| Category | Fibromyalgia |
What is Fibromyalgia?
Fibromyalgia is a chronic health problem that causes pain all over the body and other symptoms. Fibromyalgia affects two to four percent of people, mostly women.
Other Symptoms that Patients most often have are:
Some Patients also may have:
Symptoms of fibromyalgia and its related problems can vary in intensity and will wax and wane over time. Stress often worsens the symptoms.
What Causes FM?
The exact cause of FM is not known. It is likely to be multifactorial. Genetic predisposition with disease running in families is well recognized. Environmental insults including viral infections, stress (both emotional and physical), and depression in some cases can contribute to the onset of illness. FM can coexist with rheumatic diseases like rheumatoid arthritis, systemic lupus erythematosus, and Sjogren's syndrome.
How Common is FM?
It is very common. Up to 3% of the population suffers from it. It is most common around the 4th decade. FM is more common in women but it can occur in men and children too.
How is FM Diagnosed?
There is no single diagnostic test for fibromyalgia, unlike a blood sugar test for the diagnosis of diabetes. The diagnosis is based on the combination of symptoms and physical examination. Widespread aches and pains affecting both sides of the body are the hallmarks of FM. Neck pain and back pain are the common symptoms. Extreme fatigue, early morning stiffness, non-refreshing and non-restorative sleep, subjective feeling of swelling of limbs and joints, and numbness of peripheries are also common. Migraine-like headaches, abdominal symptoms like bloating, heartburn, the tendency to visit the toilet frequently, particularly after food (irritable bowel syndrome), and urgency to pass urine frequently (irritable bladder) are other associated symptoms. FM patients also have multiple tender points over the body, which the doctor can identify on examination. So it is the combination of symptoms and the presence of tender points that lead to the diagnosis of FM.
What does Current Research Say?
FM is shown now to be a syndrome of low pain threshold and altered pain perception. The volume setting for pain perception is found to be higher in FM patients compared with the normal population. Because of this FM patients would feel more pain compared with non-FM persons for the same amount of stimulus. This process is called central sensitization, high lighting that the origin of the pain is from the nervous system rather than in the places where the pain is felt. Alteration in pain-related neurotransmitters, Serotonin, and substance P have been demonstrated in cerebrospinal fluid. Abnormalities in the sympathetic nervous system, hypothalamo-pituitary adrenal axis, and growth hormone secretion have been demonstrated in FM. This might indicate defective mechanisms to fight stress. Some association with depressive illness and other psychiatric diseases like chronic fatigue syndrome, non-cardiac chest pain, non-ulcer dyspepsia, chronic pelvic pain, depression, anxiety, and fibromyalgia has been shown, indicating shared etiology.
How is FM Treated?
Usually, FM symptoms are mild and patients manage to lead a normal life in spite of the pain. Painkillers like paracetamol and NSAIDs like ibuprofen may be of some help. Unlike the pain of arthritis, the pain of FM doesn’t respond to the above drugs well. It is a different type of pain requiring a different type of medicine. Antidepressant drugs used in doses much lower than what is needed to treat depression are useful in correcting sleep disturbance and in improving pain threshold. Amitriptyline is one such drug. Dothiepin, nortriptyline, Duloxetine, and Milnacipran are some of the antidepressant drugs found to be useful in managing the symptoms of FM. Anti-convulsant drugs (anti-fits drugs ) like Pregabalin and Gabapentin also help the pain of fibromyalgia.
Cognitive behavioral therapy (CBT) will help patients to take control of his or her illness. This is usually done by trained pain psychologists. CBT changes the way the patient thinks about the illness and encourages patients to lead a more productive life.
Walking, swimming and cycling are some of the exercise strategies to improve one's stamina and physical conditioning. Pain and fatigue make one deconditioned. A graded increase in intensity and duration is essential to overcome the post-exercise increase in pain. Relaxation techniques like yoga, Tai Chi and low impact dancing, and aerobics may help many.
Fibromyalgia is generally treated by a team of pain specialists including rheumatologists, pain consultants, physiotherapists, and pain psychologists. More importantly, the patient is an active member of the treatment team.
How to cope with Fibromyalgia?
