Health

For those suffering from fibromyalgia, feeling is believing, Las Vegas doctor says

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For those living with a chronic illness, getting through the day is difficult enough. But what about when your friends, family and even your doctor don’t believe you?

“For the longest period of time, no one believed that fibromyalgia was real, including physicians,” says Dr. Mitchell D. Forman, Professor of Medicine in the Division of Rheumatology at the UNLV School of Medicine. “It continues to this day.”

Fibromyalgia is a syndrome that causes widespread musculoskeletal pain, fatigue, mood issues, impaired cognitive abilities and more. The disorder is chronic, meaning it’s long-lasting and often gets worse over time.

While fibromyalgia can affect people of all ages and genders, women are more prone to the syndrome. According to Forman, it’s the most common cause of generalized muscular-skeletal pain in women ages 20 to 55.

“Everybody at some time has a day or two of feeling horrible and having some symptoms we see frequently with fibromyalgia, but the thing that is critical is the chronicity,” Forman says. “Typically, it’s more than three months’ worth of widespread musculoskeletal pain: pain in joints, in between joints, muscle grooves, the chest wall, abdomen, and it varies from patient to patient.”

For fibromyalgia patients, the list of symptoms isn’t one-size-fits-all. “We’re sort of lumping lots of different people into this category, when they’re often very different, and that complicates things, too,” Forman adds.

Other symptoms can include cognitive disturbances, like searching for words and a feeling of forgetfulness called “fibro fog,” impaired sleep and a repetitive lack of feeling refreshed upon waking. Sufferers can also experience migraines, pelvic pain, increased urination, irritable bowel syndrome (IBS), abdominal cramps, constipation, diarrhea and more.

Because the syndrome affects people differently, and because it is largely invisible—meaning patients look and appear healthy—it’s often a struggle to receive appropriate treatment.

“For those who are affected significantly or are unable to work, there’s always been a great deal of difficulty in getting insurance companies and even government agencies like Social Security [on board], because there’s no definitive physical or laboratory diagnosis,” Forman says.

Chemical imbalance

Because people have historically struggled to find a diagnosis for their fibromyalgia symptoms, psychiatric issues such as depression are common. Many are told they have a mental health problem rather than a physical one. “They are never believed, but they have chronic complaints,” Forman says.

To understand why this oversight happens, it’s important to understand how fibromyalgia works. According to Forman, fibromyalgia is a “pain amplification syndrome.” The brain amplifies sensations of pain, because neurotransmitters like norepinephrine, dopamine and serotonin are not being released as they should.

“The problem is in their head,” Forman explains. “It’s a chemical situation in the brain based upon a very complicated series of things,” mainly a dysfunction of the neurotransmitters that help regulate pain.

“When they work well, they reduce the perception of pain from a variety of stimuli,” Forman says. “When they don’t work and aren’t releasing in the right manner, then people experience pain.”

Lab results, therefore, rarely find abnormalities, “so [it’s] blamed on a psychiatric cause,” Forman says. “I would become depressed, too, if no one thought my symptoms were real.”

Because fibromyalgia is so often invisible to everyone but the patient, it’s important that those suffering with symptoms become their own advocates when seeking a diagnosis. The pain is not imaginary, and the sensations are very real.

“There’s no good objective way of diagnosing pain,” Forman says. “What is pain? Whatever a patient tells you.”

Managing pain

Antidepressants are often used to treat fibromyalgia. They can work, but not because the syndrome is caused by depression. Antidepressants often affect the release of norepinephrine and serotonin, which can help mitigate a patient’s pain perception and mood.

“Most patients have had fibro for years before a diagnosis is made,” says Forman, explaining that it’s important to assure patients that “it really is an illness and not a psychiatric problem.”

So how do people with fibromyalgia combat constant pain? Forman says patients have to find a way of addressing external stressors and other stimuli that can potentially make the condition worse. Meditation, adequate sleep, exercise and medication like SSRIs and other antidepressants can be utilized in tandem to ensure a better quality of life.

“There’s very good data that exercise appropriate to the patient’s medical condition can reduce deconditioning,” Forman says. “When you’re out of shape, trying to do anything—walking, going to work, shopping—can be more painful. Develop a program that gradually improves your deconditioning,” whether that includes physical therapy so the patient can exercise gradually, or developing a healthy program on their own.

“If they exercise too abruptly, they’re going to feel worse,” Forman adds. Similarly, seeing a specialist like a chiropractor should be done with caution, because people with fibromyalgia often experience heightened tenderness and pain.

Sleep is another area that shouldn’t be overlooked. “People who need to get a good night’s sleep shouldn’t eat or drink, watch TV or read before they go to bed,” Forman says. “You want to remove stimulants when you plan to go to sleep.”

While most fibromyalgia patients will continue to have chronic pain and fatigue throughout their lives, there are ways to mitigate the pain. And more alternative therapies, like the use of CBD or attending a fibromyalgia support group, have helped some struggling with the syndrome.

“There’s a great deal of research going on,” Forman says, and, hopefully, better ways of managing the chronic illness are on the horizon.

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