Fibromyalgia and Irritable Bowel Syndrome
Irritable bowel syndrome affects between 25 and 55 million Americans every year. Characterized by abdominal cramping, bloating, and changes in bowel function, IBS is a very uncomfortable condition, which can interfere with all aspects of life. Fibromyalgia is often associated with IBS, and anywhere between 30% and 70% of fibromyalgia sufferers will have to battle with this illness. In fact, more and more research indicates that the causes of fibromyalgia and IBS are similar, and perhaps even identical. If you are suffering from symptoms of IBS with fibromyalgia syndrome, read on to discover more about this illness.
For people suffering from both fibromyalgia and IBS, it is important to understand how the two illnesses can impact upon each other. As many as 70% of fibromyalgia sufferers have IBS; similarly, 1 in 5 IBS sufferers have fibromyalgia. Dealing with both illnesses at the same time can be very difficult because the symptoms tend to be much more severe.
Recent studies have shown that people who have both IBS and fibromyalgia suffer from symptoms that are 38% more severe than those who only have one illness. IBS tends to exacerbate fibromyalgia pain and fatigue, while fibromyalgia tends to increase the severity and frequency of IBS symptoms. Studies also show that people with both illnesses tend to have a worse quality of life than those with only one. This is because of the limitations that the disease can put on your daily lifestyle.
Is there a connection between these two functional disorders?
As many as one-third of irritable bowel syndrome (IBS) patients have described extra intestinal symptoms such as rashes, tension headaches, and muscle pains. Research has shown that as many as 60% of IBS patients also suffer from fibromyalgia syndrome (FMS). Conversely, as many as 70% of FMS patients have reported experiencing symptoms of IBS.(1) Could there be a common cause for both conditions?
Fibromyalgia
FMS is a disorder of the musculoskeletal system that is associated with symptoms of general muscle aches, stiffness, overall fatigue, and poor sleeping habits. Symptoms can vary in both severity and duration; the pain may be dull or knife-like, linger persistently, or be intermittent. Like IBS, FMS is a functional disorder, therefore tests to find the origins of the pain often come back negative (see Table below for the diagnostic criteria for FMS). Approximately 3.4% of women, and 5% of men suffer from FMS.
The IBS-FMS connection.
Given the co-existence of IBS and FM in so many, it is reasonable to consider a connection. Even though IBS affects the gastrointestinal tract and FMS the musculoskeletal system, there are similarities. Neither condition can be explained by organic disease; they are considered functional disorders. Both occur frequently in women and the onset may be during a stressful event in life. Cognitive behavior therapy and certain types of prescription drugs have been used to treat FMS with mixed results.
To help your family and friends relate to your condition, have them think back to the last time they had a bad flu. Every muscle in their body shouted out in pain. In addition, they felt devoid of energy as though someone had unplugged their power supply. While the severity of symptoms fluctuate from person to person, FMS may resemble a post-viral state. This similarity is the reason experts in the field of FMS and chronic fatigue syndrome (CFS) believe that these two syndromes may be one and the same. Gulf War syndrome also overlaps with FMS/CFS.
For most people, IBS is a chronic condition, although there will likely be times when the signs and symptoms are worse and times when they improve or even disappear completely.
Research has been suggested that people with IBS or FMS respond to pain differently than other persons. However, IBS patients have an altered response to visceral (intestinal) pain, while persons with FMS have an altered response to somatic (skin and muscle) pain. Not surprisingly, further studies have shown that people with both conditions have an altered response to both types of pain. Additionally, persons with severe IBS were more likely to have FMS than those with less acute symptoms.(2)
Although researchers suggest a common mechanism for both disorders, its origins are still unknown. Relatively speaking, the medical community has only just recognized IBS and FMS as legitimate disorders and not psychosomatic problems. Therefore, research on either condition is still in its infancy, and studies connecting the two are rare. However, there is hope, as researchers are taking new interest in discovering why IBS and FMS seem to be connected.
