By R. Paul St. Amand, M.D.
About 35 years ago I began working with a strange illness in which patients had many common symptoms, but great individual variability. Each patient qualified for the diagnosis “anxiety neurosis.” The disease was cyclic and progressive and produced variably disabling effects.
“Fibrositis” was described in 1843, but this name implied inflammation. When muscle biopsies showed none, the name “Fibromyalgia” was coined and went into common usage several years ago. We had, by then, treated several hundred patients using such names as rheumatism to cover the diagnosis. It was obviously a very common disorder that needed attention, especially since I, too, suffered from the problem.
Though we estimate we have treated over three thousand such patients, we have never seen a case of pure fatigue syndrome. In well-detailed medical papers, the symptom overlap between Fibromyalgia and Chronic Fatigue is obvious. For the purposes of this article, let me use Fibromyalgia to cover the subject.
The symptoms are well known but bear repeating. They consist of fatigue, irritability, nervousness, depression, insomnia (frequent awakening), impaired memory, and concentration. Headaches, dizziness, blurring of vision, eye irritation or dryness, inappropriate flushing, sweating, or sudden cold spells continue on this list. Equally frequent are nasal congestion, abnormal taste varying from bad to metallic, ringing or other ear sounds, numbness, or tingling in various locations. The irritable bowel syndrome, or spastic colon consisting of gas, bloating, constipation with or without diarrhea are commonplace. There is a high incidence of transient burning on urination, strong pungent urine (often dark and foamy), and, in some patients, repeated bladder infections. Patients also noted cyclic chipping, breaking or pealing of fingernails. The restless leg syndrome and frequent foot or leg cramps are often present, usually at night.
We usually elicit in a history of arthritis or rheumatism especially in older family members. In fact, it is quite common not to find symptoms suggesting fibromyalgia in other relatives. For example, my father, two sisters, and my three daughters all have this illness.
A multigenic disease is likely. We have treated patients as young as four and have seen onset in patients in their seventies. Women predominate 80% to 20% men. Belgian authors have reported three genes associated with fibromyalgia, and since none was located on the X chromosome, such linkage will probably never be found. The age of onset and severity of the illness may depend on the number of inherited gene defects. Thus, inheritance from both parents assures early onset of fibromyalgia.
Results of physical examination of patients places much emphasis on the finding of 11 out of 18 predetermined “tender points.” This has been a useful concept, though somewhat artificial. We easily find many more widely distributed areas of swelling, spasm, and tenderness scattered all over the body. We map such findings and sketch the approximate size and in duration of each. This map does not depend on tenderness, but mainly on what trained examiners feel. This map serves as an easy reference on subsequent visits to assure clearing of lesions.
It is our premise that an inherited enzyme abnormality leads to faulty urinary excretion of something which then accumulates in the body as an intracellular, abnormal excess. From this there is partial blockage to the formation of ATP, the source of “power” which energizes most functions of every cell. Only this or a similarly basic, total body problem would seem to account for all the symptoms of Fibromyalgia. We have suspected an abnormality in excretion of phosphates as the cause of the ATP problem. In turn, calcium would follow phosphates into the cell, and when this sits free in the intra cellular fluid, forces the cell into either action, or blocks its function. Calcium belongs in certain cellular reservoirs, and when it is released into the fluid of a cell (cytoplasm), effects such as a continuous muscle contraction occurs. Since nothing other than calcium free in the muscular fluid can sustain muscular contraction, it follows that the spastic muscle parts we find in the so-called tender points are sustained by excess calcium in the wrong place.
We have measured the excretion of phosphates, calcium, oxalates, etc., in the urine of a few patients as we have begun treatment.
Fibromyalgia requires the over-utilization of fuel —- that is, foodstuffs. The constantly contracted muscles indeed work day and night. We find some 50% or more of our patients have a sugar craving, especially during cycles of pain and fatigue. This will push some into hypoglycemia syndrome, or worse, into panic attacks caused by the release of adrenaline. This complex must be treated -dietarily. It is the subject of another article to explain the interplay of Fibromyalgia with the entity we have mislabeled the hypoglycemia syndrome. These same hormonal, chemical, and enzymatic disturbance may also explain some weight gain experienced by many fibromyalgics.
Life has charm for the healthy. There is hope for the Fibromyalgics and fatigued of the world. Happiness has been defined as freedom from pain (mental or physical). I wish you all that happy state.