Fibromyalgia

 

What is Fibromyalgia?

Fibromyalgia (FM) is a disease or symptom complex characterised by widespread pain and profound fatigue.

What causes FM?

The exact cause of FM is not known. It is likely to be multifactorial. Genetic predisposition with disease running families is well recognised. 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 rheumatic arthritis, systemic lupus erythematosus and Sjogren's syndrome.

How common is FM?

It is very common. Upto 3% of the population suffers from it. FM also occurs all over the world. 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 blood sugar test for the diagnosis of diabetes. The diagnosis is based on the combinations of symptoms, 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, numbness of peripheries are also common. Migraine like headaches, abdominal symptoms like bloating, heart burn, tendency to visit  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 the symptoms and the presence of tender points that lead to the diagnosis of FM.

As mentioned earlier, there are no laboratory tests in the diagnosis of FM. Many patients are suspected to have other diseases and are investigated extensively before FM is diagnosed. Your doctor would have ruled out diseases like cancer and arthritis.

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 sensitisation, high lighting that the origin of pain is from nervous system rather than in the places where pain is felt. Electrophysiology study of sleep has shown disturbance in sleep patterns and some of FM patients may have sleep apnoea syndrome. Alteration in pain related neurotransmitters, Serotonin and substance P have been demonstrated in cerebrospinal fluid. Abnormalities in sympathetic nervous system, hypothalamo-pituitary adrenal axis, growth hormone secretion have been demonstrated in FM. This might indicate defective mechanisms to fight stress. Some association with depressive illness and other psychiatric illness are found. There is a significant overlap between diseases like chronic fatigue syndrome, tension head ache, irritable bowel syndrome, non cardiac chest pain, non ulcer dyspepsia, chronic pelvic pain, depression, anxiety and fibromyalgia indicating shared aetiology.

 

How is FM treated?

Usually FM symptoms are mild and patients mange to lead a normal life in spite of the pain. In some cases, pain can be severe and is comparable with the pain of patients with Rheumatoid Arthritis.

There is no cure. But the symptoms can always be helped. 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 medicines. Antidepressant drugs used in doses much lower than what is needed to treat depression are useful in correcting sleep disturbances and in improving pain threshold. Amitriptyline is one such drug. Dothiepin, nortriptyline, Duloxetine, milnacipran are some of the anti depressant 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 behavioural therapy ( CBT) will help patients to take control of his or her illness. This is usually done by trained pain psychologists. Chronic pain leads to lot of mal-adaptive behaviours and beliefs. CBT helps in changing the way one think about the illness and encourages patients to lead a more productive life. Stretching exercises (must be done for thirty minutes atleast five times a day) are an important aspect of the therapy.

Walking, swimming and cycling are some of the exercise strategies to improve one's stamina and physical conditioning. Pain and fatigue make one de conditioned. Graded increase in the intensity and the duration is essential to overcome post exercise increase in pain. Relaxation techniques like yoga, Tai Chi and low impact dancing and aerobics may help many.

Fibromylgia 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 up with Fibromyalgia?

  • Knowing that FM, though a chronic painful disease is not a life threatening or a crippling should reassure you.
  • Learn to relax, pace your activities according to pain levels and energy levels.
  • Pain does not always mean tissue damage. So don't stop your activities totally.
  • Ignore some discomfort, count on functional improvement.
  • Be prepared for some bad days and some good days.
  • A brief period of rest in between work (micro-rest) and an afternoon nap can be energising.
  • Hot water shower and heat in any form will refresh you. A shower in the evening may help you to fresh at dinner time.
  • Regular sleep habits will help. Avoid caffeine and cola drinks after 6 PM. Avoid watching movies from the bed. Condition your mind that bed is for sleeping. Having the fan on can act as the white noise to filter extraneous noises at night.
  • Be open with parents, partner and friends so that they will understand your illness and be more supportive.
  • Develop new hobbies; divert your attention and energy towards positive side of life.
  • By understanding the nature of the illness, you may be able to avoid unnecessary investigations and harmful therapy.
  • Be regular with your exercises and taking the prescribed medicine.
  • Discuss with your physician, your doubts and the concerns regarding the disease and the medications.