Fibromyalgia
Fibromyalgia (FM) is a condition in which pain occurs in muscles and surrounding structures without any obvious tissue damage. It is an increasingly recognized chronic pain illness which is characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle and hands, but any body part can be involved.
The most common symptoms of FM include any of the following:
• pain, ranging from mild to severe, widespread and chronic. It knows no boundaries, migrating to all parts of the body and may present in a variety of ways such as aching, burning, throbbing or stabbing. Neurological complaints such as numbness, tingling and burning are often present and add to the discomfort of the patient. Aggravating factors which affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress
• stiffness, usually worse in the morning
• sleep disturbance
• fatigue
• headaches.
Some people with FM may also have symptoms such as irritable bowel syndrome, cystitis, swelling and numbness or tingling in the arms and legs
What causes Fibromyalgia?
The underlying cause or causes of FM still remain a mystery. Nowadays it is believed that FM patient experiences pain amplification due to abnormal sensory processing in the central nervous system. Genetic factors may predispose individuals to a genetic susceptibility to FM. For some, the onset of FM is slow; however, in a large percentage of patients, the onset is triggered by things such as viral illnesses, physical or emotional trauma. These events may act to incite an undetected physiological problem already present.
Who Gets Fibromyalgia?
Although a higher percentage of women aged between 20 and 40 are affected, it does strike men, women and children of all ages and races. It is estimated that approximately 3-6% of the U.S. population has FM.
The Diagnosis of Fibromyalgia?
Currently, there are no laboratory tests available for diagnosing FM . There are key signs that may assist the doctor in making a diagnosis, including a history of widespread pain for three months or longer and tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see figure below)
Medications
Painkillers such as acetaminophen or non-steroidal anti-inflammatory drugs may be helpful in relieving pain. Low doses of antidepressants or benzodiazepines can help to improve sleep and relieve pain. If the patient is experiencing depression, higher levels of these or other medications may be needed. Another beneficial pain therapy, which works well on localized areas of pain, is lidocaine injections into the patient’s tender points.
Treatment
Effective management of FM starts with a correct diagnosis. Generally, management will include a combination of the following:
• Education is one of the most important components of treatment to help the patient understand the condition in order to decide what treatment will be effective for their individual circumstances.
• Medication may be used in combination with other strategies to manage pain, reduce stress or promote sleep.
• Exercise: a gentle exercise program such as tai chi or water-based exercise can have multiple benefits for the person with FM and can assist in the management of symptoms such as pain, fatigue and sleep disturbance.
• Stress management and relaxation techniques.
• Massage
What is the outlook?
FM does not cause joint deformity. Although the pain and discomfort can last for many years and often wax and wane, most patients do tend to improve over time.