Symptoms and Associated Syndromes
Pain - The pain of FMS has no boundaries. People describe the pain as deep muscular aching, throbbing, shooting, and stabbing. Intense burning may also be present. Quite often, the pain and stiffness are worse in the morning and you may hurt more in muscle groups that are used repetitively.
Chronic Fatigue - This symptom can be mild in some patients and yet incapacitating in others. The fatigue has been described as "brain fatigue" in which patients feel totally drained of energy. Many patients depict this situation by saying that they feel as though their arms and legs are tied to concrete blocks, and they have difficulty concentrating, e.g., brain fog.
Sleep disorder - Most FMS patients have an associated sleep disorder called the alpha-EEG anomaly. This condition was uncovered in a sleep lab with the aid of a machine which recorded the brain waves of patients during sleep. Researchers found that most FMS patients could fall asleep without much trouble, but their deep level (or stage 4) sleep was constantly interrupted by bursts of awake-like brain activity. Patients appeared to spend the night with one foot in sleep and the other one out of it.
Sleep lab tests may not be necessary to determine if you have disturbed sleep. If you wake up feeling as though you've just been run over by a Mack truck — what doctors refer to as unrefreshing sleep — it is reasonable for your physician to assume that you have a sleep disorder. Many FMS patients have been found to have other sleep disorders in addition to the alpha-EEG, such as sleep apnea (as well as the newly discovered form of interrupted breathing called upper airway resistance syndrome, or UARS), bruxism (teeth grinding), periodic limb movement during sleep (jerking of arms and legs), and restless legs syndrome (difficulty sitting still in the evenings).
Irritable Bowel Syndrome - Constipation, diarrhea, frequent abdominal pain, abdominal gas, and nausea represent symptoms frequently found in roughly 40 to 70% of FMS patients. Acid reflux or gastroesophogeal reflux disease (GERD) also occurs with the same high frequency.
Chronic headaches - Recurrent migraine or tension-type headaches are seen in about 70% of FMS patients and can pose a major problem in coping for this patient group.
Temporomandibular Joint Dysfunction Syndrome - This syndrome, sometimes referred to as TMJ or TMD, causes tremendous jaw-related face and head pain in one quarter of FMS patients. However, a 1997 published report indicated that close to 75% of FMS patients have a varying degree of jaw discomfort. Typically, the problems are related to the muscles and ligaments surrounding the jaw joint and not necessarily the joint itself.
Other common symptoms - Premenstrual syndrome and painful periods, chest pain, morning stiffness, cognitive or memory impairment, numbness and tingling sensations, muscle twitching, irritable bladder, the feeling of swollen extremities, skin sensitivities, dry eyes and mouth, dizziness, and impaired coordination can occur. Patients are often sensitive to odors, loud noises, bright lights, and sometimes even the medications that they are prescribed.
Aggravating factors - Changes in weather, cold or drafty environments, infections, allergies, hormonal fluctuations (premenstrual and menopausal states), stress, depression, anxiety and over-exertion may all contribute to symptom flare-ups.
Diagnosing fibromyalgia
In 1990, criteria for the diagnosis of fibromyalgia were established by the American College of Rheumatology.(3) These are:
1. A history of widespread pain, which is identified by pain being present:
- In the left side of the body.
- In the right side of the body.
- Above the waist.
- Below the waist.
Shoulder and buttock pain are considered pain in the side of the body. Axial skeletal pain must also be established by pain in one of the following:
- Cervical spine.
- Anterior chest.
- Thoracic spine.
- Low back (lower segment).
2. Pain must also be present in 11 of 18 pre-defined sites on the body when palpated (touched) by a physician.
- 1-2:The base of the skull, right and left sides (occiput: bilateral, at the suboccipital muscle insertions).
- 3-4: The lower neck, right and left sides (low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7).
- 5-6: The midpoint between the neck and shoulder, right and left sides (trapezius: bilateral, at the midpoint of the upper border).
- 7-8: Muscles over the shoulder blades, right and left sides (supraspinatus: bilateral, at origins, above the scapula spine near the medial border).
