Healthy Living

Standing: An Overlooked Issue in Fibromyalgia

Standing: An Overlooked Issue in Fibromyalgia

The fibromyalgia disease is a very complicated disease that affects an individual in many ways than one. It has been researched properly and its effects have been made clearer. The fibromyalgia disease makes alterations in the functions of some parts of the internal body system such as: activating the sympathetic nervous system (flight or fight system) during rest or sleep and the sympathetic nervous system diminishing during rest, drastically decreasing the rate of response of the heart during exercise (Chronotropic Incompetence), and improper functioning of the baroreflex response. This series of effects have been known to cause a lot of pain to a fibromyalgia patient.

The baroreflex response has been known to be the regulator of the functioning of the autonomic nervous system and the maintenance of blood pressure. How this affects the individual affected by fibromyalgia and how he or she copes with it are the main questions in this study. Why? Because standing is also influenced by the baroreflex system

The Baroreflex Response

The baroreflex response is responsible for standing without feeling dizzy or fainting. This response works with the nerves around and in the heart. It is the receptors in these nerves that consistently monitor the body blood pressure. It alters the heart rate by reducing the activity of the sympathetic nervous system, whenever the pressure of the blood gets too high. In the same manner, it also increases the activity of the sympathetic nervous system in case the blood pressure gets too low. This system helps the body easily and quickly adjust to any changes in blood pressure, either it is severe or not.

One major advantage of the baroreflex response in balancing the blood pressure of the body is that it keeps blood regulated at the upper part of the body while standing. The body is acted upon by gravity while standing, and this forces the blood to the lower part of the body. A slight problem with the baroreflex response can cause one to feel light headed or signs of fatigue when standing.

Since the problems with the baroreflex system is one of the common effects of the fibromyalgia disease, therefore it has to be studied critically. Reduction in the function of the baroreflex reflex would lead to an increase in pain for those affected with the fibromyalgia disease. A study was carried out in 2010 to show the role baroreceptors play in pain inhibition. It was shown that cardiovascular control problems had a role to play in the pain problems that fibromyalgia patients faced. Therefore, a faulty baroreceptor response would lead to pain and problems standing and exercising.

Are problems standing the more dominant in fibromyalgia than other effects?

A study was carried out in June 14, 2017 and showed that the quality of life of a fibromyalgia patient affects his or her degree of cardiac baroreflex involvement while actively standing.

The study carried on fibromyalgia patients while standing included electrocardiogram, respiratory activity and autonomic tests, blood pressure, and quality of life assessment. The goal of this study was to determine and record the baroreflex response problems in fibromyalgia, and also determine if reduction in the quality of life and increment in pain were associated with the disease.

The results showed that the problems of the baroreflex response in fibromyalgia really mattered. The study showed that patients with a lower level of baroreflex activity had a higher level of pain and a lower quality of life score. This signified that the reduced level of baroreflex response activity was more likely to hinder the fibromyalgia patients from carrying out daily activities, especially activities that involved standing.

It is important that more research has to be carried out on the fibromyalgia disease. It is clear that a common symptom of the disease is the orthostatic intolerance, but it cannot be ascertained that it is the main symptom. Orthostatic intolerance has never been stated by WebMd, Medical News Today, and Mayo Clinic as the major symptom of fibromyalgia. Although, Medical News Today stated dizziness as a secondary symptom of the disease.

The orthostatic intolerance problems were first noticed as far back as 1997. A study was carried out, and 60% of the fibromyalgia patients showed a very substantial drop in blood pressure in a tilt-table test. Another follow up study was carried out by Martinez-Lavin in 1998 to show the autonomic nervous system problems fibromyalgia patients faced while standing.

Another study carried out in 2005 showed a high level of fainting in a step-wise TILT test. This high level of fainting accounted for 44% of the fibromyalgia patients. During this study, the Postural Orthostatic Tachycardia Syndrome (POTS) test was not carried out at all. The Postural Orthostatic Tachycardia Syndrome (POTS) leads to a heart rate greater than 30 while standing. It was later review by Staud in 2008, stating that the Postural Orthostatic Tachycardia Syndrome (POTS) commonly occurred in tilt-table tests for fibromyalgia.

The common mistake in all studies was carrying out improper tests. To carry out a proper fibromyalgia test, there has to be a stressor which is usually standing or exercises to bring out every defect present.

Connection of the Autonomic Nervous System with Pain

It is no news that autonomic nervous system is associated with pain, in relation to the fibromyalgia disease. This has been proved in two studies which indicated that the symptom severity has a high correlation with the indices of the autonomic system stress. These studies have shown that some symptoms like problems standing, stressful events, tolerating warm temperatures, dry eyes and/or mouth, sensitivity to light, sweating, problems with the bladder and bowel might be indicative.

Later in 2015, a study discovered a direct correlation of the sympathetic nervous system activation with the amount of pain experienced by a fibromyalgia patient. Another study indicated that an autonomic dysfunction is characteristic of fibromyalgia. Although the central sensitization has been the dominant trait, the autonomic nervous system has to be considered as well.

For a fibromyalgia patient to be sure of orthostatic intolerance or autonomic nervous system dysfunction, he or she should look out for the following symptoms while standing whether for a short or long period of time: weakness, dizziness, fatigue, fainting, exercise intolerance, anxiety feelings, rapid heartbeats, increased pain, headaches, blurred vision such as white-outs and black-outs, difficulty in breathing (hyperpnea) and swallowing, sensitivity to heat, nausea, sweating, pallor and cognitive difficulties.

The affected individual should also make sure he or she assesses himself with the following questions

  • Does the feeling to move around while standing occur?
  • Is there lack of comfort when standing, sitting upright, and standing for a long period of time?
  • Is there comfort sitting with a foot up or with legs crossed?
  • Is there a feeling of tiredness after eating a meal?
  • Are cold showers preferred to warm showers?
  • Is there a feeling of discomfort during a warm weather?

All these questions would give the individual a brighter insight on whether he has orthostatic intolerance or autonomic nervous system problems. These tests can be carried out at home. If the patient would prefer a more professional method but at the comfort of his or her home, he or she should opt in for home testing at any orthostatic intolerance or autonomic nervous system problems resource center.