Identifying Fibromyalgia

The Complexities of Identifying Fibromyalgia

Does any of the following sound familiar?

Are you a female in your 40’s experiencing fatigue??Have you recently been suffering from extreme tiredness the past few months even though your daily routine and life hasn’t changed??Do you sleep at night, but wake up unrefreshed??Do you experience pain in your arms, hips and/or shoulders that feels like muscle pain??Do you have frequent headaches centered on your forehead??Have you skipped out on social events because you’re too tired to attend??Do you feel mildly depressed and don’t know why??Has your quality of life decreased lately??Did you previously exercise and now can’t seem to gather the energy to continue?

These symptoms may indicate several different conditions.?What can you do to determine the root cause of your symptoms and seek proper treatment??Work with a qualified healthcare practitioner experienced in assessing for conditions like fibromyalgia.

?Step 1:?Start with a Client or Patient Questionnaire

Ensure your preferred health care practitioner asks you the following questions:

a.?????What medications/herbs/supplements are you taking and their dosages?

b.?????Describe your typical diet on both a workday and non-workday.

c.?????Do you have any allergies to foods or other environmental allergens?

d.?????Have you experienced any recent trauma or other illnesses?

e.?????What is your family history of health and illness?

Asking these questions helps determine whether there may be any confounding variables or other potential causes of the symptoms, such as nutritional deficiencies, drug interactions, family predisposition to illness/disease related to genetics, environmental influences on health, such as allergies or toxins.?Understanding the full picture helps your healthcare practitioner identify the root cause of your symptoms and treat the cause, while alleviating the symptoms.

Step 2:?Physical Exam

If your healthcare practitioner is not a physician, it may be prudent to have a physical exam conducted to test tender points, as indicated by The American College of Rheumatology Classification Criteria for Fibromyalgia.?Criteria for diagnosis is tenderness in 11 of 18 points (4).??

A physical exam checking for the following is also advised: heart rate, blood pressure, reflexes, check for swollen lymph nodes, and other physical signs of virus or infections. Biometrics of height, weight, BMI, etc. would also be helpful in determining whether body composition plays a role here. This basic checkup will help rule out other causes of symptoms (5).

Step 3: Laboratory Tests

Some lab tests your physician may recommend to further pinpoint the root cause of your symptoms include Complete Blood Count; TSH (Thyroid Stimulating Hormone); Free T-4; a partial CMP paying close attention to MCV, hematocrit and hemoglobin; serum ferritin; salivary cortisol, DHEA, Estrone, Estradiol, Estriol, and Testosterone.?These tests may indicate conditions that also present with fatigue as a primary symptom, such as hypothyroidism, cortisol dysregulation, hormonal imbalances, and iron-deficiency anemia. (9, 12)

Additional tests may include ESR (erythrocyte sedimentation rate) to determine whether there exists an infectious, inflammatory, or malignant disease that could be perpetuating the symptoms (9), and fasting plasma amino acids to check for nutrient depletions with special attention to L-tryptophan levels (10, 11).

Step 4: Identification of Fibromyalgia

Once other conditions are ruled out, your healthcare practitioner may determine fibromyalgia as the cause of your symptoms.?Although the pathophysiology of fibromyalgia is still largely undetermined, studies propose low levels of the amino acid, L-tryptophan, necessary for the synthesis of serotonin, as a potential cause.?It has been observed that fibromyalgia patients have lower plasma tryptophan.?Tryptophan induces sleep as it increases serotonin production in the brain stem.?Plasma levels may be increased when there is sleep deprivation due to underutilization.?Conversely, low levels of tryptophan are correlated with depression. (11,12)??The pathophysiology of fibromyalgia involves changes in CNS pathways and peripheral pathways, causing hypersensitivity to pain (13).?The current hypothesis focuses on atypical sensory processing in the CNS and dysfunction of skeletal muscle nociception and the HPA axis (14).?