- 9-10: The upper edge of the breastbone, right and left sides (second rib: bilateral, at he second costochondral junctions, just lateral to the junctions on upper surfaces).
- 11-12: Two centimeters towards the wrist from either elbow (lateral epicondyle: bilateral, 2 cm distal to the epicondyles).
- 13-14: The outer buttock muscles, right and left sides (gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle).
- 15-16: Upper buttock muscle where the buttocks meet the back, right and left sides (greater trochanter: bilateral, posterior to the trochanteric prominence).
- 17-18: Just inside and above either kneecap (knee: bilateral, at the medial fat pad proximal to the joint line).
Treatments
Prescription sleeping pills, such as zolpidem (Ambien), may provide short-term benefits for some people with fibromyalgia, but doctors usually advise against long-term use of these drugs. These medications tend to work for only a short time, after which your body becomes resistant to their effects. Ultimately, using sleeping pills tends to create even more sleeping problems in many people.
Benzodiazepines may help relax muscles and promote sleep, but doctors often avoid these drugs in treating fibromyalgia. Benzodiazepines can become habit-forming, and they haven't been shown to provide long-term benefits.
Doctors don't usually recommend narcotics for treating fibromyalgia because of the potential for dependence and addiction. Corticosteroids, such as prednisone, haven't been shown to be effective in treating fibromyalgia.
What Is the Prognosis?
Long term follow-up studies on FMS have shown that it is chronic, but the symptoms may wax and wane. The impact that FMS has on daily living activities, including the ability to work a full-time job, differs among patients. Overall, studies show that FMS may be equally as disabling as rheumatoid arthritis.
Complications
Fibromyalgia isn't progressive and generally doesn't lead to other conditions or diseases. It can, however, cause pain, depression and lack of sleep. These problems can then interfere with your ability to work at home or on the job, or maintain close family or personal relationships. The frustration of dealing with an often-misunderstood condition also can be a complication of the condition.
Self-care
Self-care is critical in the management of fibromyalgia.
- Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
- Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
- Exercise regularly. At first, exercise may increase your pain. But doing it regularly often decreases symptoms. Appropriate exercises often include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
- Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days.
- Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.
Coping skills
Besides dealing with the pain and fatigue of fibromyalgia, you may also have to deal with the frustration of having a condition that's often misunderstood. In addition to educating yourself about fibromyalgia, you may find it helpful to provide your family, friends and co-workers with information.
It's also helpful to know that you're not alone. Organizations such as the Arthritis Foundation and the American Chronic Pain Association provide educational classes and support groups. These groups can often provide a level of help and advice that you might not find anywhere else. They can also help put you in touch with others who have had similar experiences and can understand what you're going through.
References
1. Veale D, Kavanagh G, Fielding JF, Fitzgerald O. Primary fibromyalgia and the irritable bowel syndrome. Br J Rheumatol. 1991;30:220-222.
2. Lubrano E, Iovino P, Tremolaterra F, et al. Fibromyalgia in patients with irritable bowel syndrome. An association with the severity of the intestinal disorder. Int J Colorectal Dis. 2001;16:211-215.
3. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160-172.
Web Links
The American Fibromyalgia Syndrome Association (AFSA) is a 501(c)3 nonprofit organization dedicated to research, education, and patient advocacy for fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS). AFSA is the only charitable organization whose primary mission is to seed research in FMS and CFS. Over 90% of contributions go directly towards their mission.
The The American Association for Chronic Fatigue Syndrome (AACFS) is a non-profit organization which promotes physician education and increased awareness of chronic fatigue syndrome.
The National Fibromyalgia Association
Haworth Medical Press
10 Alice Street
Binghamton, NY 13904
(800) 342-9678
Publisher of two peer-reviewed medical journals relating to MPS/FMS/CFS.
Journal of Musculoskeletal Pain
Journal of the Chronic Fatigue Syndrome
The following are Web sites that provide information on chronic pain treatments and prescription guidelines:
The American Pain Society
Partners Against Pain provides public info on chronic pain treatment
The Pain and Policy Studies Group site hosted by University of Wisconsin
