Pain DisordersHEALTH IN OUR HANDS
The Arkansas State University Wellness Newsletter
www.clt.astate.edu/wellnessContents:
Pain Disorders
Fibromyalgia
- Symptoms
- Diagnosis and Cause
- Treatment
Myofascial Pain Syndrome
- Symptoms
- Treatment
- University News
Welcome back to Arkansas State University! The staff of the Employee Wellness Program hopes everyone had a great summer, and we are looking forward to an exciting year at ASU. This issue of Health in Our Hands will focus on two different types of pain disorders, fibromyalgia and myofascial pain syndrome.
Fibromyalgia is a chronic rheumatic condition that is characterized by widespread, migrating, and often debilitating pain and fatigue in tissues and muscles throughout the body. This condition often prevents patients from performing their normal daily activities.
There are many different symptoms
that are associated with fibromyalgia. Some of these include:
1) multiple tender areas all over the body
2) fatigue
3) sleep disturbances
4) body aches
5) reduced exercise tolerance
6) chronic facial muscle pain or aching
Symptoms can range from mild
discomfort to completely debilitating pain. Other problems associated
with fibromyalgia include poor concentration, irritable bowel syndrome,
and increased sensitivity to light, noise, and cold. There
are also several aggravating factors associated with fibromyalgia.
Some of these stressors include weather changes, over-exertion, stress,
high humidity, anxiety, depression, and hormonal fluctuations.
This disease affects approximately
eight times as many women as men. Fibromyalgia strikes mostly women
between the ages of 20 and 50. Many doctors believe that as much as two
percent of the population may suffer from fibromyalgia. However,
it is difficult to diagnose so no one is sure of the prevalence of this
condition. Many patients see an average of five physicians before
being accurately diagnosed with fibromyalgia.
The formal diagnosis of
fibromyalgia entered mainstream medicine in 1990. The American College
of Rheumatology described two criteria that must be met for a diagnosis
of fibromyalgia. These include:
1) widespread pain in all four quadrants of the body
for at least three months
2) abnormal sensitivity to palpation in at least eleven
out of eighteen specific tender points throughout the body.
These tender points are sites of fibrous tissue or muscle
of the neck, shoulders, chest, rib cage, lower back, thighs, knees, and
elbows. Tender points hurt only when pressed.
This diagnosis can be
made after a tender point exam by a knowledgeable physician, a thorough
medical history, and an appropriate series of lab tests to rule out other
conditions.
The cause of fibromyalgia has
not yet been established. However, there are several theories.
Researchers have found that patients with fibromyalgia have elevated amounts
of a neurotransmitter called Substance P that signals pain responses to
the body. These patients also have decreased levels of a natural
pain killer called serotonin and growth hormones that facilitate muscle
regeneration. One proposed theory is that some people have a genetic
predisposition that makes them more susceptible to fibromyalgia.
Fibromyalgia can develop after a triggering event such as a virus, trauma,
sleep deprivation, or repetitive stress.
Since the exact cause of fibromyalgia
is still unknown, treatment focuses on relieving the symptoms such as pain
and sleeplessness. The symptoms of fibromyalgia often are characterized
as a pain cycle. Pain prevents sleep which then causes more pain.
Treatment aims to break this cycle. There are several components
to a successful treatment program.
These include:
1) Exercise - This program should include gentle stretching
and gradual progression to aerobic conditioning. Exercise can provide
natural painkillers as well as improve fitness and strength, sleep quality,
and endurance.
2) Drug therapy - Many different types of drugs may be
prescribed to help with the symptoms of fibromyalgia. Some of these
include antidepressants (to help with sleep), painkillers, sleep
medications, and muscle relaxants.
3) Energy conservation - Patients have to learn to pace
themselves. They will often need to take breaks while performing
daily activities. Patients must learn energy conservation techniques
for all aspects of their lives.
4) Physical therapy - Various physical therapy techniques
such as heat application, cryotherapy, massage, whirlpool, and electrical
stimulation can help these patients. Physical therapists also help
educate patients about their disease and energy conservation measures.
Myofascial Pain Syndrome (MPS)
is a painful musculoskeletal condition that is characterized by the development
of a number of sensitive trigger points throughout the body. These
trigger points are very painful locally when active and usually refer pain
to other areas of the body in a specific pattern. These trigger points
differ from tender points because they refer pain to other body parts.
Trigger points can develop for a number of causes such as trauma to a tissue,
injury to an
intervertebral disc, repetitive motions, lack of activity,
systemic conditions, stress, or hormonal changes.
Fascia is a tough connective
tissue that surrounds every muscle, bone, nerve, blood vessel, and organ
of the body. A malfunction of this fascia because of a trauma or
other problem can cause the fascia to bind or thicken which can result
in abnormal pressures on nerves, muscles, bones, or organs. Most
standard tests such as X-rays, CAT scans, and myelography do not show fascia.
Therefore, this disorder can also be hard to diagnose because no definitive
tests exist.
Several symptoms may exist as
a result of myofascial pain syndrome. Some of these include:
1) Local pain at trigger point
2) Referred pain from trigger point
3) Possible autonomic nervous system changes such as
goose bumps, sweating, or flushing of the skin
4) Possible shortness of breath
Treatment focuses on managing
the pain associated with this disease. The symptoms of MPS
will often be resolved with proper treatment. Some components
to treatment include:
1) Trigger Point Therapy - a form of massage therapy
and myofascial release therapy
2) Spray and Stretch Technique - A coolant is sprayed
on a trigger point and then the muscle is stretched.
3) Trigger Point Injections - A local anesthetic such
as lidocaine is injected directly into the trigger point.
4) Physical Therapy treatment - This may include an array
of treatments including items 1 and 2 listed above.
5) Exercise and changes in nutrition can also help.
** Sources for this newsletter include:
http://www.nih.gov/niams/healthinfo
http://health.yahoo.com/
http://members.aol.com/fibroworld/mps.htm
** Remember the annual Race for the Cure on September 29 in Little Rock. The last day to sign up for the Pink Warrior team is August 27th. Contact Susan Hanrahan at ext. 3112 for a race form.
** Mark these dates on your calendar, and watch for more information in future newsletters.
October 7 - Heart Walk at Craighead Forest Park
November 6 - Ladies Night Out at the ASU Convocation Center
ooOoo
The Arkansas State University
Employee Wellness Newsletter is published monthly during the academic year
by the College of Nursing and Health
Professions. Health questions can be addressed to Dean Susan
Hanrahan, Ph. D., ext. 3112 or hanrahan@mail.astate.edu.
Produced by Kimberly McGaughey, graduate student in the College of Nursing
and Health Professions, Physical Therapy Program.