Fibromyalgia

To date, medical science has not been able to determine the cause of fibromyalgia, but there are many events that may be related to its onset. Some of the events that are being evaluated as possible triggers include infections (viral or bacterial), physical trauma such as an automobile accident, or the development of other health problems such as rheumatoid arthritis, lupus, "leaky gut" syndrome, or hypothyroidism. Rather than causing fibromyalgia, these triggering events may awaken an underlying physiological abnormality.

The published clinical definition of fibromyalgia syndrome may not be the best one possible.(1) It has been argued that tender points have been over-emphasized as diagnostic markers. The difference between individuals who meet the criteria for diagnosis of chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) is often only the degree of pain. Indeed, 70 percent of patients diagnosed with fibromyalgia meet all of the diagnostic criteria for CFS. Tracked over time, some individuals initially diagnosed with CFS will subsequently fit the criteria for diagnosis of FMS. More than two-thirds of patients with FMS meet the CDC (Center for Disease Control) criteria for CFS,(2) and two-thirds of patients with CFS meet the criteria for FMS.(3)

Other conditions that may commonly mimic fibromyalgia include hypothyroidism, lupus, Lyme disease, rheumatoid arthritis, and infections. There may be a link between fibromyalgia and sleep disturbance disorder, since most fibromyalgia patients have disruptive sleep patterns. Other factors that may contribute to the development of fibromyalgia or its symptoms are psychological stress, immune or endocrine abnormalities, mitochondrial uncoupling of energy production, or biochemical abnormalities in the central nervous system. Many patients have no apparent underlying disorders, while others who develop fibromyalgia may have conditions such as those mentioned above.

It has been observed that patients with fibromyalgia have alterations in the metabolism and regulation of neurotransmitters such as serotonin, norepinephrine, and dopamine.(4) Substance P is a pain neurotransmitter that has been found to be elevated threefold in the spinal fluid of fibromyalgia patients.(5) Other studies report that patients with fibromyalgia have abnormal levels of cortisol and growth hormone.(6)

A more recent theory postulates a deficiency of a hormone known as relaxin, which is a polypeptide very similar to insulin. In women, relaxin is secreted from the ovaries, uterus, and breast tissue. Relaxin is a hormone that helps regulate muscle, tissue, and organ function in many areas of the body. Relaxin levels are highest during pregnancy and diminish progressively during menopause. Women who are menopausal, or those who have had a hysterectomy, oophorectomy, tubal ligation, or extended use of oral contraceptives, which suppress ovarian functions, may be at greater risk of developing fibromyalgia because their relaxin production has been severely diminished.(7)

Connection to "Leaky Gut" Syndrome: Epidemiological studies have confirmed that patients with functional gastrointestinal disorders such as irritable bowel syndrome (IBS) frequently overlap with fibromyalgia (FM), suggesting some commonality. Fibromyalgia occurs in up to 60 percent of patients with functional bowel disorders. Up to 50 percent of patients with a diagnosis of FM syndrome complain of symptoms characteristic of functional dyspepsia, and 70 percent have symptoms of IBS.(8) These patients usually have an abnormal microbial population in the gastrointestinal (GI) tract, which results in dysbiosis. This can cause digestive problems and a leaky gut, which can cause multiple food allergies, weakened immunity, increased toxicity, psychological disturbances, nutrient depletions, and low energy. At the cellular level, it is hypothesized that fibromyalgia patients experience a breakdown or uncoupling of mitochondrial energy production processes.(9) This defect in mitochondrial energy production may be related to or responsible for the chronic fatigue and the characteristic pain and muscle soreness in FM patients. Elevated blood lactate is characteristic in FMS patients. This may explain the muscle soreness and muscular fatigue. It is believed that in FMS, there is a down regulation of lactate and pyruvate conversion to energy within the cell. Elevated lactate mimics the effects of prolonged exercise on muscle tissue (soreness).

For years, the diagnosis of fibromyalgia was difficult because objective signs, such as inflammation and joint deformity, are not associated with the condition. In