Step 5: Treatments for Fibromyalgia

Switching to an anti-inflammatory diet high in antioxidants together with supplementary vitamin C, E, lipoic acid and L-tryptophan or melatonin could serve as the first line of defense in treating fibromyalgia.?Although fibromyalgia is not considered to be an auto-immune disease, markers of increased oxidative stress and low levels of superoxide dismutase have been found in patients with fibromyalgia (15,16).?Additionally, as some patients have lower nocturnal melatonin production, supplementing with 3-5mg of melatonin nightly has been shown to reduce tender points, pain intensity and trouble sleeping (11,17). Lastly, there is some evidence that oral vitamin D supplementation may reduce pain in fibromyalgia patients if they are deficient (18).?

In summary, fibromyalgia is not an easy condition for the healthcare practitioner to identify without further investigation via client questionnaire (including medical history and knowledge of past or present viruses, illnesses, and diseases), physical exam, laboratory testing, nutritional assessment, and specialty testing of ESR and amino acids. Work with a qualified healthcare practitioner such as those at The Harmony Health Collective to determine the root cause of your symptoms and be on your way to living a better quality of life!

References

1.?????Clauw DJ. Fibromyalgia:?A Clinical Review.?JAMA.?2014;311(15):1547–1555. doi:10.1001/jama.2014.3266

2.?????Marcus, D.A., Bernstein, C. & Rudy, T.E. Fibromyalgia and headache: an epidemiological study supporting migraine as part of the fibromyalgia syndrome.?Clin Rheumatol?24,?595–601 (2005). https://doi.org/10.1007/s10067-005-1121-x

3.?????Glass JM. Cognitive dysfunction in fibromyalgia and chronic fatigue syndrome: new trends and future directions.?Curr Rheumatol Rep. 2006;8(6):425-9.

4.?????Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee.?Arthritis Rheum. 1990;33(2):160-172. doi:10.1002/art.1780330203

5.?????Katz RS, Wolfe F, Michaud K. Fibromyalgia diagnosis: a comparison of clinical, survey, and American College of Rheumatology criteria.?Arthritis Rheum. 2006;54(1):169-76.

6.?????Aoki Y, Belin RM, Clickner R, et al. Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002).?Thyroid. 2007;17(12):1211-23.

7.?????DeLoughery TG. Iron Deficiency Anemia.?Med Clin North Am. 2017;101(2):319-332. doi:10.1016/j.mcna.2016.09.004

8.?????Uygur MM, Yoldemir T, Yavuz DG. Thyroid disease in the perimenopause and postmenopause period.?Climacteric. 2018;21(6):542-548. doi:10.1080/13697137.2018.1514004

9.?????Pagana, T.?Pagana, K. MOSBY'S Manual of Diagnostic and Laboratory Tests. 5th edition. St. Louis.?Elsevier. 2021.

10.??Wikner J, Hirsch U, Wetterberg L, et al. Fibromyalgia--a syndrome associated with decreased nocturnal melatonin secretion.?Clin Endocrinol (Oxf). 1998;49(2):179-83.

11.??Citera G, Arias MA, Maldonado-Cocco JA, et al. The effect of melatonin in patients with fibromyalgia: a pilot study.?Clin Rheumatol. 2000;19(1):9-13.

12.??Lord RS, Bralley JA. Laboratory Evaluations for Integrative and Functional Medicine. Duluth, GA: Genova Diagnostics; 2012.

13.??Chinn S, Caldwell W, Gritsenko K. Fibromyalgia Pathogenesis and Treatment Options Update.?Curr Pain Headache Rep. 2016;20(4):25. doi:10.1007/s11916-016-0556-x

14.??Gur A, Oktayoglu P. Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: new concepts in treatment.?Curr Pharm Des. 2008;14(13):1274-1294. doi:10.2174/138161208799316348

15.??Hein G, Franke S. Are advanced glycation end-product-modified proteins of pathogenetic importance in fibromyalgia??Rheumatology (Oxford). 2002;41(10):1163-7.

16.??Bagis S, Tamer L, Sahin G, et al. Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder??Rheumatol Int. 2005;25(3):188-90.

17.??Wikner J, Hirsch U, Wetterberg L, et al. Fibromyalgia--a syndrome associated with decreased nocturnal melatonin secretion.?Clin Endocrinol (Oxf). 1998;49(2):179-83.

18.??Wepner F, Scheuer R, Schuetz-Wieser B, et al. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial.?Pain. 2014;155(2):261-268.

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