Thursday, May 2, 2013

Understanding the Musculoskeletal Pain Syndrome - Fibromyalgia and Back Pain Part I

Neck pain, back pain, and sciatica, also referred as the back pain complex, have many causes. One the principle, least understood causes of back pain, and there are myriad causes, is commonly referred to as the musculoskeletal pain syndrome. Musculoskeletal pain syndrome is expressed in one of two forms, fibromyalgia or myofascial pain syndrome. The two pain syndromes are responsible for pain in various parts of the body, to include the neck, back, both upper and lower, and the legs (sciatica). This article will deal with the former, fibromyalgia. Fibromyalgia results in pain to the affected area when touched, these areas are known as trigger points. Fibromyalgia may also be responsible for fatigue, stiffness, and sleep disturbances. Fibromyalgia is a more widespread condition than myofascial pain syndrome and is found throughout the body. Both pain syndromes are thought to be related to a change in or alteration of the body's pain threshold, meaning that the pain reported is out of proportion with the actual pain stimuli. Fibromyalgia is an often disputed classification and in fact has been referred to as the "non-disease."

Fibromyalgia is defined as muscle and connective tissue pain. The condition is characterized by widespread, chronic pain combined with an overly sensitive reaction to allodynia, or gentle touch. As noted above, fibromyalgia is not only responsible for widespread pain, to include neck pain, back pain, and sciatica but may also be characterized by debilitating and disabling levels of fatigue, sleeplessness and sleep dysfunction, stiffness and soreness, difficulty breathing and swallowing, and a myriad of symptoms expressed by and affecting various body systems. The concert of symptoms, not always present in full, are generally referred to collectively as the "fibromyalgia syndrome." In addition to the above mentioned symptoms, fibromyalgia may also be expressed in terms of cognitive dysfunction, as in difficulty shaping and expressing concepts and thoughts, and an increase incidence of anxiety and affective symptoms. The link between stress and fibromyalgia appears to be a significant one, with a number of psychological manifestations being present, to include depression. In fact, there is a powerful link between major depression and fibromyalgia. The etiology or cause remains highly speculative, as it has not been shown that there is a true causal link between the two. It has been suggested, and this author concurs, that depression may be a consequence of having to endure multiple symptoms, including sleeplessness and sleep dysfunction, with no clear cause or treatment options.

Fibromyalgia, as noted above, is defined as widespread, chronic pain and a response to allodynia or gentle touch, particularly at various trigger points on the body. Additionally, pain expressions or symptoms may include deep muscle aches and pains, at times deep, almost burning sensations; muscle cramps and spasms, mild to severe and debilitating, particularly low back pain radiating into the legs (sciatica); nerve pain, to include prickly or needle-like sensations on the skin; generalized weakness, particularly in the limbs; and, disturbances of the bowel, to include colitis-like spasms.

Sleeplessness and sleep disturbances are common in fibromyalgia sufferers, and may grow in severity and frequency over time; and, as psychological symptoms become more prevalent, particularly anxiety and depression. Significantly, a kind of "fibrofog" or "brain fog," manifesting itself as cognitive dysfunction, may be a consequence of sleeplessness and dysfunction. There is a clear and demonstrable link between fibromyalgia symptoms and the inability to concentrate, difficulty with memory, both short and long term, and impaired attention span and an inability to multi-task. There are many more symptoms expressed by fibromyalgia sufferers but they are beyond the scope of this article.

Ultimately, there are a multitude of symptoms and consequences linked to this devastating and debilitating syndrome. Neck pain, back pain, and sciatica are certainly significant in fibromyalgia patients but the concert of symptoms, the syndrome, has multiple expressions and possible causes, physiological and psychological. The fibromyalgia treatment focus must be a holistic one, primarily because of the multiple-system, multi-symptom nature of the syndrome. There is no clear and systematized approach to the handling of, much less a cure for, fibromyalgia sufferers. Treatment strategies often include analgesics such as NSAIDS (naproxen-sodium) for aches and pain. Antidepressants are often prescribed for depression and for possible serotonin dysfunction and its impact on the central nervous system's ability to properly process pain impulses. The impact of norepinephrine and serotonin affecting and stimulating drugs is being explored, a link has been discussed and it is suggestive but the outcome is still unclear. Additionally, behavioral intervention and alternative medicine are options many pursue. As with most cases of neck pain, back pain, and sciatica, exercise is an essential component in the treatment strategy, more so due to the wide-ranging, often ambiguous constellation of pain symptoms. Again, a holistic approach is vital if there is to be a resolution for not only the neck pain, back pain, and sciatica but the myriad of additional symptoms collectively classified as the fibromyalgia syndrome.

No comments:

Post a Comment