What is Fibromyalgia?
Fibromyalgia is a condition characterised by pain in joints, muscles, tendons, and other soft tissues. The pain occurs in areas called ‘tender points’. Common tender points are the front of the knees, the elbows, hip joints and around the neck.
What are the causes?
The cause of this disorder is unknown. Physical or emotional trauma may play a role in development of this syndrome. Fibromyalgia patients have abnormal pain transmission responses. It can develop on its own, or secondary to other musculoskeletal conditions, such as rheumatoid arthritis, or systemic lupus.
It has been suggested that sleep disturbances, which are common in fibromyalgia patients, may actually cause the condition. The disorder may be associated with changes in skeletal muscle metabolism, possibly caused by decreased blood flow, which could cause chronic fatigue and weakness. Others have suggested that an infectious microbe, such as a virus, triggers the illness. No such virus or microbe has yet been identified. Studies have shown a possible inherited tendency toward the disease, though evidence is very preliminary.
What are the symptoms?
Increased sensitivity to pain is the main symptom of fibromyalgia. Symptoms may come and go. One may have some degree of constant pain, but the pain may get worse in response to activity, stress, weather changes and other factors. One may also have a deep ache or a burning pain, muscle tightening or spasms. Many people have migratory pain (pain that moves around the body). Most people with fibromyalgia feel tired or fatigued (out of energy). This fatigue may be mild or very severe. They may also have trouble sleeping, which may add to the fatigue. One has feelings of numbness or tingling in parts of the body, or a feeling of poor blood flow in some areas. Many people are very sensitive to odours, bright lights, loud noises and even medicines. Headaches and jaw pain are also common.
In addition, one may have dry eyes or difficulty focusing on nearby objects. Problems with dizziness and balance may also occur. Some people have chest pain, a rapid or irregular heartbeat, or shortness of breath. Digestive symptoms are also common in fibromyalgia and include difficulty swallowing, heartburn, gas, cramping abdominal pain, and alternating diarrhoea and constipation. Some people have urinary complaints, including frequent urination, a strong urge to urinate and pain in the bladder area. Women with fibromyalgia often have pelvic symptoms, including pelvic pain, painful menstrual periods and painful sexual intercourse.
Multiple tender areas (muscle and joint pain) on the back of the neck, shoulders, sternum, lower back, hip, shin, elbows, knees.
Reduced exercise tolerance
Chronic facial muscle pain or aching
How is it diagnosed?
Diagnosis of fibromyalgia requires a history of a least three months of widespread pain, and pain and tenderness in at least 11 of 18 tender-point sites. Number of tests may be done to rule out other disorders. An examination reveals multiple tender areas on the back of the neck, shoulders, sternum, lower back, hip, shin, elbows, or knees.
Sometimes, laboratory and X-ray tests are done to help confirm the diagnosis. The tests will also rule out other conditions that may have similar symptoms. Other underlying ailments, such as chronic fatigue syndrome, irritable bowel syndrome, and rheumatoid arthritis, can also be present. New patients should be checked for these underlying conditions as well as fibromyalgia.
What is the treatment?
In mild cases, symptoms may go away when stress is decreased or lifestyle changes are implemented. A combination of treatments including medications, patient education, physical therapy, and counselling are usually recommended. Many fibromyalgia sufferers have found support groups helpful. Certain classes of antidepressant medications are sometimes prescribed for the disorder. Antidepressants in low doses can decrease depression, relax craniofacial and skeletal muscles, improve sleep quality, and release pain-killing endorphins. Other medications that are used include anti-inflammatory pain medications and medications that work on pain transmission pathways. Eating a well-balanced diet, and avoiding caffeine may help with problems of sleeping, and may help reduce the severity of the symptoms. Lifestyle measures to improve the quality of sleep can be effective for fibromyalgia.
Improved fitness through exercise is recommended. Fibromyalgia symptoms can be relieved by aerobic exercise. The best way to begin a fitness programme is to start with low impact exercises, like walking and swimming. Starting slowly helps stretch and mobilise tight, sore muscles. High-impact aerobics and weight lifting could cause increased discomfort. Gentle stretching and light massage may help relieve symptoms, as do relaxation techniques. Severe cases of fibromyalgia may require a referral to a pain clinic.
What is the prognosis?
Fibromyalgia is a common and chronic problem. The symptoms sometimes improve. At other times, the symptoms may worsen and continue for months or years. The key is seeking professional help which includes a multi-faceted approach to the management and treatment of the disease. There is no proof that fibromyalgia syndrome results in an increased death rate.