Fibromyalgia: understanding causes and taking charge

One of the most frustrating aspects of fibromyalgia (FM) is the absence of any definite cause or causes. For now, experts have proposed a number of theories for what causes FM, including the following.

• Research shows that FM patients are more likely than other people to have a family history of pain, depression or alcoholism.
• Not surprisingly, FM is more common among relatives of FM patients than among relatives of nonaffected people.

• Most researchers agree that stress is a key factor in FM. Studies show that FM patients report high levels of stress in their lives — more, for example, than in RA patients or in other non-FM sufferers.
• A recent study involving FM patients found that the greater their psychological distress, the more sensitive they are to pain and the more physical complaints they have.
• What's not clear is whether stress causes FM or is the consequence of living with a severe and sometimes disabling condition.
• Even if stress causes FM, the disorder clearly isn't "all in the mind," as some skeptics contend, but is a genuine medical problem.
• Mind-body research over the past decade shows that emotional stress can cause major changes in the body and adversely affect the nervous system, immune system and hormone levels.
• Responsible for alerting the nervous system to a painful injury of the tissues, elevated levels of the chemical known as "substance P" are found in the cerebrospinal fluid of FM patients.
• In some people with FM, levels of substance P consistently measure two to three times above normal; in others, substance P levels gradually increase as symptoms become more severe.
• Increased substance P levels, perhaps induced by stress, may help explain the recent finding that FM patients have lower pain thresholds than people who don't have the condition.

Some people can trace the onset of their FM to relatively minor accidents such as fender-bender collisions. But most experts doubt that minor trauma can produce the long-lasting effects on muscles and other soft tissue throughout the body that characterizes FM.

Sometimes it's easier to have a clear-cut medical problem than one like FM, with its largely subjective symptoms of pain and fatigue. People with FM must often contend with skeptical doctors and family members who doubt whether their complaints are real. Here are a few ways to take charge of your condition:

Hands-on benefits. For this and other reasons — including a lack of truly effective treatments — FM can be an especially difficult illness to cope with, but also one that can be greatly helped by a take-charge approach.

• Studies consistently show that by gaining self-empowerment — believing in your ability to control your disease and overcome symptoms — FM patients can improve their mood, decrease pain and better tolerate the pain they still have.

Electroacupuncture. In one study, published in 1992 in the British Medical Journal, 70 FM patients were randomly assigned to receive six treatments using either electroacupuncture (where electric current is applied to the needles) or superficial needling.

• At the end of the treatment period, patients receiving genuine acupuncture treatment were experiencing significantly less pain than patients receiving the sham treatment.

Exercise. FM patients embarking on an exercise regimen should start out slowly, especially if they've been inactive, since unaccustomed exertion can cause severe pain.

• You should also avoid high-impact exercises — jogging or tennis, for example — and opt for road biking, walking or swimming instead.