Fibromyalgia is a neurophysiological condition characterized by widespread, diffuse pain, usually accompanied by fatigue, and sometimes a wide range of other symptoms. Symptoms are often aggravated by exercise, unrelated illness, or changes in the weather. In general, fibromyalgia does not result in any noticeable inflammation of the painful areas, nor are there usually abnormal laboratory findings.
The cause of fibromyalgia is unknown. One theory is that the protective chemical coating erodes around sensory nerves. Other theories relate to autoimmune disorders, other immune dysfunctions, and various toxins. The only specific finding is that it is related to sleep quality: circumstances that interfere with "stage 4" deep sleep (such as drugs, pain, or anxiety) appear to be able to cause or worsen the condition.
The theory surrounding sleep disturbance as a cause is perhaps the most effective at explaining how fibromyalgia starts and how it presents. Fibromyalgia generally starts as a result of some trauma (such as a traffic accident) or illness, but there is no strong correlation between any specific type of trigger and the subsequent initiation of fibromyalgia. According to the sleep disturbance theory, the common thread of these events is that they cause sleep disturbance and, possibly, some sort of initial chronic pain. These are required (per this theory) to initiate the disorder.
The sleep disturbance theory supposes that "stage 4" sleep is critical to the function of the nervous system as it is during that stage that certain neurochemical processes in the body "reset". In particular, pain causes the release of substance P in the spinal cord, and substance P has the effect of amplifying pain and causing nerves near the initiating ones to become more sensitive to pain. Under normal circumstances this just causes the area around a wound to become more sensitive to pain, but if pain becomes chronic and body-wide then this process can run out of control. The sleep disturbance theory holds that deep sleep is critical to reset the substance P mechanism and prevent this out-of-control effect.
An interesting aspect of the sleep disturbance/substance P theory is that it explains the "tender points" that are characteristic of fibromyalgia but which are otherwise enigmatic, since their positions don't correspond to any particular set of nerve junctions or other obvious body structures. By the sleep disturbance theory these locations are "special" simply because the sensory nerves that serve them are positioned in the spinal cord to be most strongly affected by substance P.
Diagnosis of fibromyalgia can be difficult. Very often it appears in combination with some other disorder such as chronic fatigue syndrome, so often the symptoms of one disorder are attributed to the other. The primary diagnostic of fibromyalgia, however, is relatively unambiguous: the presence of at least 11 of the standard 18 "tender points" -- specific spots on the body that are usually very pressure sensitive in individuals with the disorder.
Treatment
Treatment for fibromyalgia can include exercise in an attempt to build up muscle bulk in an attempt to reduce stress on the muscles; conventional pain-killers to reduce the effects of fatigue and pain as well as medication sometimes used as anti-depressants to adjust nerve response and/or help to deal with the psychological effects of constant fatigue and pain. One highly-touted but unproven treatment is the "guai treatment", which involves taking large amounts of the drug guaifenesin while avoiding any foods, drugs, or cosmetics containing salicylate. The most effective known treatment regime combines mild exercise with drugs carefully chosen to improve sleep quality without affecting "stage 4" sleep.
In the United States, those affected by fibromyalgia may qualify under programs for those whose work is adversely affected by disabilities. For children and college students, this can include more time to take tests, splitting tests, changes in physical education requirements and college housing closer to class locations.
