Fibromyalgia: Why No One Understands It
FIBROMYALGIA: WHY NO ONE UNDERSTANDS IT
by James Gruft, MD, FAAPMR, DABP
Do you know the difference between a syndrome and a disease? That’s o.k. I teach at Rush University, Chicago and have to teach the difference to the resident physicians there.
A syndrome is a collection of signs & symptoms.To be a disease you have to fulfill two out of three criteria:
1. A collection of signs & symptoms.
2. A definitive etiology (cause)
3. A definitive tissue marker (test)
Fibromyalgia does not have a definitive cause or a definitive tissue marker (an objective test that tells you the person has Fibromyalgia). That is why it is just a syndrome; it is just a collection of signs (something the doctor clinically finds on exam) and symptoms (manifestations of illness that the patient tells the doctor).
Herein lies some of the mystery of what makes Fibromyalgia so hard to understand: being just a group of signs and symptoms doesn’t tell you a lot about why the person is having these symptoms. What I have found as a result of treating thousands of people with Fibromyalgia is that these symptoms can have different causes from different types of biological imbalances. It is by exploring the nature of these imbalances — using a systems biological approach called Functional Medicine — that can reveal some of the imbalances leading to the symptoms of Fibromyalgia and illuminate what may be used to treat the condition.
Before going further, I would like to lay out the definition of pain given out by the – IASP (International Association for the Study of Pain) :
“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of tissue damage.
Note: pain is always subjective. Each individual learns the application of the word through experience related to injury.”
In 1990, the American College of Rheumalology made an attempt to standardize the criteria for diagnosing Fibromyalgia.
They wrote that there must be:
- A history of widespread pain, defined as: pain in the left side and right side of the body as well as above and below the waist. Axial skeletal pain (cervical, anterior chest, thoracic or LBP) must also be present.
- Eleven out of 18 recognized tender spots. These spots are at the back of the head, at the shoulders, anterior neck, above the shoulder blades, at the second rib, the lateral elbow, the head of the hip bone, the medial aspect of the knees and the upper outer quadrants of the buttocks”
They also noted associated symptoms, besides pain:
- Fatigue, Sleep Dysfunction and Morning Stiffness (73-85%)
- Headaches [occurance 28-58% Caro (1989)]
- Irritable Bowel Syndrome 34-53% Goldberg (1987) (Alternating constipation/diarrhea, bloating).
I have come to believe that Fibromyalgia is heterogeneous (there are many different types).
I classify different types of Fibromyalgia as:
So, widespread pain, fatigue, and sometimes headaches and gut symptoms can have many different causes.
Using a systems biology approach, I characterize the condition as either a problem with :
- Energy – deficiency (oxidative, mitochondrial)
- Gut dysfunction
- Psychological/ Spiritual dysfunction
In my next installment, I will show how to characterize these sub-types of Fibromyalgia and how this leads to different approaches to treatment.