clinically determined, all other potential diseases must be ruled out. If you have had wide-spread pain and 11/18 designated tender spots (see Figure 1) for a period of at least three months, you may be diagnosed with fibromyalgia.
These diagnostic criteria do not take into consideration the wide range of symptoms that people with fibromyalgia experience.
The new diagnosis requirements allow for more accurate results and reflect a better understanding of fibromyalgia syndrome. The two new assessment methods are the Widespread Pain Index (WPI) and the Symptom Severity (SS) Scale Score.
The WPI is similar to the criteria of the American College of Rheumatology, as it focuses on areas of pain. The WPI provides 19 areas where you may be experiencing pain within a week. You mark the location of pain, scoring one point for each area. The WPI score provides a range from 0-19.
The SS Scale is a new diagnostic tool that assesses and evaluates pain and fatigue. It is a questionnaire that helps to diagnose fibromyalgia syndrome and measures its severity without tender points. The SS scale includes depression and anxiety, fatigue, poor sleep, cognitive problems, headache, weakness, gastrointestinal difficulties, and sensations of numbness and tingling. Scoring for each category is tallied between 0-12.
According to the new diagnostic criteria, you have fibromyalgia syndrome if you have a WPI score of ≥ 7 with an SS scale score of ≥ 5 or a WPI of 3-6 and an SS scale score ≥9. Symptoms must still be present for at least three months and you must not have another disorder that would explain the pain. The new diagnostic criteria are not meant to replace the classification by the American College of Rheumatology; rather they allow for more inclusive results.
What treatments have you found works best for your fibromyalgia?
Managing Fibromyalgia Syndrome with Natural Medicine
Unfortunately, the options available to managing fibromyalgia allopathically are limited. Medications are available, though they come with side effects and can create more symptoms. Lyrica and Neurontin are used to manage neuropathic pain. Many people with fibromyalgia are often prescribed antidepressants; this may just mask the symptoms of what is really going on.
If you suffer from fibromyalgia, you may decide to pursue complementary and alternative medicine (CAM). Clinically, I have seen the most success with a combination of acupuncture, exercise, and eating a whole foods/anti-inflammatory diet. Chiropractic care also works well with managing symptoms of fibromyalgia. In my clinical experience, I have seen better results with acupuncture over chiropractic care. However, each person is unique and chiropractic medicine is still a powerful method of working with fibromyalgia syndrome.
Exercise is crucial in managing fibromyalgia syndrome. Difficulties may arise due to pain and lack of energy, but it is important to keep muscles strong, maintain flexibility, and ensure proper conduction of nerves and circulation of blood. Programs such as Taiji (or Tai Chi), Qigong, and Yoga are beneficial due to their integration of the mind and body.
Other methods of managing fibromyalgia include, but are not limited to massage therapy, meditation, biofeedback, Reiki, and Ayervedic medicine.
A Better Understanding?
While there is still a long way to go, changes in the diagnostic criteria and new methods of managing fibromyalgia syndrome reflect progress. I find that the best "medicine," no matter what the condition, is to remain optimistic and surround yourself with positive energy. If you are dealing with a chronic condition such as fibromyalgia, this can be a challenging task. However, factors such as the new diagnositc criteria exist because more people are beginning to understand the difficulties associated with fibromyalgia.
When it comes right down to it, its up to you to take charge of your health and provide others with better understanding.
Wolfe, Frederick, Daniel Clauw, Mary-Ann Fitzcharles, Don Goldenburg, Robert Katz, Philip Mease, Anthony Russell, I. Jon Russell, et al. "The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity." Arthritis Care & Research. 62. (2010): pp 600–610. Web. 13 Jan. 2012. <http://www.rheumatology.org/practice/clinical/classification/fibromyalgia/2010_Preliminary_Diagnostic_Criteria.pdf>.