Part 1 - Physically Traumatic Events      The role of physical trauma in the development of Fibromyalgia Syndrome (FMS) continues to be deliberated in the literature. A major difficulty has been the reliance on someone’s ability to recall events that may have occurred thirty years prior. Post-traumatic fibromyalgia is also known as reactive fibromyalgia syndrome and the first paper on the subject was published in 1992. Those researchers reported that 23% of 127 FMS patients reported a specific event – trauma, surgery, or medical illness preceded their FMS. Patients in this group were significantly more affected with 70% losing their job, 34% receiving disability, and 45% having reduced physical activity. Shortly thereafter, in 1994, another study reported a follow-up of 176 FMS patients; 61% reported symptoms after a motor vehicle accident, 12.5% after a work injury, 7% after surgery, 5% after a sports related injury, and 14% after some other type of traumatic injury.      A 2002 case-control study was published, which is a type of study where people with FMS are matched to healthy, normal individuals in as many characteristics as possible except for their disease, FMS. Then researchers try to find out what was different about people who…

Or, Cyto-What?      Cytokines are small molecules that do not stay around very long in the body before they are either taken up or degraded. They act as chemical messengers to affect immune responses, tissue repair, or cell growth.  Their production is influenced by both the central nervous system and the immune system. The sympathetic nervous system, through the secretion of catecholamines, will activate the hypothalamic-pituitary-adrenal axis (HPA) and stimulate the release of cytokines. If you don’t know about HPA axis then read the two short reports on “The Neuroendocrine Theories Behind Fibromyalgia.” Catecholamines are the “fight or flight” hormones produced by the adrenal glands – epinephrine and norepinephrine and they primarily act through the sympathetic nervous system. For more information about epinephrine and norepinephrine you can read the short reports on “Dysautonomia, ”and the two-part series on ‘The Neuroendocrine Theories of Fibromyalgia.”      The most common cytokines are “interleukins,” and they are abbreviated and numbered, e.g. IL-1, IL-6, IL-8, and so on. IL-8 is a key cytokine that plays a role in inflammation. It is released by macrophages, cells that are activated in response to tissue injury.  They help promote pain in laboratory animals and will cause pain in…

More Than Just a "Bad Hormone" Day - Part 2      The first part of this series described some basics about the hypothalamic-pituitary-adrenal axis in FMS and came to the conclusion, in 2004, that nobody quite knew what was going on. The bottom line seemed to be that there was a disruption seen in the normal circadian rhythm for plasma cortisol levels with abnormally elevated concentrations noted in the evening. Well, some researchers tried to look at things more exactly by convincing people to allow them to test their cortisol by taking a saliva sample to measure their cortisol every 10 – 20 minutes for 24 hours rather than what had been done in the past – one 24 hr measurement collected from urine. Some people even allowed researchers to use an intravenous blood sample to be taken every ten minutes – which gave even better results. Now, some more precise numbers began to appear.      In this more exact study it was noted that evening levels of cortisol were slightly elevated and there was also a delay in the decline of the cortisol levels such that 50% of the FMS patients in the study never met the criteria for…

Submitted by the Illinois Pain Institute Sciatica and low back pain are leading complaints of pain and discomfort among adults. Typically, people associate such pain with a pinched nerve or bulging disc.  Often times, some of the other common causes of low back pain are overlooked and subject patients to sometimes unnecessary, invasive, sometimes painful, and expensive diagnostic procedures. Common disorders, symptoms, and physical signs causing low back pain are listed below. Painful Conditions Sacroiliitis Symptoms: Low back and buttock pain; when severe, may radiate to the posterior thigh Physical Signs: Joint tenderness on palpation. Myofascial Pain (Quadratus Lumborum Muscle)     Symptoms: Backache, hip, or buttock pain, abdomen or groin pain     Physical Signs: Tenderness below and close to the 12th rib, just along side of the spine Myofascial Pain (Gluteus Medius Muscle)     Symptoms: Low back and buttock pain; increasing with lying or sitting on affected site     Physical Signs: Tenderness above hip with painful sensations along the side of the leg. Taught band of muscles or knot felt under the skin. Myofascial Pain (Piriformis Muscle)     Symptoms: Pain in lower back, groin, perineum, buttock, hip, posterior thigh, leg, or foot     Physical Signs: Localized tenderness at the tailbone…

Dysautonomia is a rather fancy medical term that refers to the autonomic nervous system (ANS). This is the unconscious or automatic part of the nervous system that regulates almost all the working parts of the body such as your heart rate, breathing, blood pressure, digestive system, temperature, and the way you sleep and wake up. The ANS has two components, the sympathetic and parasympathetic nervous systems. Without getting into too much detail, the sympathetic nervous (SNS) system tends to speed things up while the parasympathetic nervous system (PNS) tends to slow things down. For example, the SNS will increase your heart rate and blood pressure while the PNS will do the opposite – it will lower your heart rate and decrease your blood pressure. As another example, inappropriately regulated blood flow triggers nausea and abnormal bowel motility resulting in constipation or diarrhea.

Some people with Fibromyalgia Syndrome (FMS) may notice they tend to develop hives more frequently than other people. Hives is medically known as urticaria.  Urticaria comes from the Latin word, "urere," which means, “to burn.” Usually, it’s a kind of skin rash that has a pale, itchy, red, raised area of the skin that usually has bumps. Hives is frequently caused by allergic reactions.

Interstitial cystitis (IC) is also known as “painful bladder syndrome.” As a medical condition, it covers a multitude of symptoms. These include: general pain in area of the bladder; pain associated with with urination, which is medically known as dysuria; an increase in the frequency of urination, which can be every ten or fifteen minutes; and, a feeling of pressure or discomfort in the lower abdomen. IC is not a condition to be taken lightly. The symptoms may be decreased with urination and increased with stress, intercourse, or tight clothing and aggravated by acidic beverages, coffee, and spicy foods. In its most severe forms its impact on a person’s life has been likened to being on kidney dialysis and people have been given permanent disability as a result of not being able to find adequate treatment; there are cases of suicide associated with severe IC.  

We’ll talk more about different types of headaches and the unique treatments that only pain physicians can provide in future short reports, but now we’ll just consider headaches as they relate to Fibromyalgia Syndrome (FMS). The classification and diagnostic criteria for headaches are contained in the International Headache Society guidelines that were published in 1988 and physicians, including pain physicians, will use these in matching symptoms to specific headache types.

Your Brain on Fibromyalgia Cognitive abnormalities, colloquially known as “fibro fog” are another chief complaint of patients with fibromyalgia syndrome (FMS). The new term making its way into the FMS literature is “dyscognition,”which refers to both the experiences related by patients as well as measureable observations made by researchers. In two surveys, one by the National Fibromyalgia Association in 2006 and the second by the German Fibromyalgia Association in 2007, concentration related symptoms were rated the 5th most troublesome symptom, after pain, sleep, fatigue, and stiffness.