Fibromyalgia is chronic neurological disorder that involves widespread pain, tenderness, fatigue, and other symptoms. It is common in middle-aged women but can affect patients of either sex and at any age. 2-4 percent of people may be affected by fibromyalgia. The term fibromyalgia means pain in muscles and fibrous tissues (tendons and ligaments).
Fibromyalgia is still considered a medically benign disorder, as it does not cause any serious problem or physical deformities, or loss of life. But it has a profound effect on the quality of life of the patient because it interferes with a person’s ability to perform everyday activities and affects cognitive functioning such as the ability to think, to reason, to remember. The diagnosis can be made with careful examination and exclusion of other diseases having similar symptoms.
There is no cure for the fibromyalgia; support from health professionals can provide positive effects on patients’ quality of life. Health services (general practitioners, specialists, public health facilities, medical insurance companies) can play a key role in helping patients come to terms with the disease; and for that, it is important that all professionals involved in managing fibromyalgia to have specific knoweldge about the disease.
Fibromyalgia is a syndrome combined with several signs and symptoms that includes:
Pain: There are widespread different types of pain in body which are not consistent and may vary in severity and location. There are days when person may not feel pain at all.
Fatigue: People with fibromyalgia often feel tired; even after awakening from long duration of sleep. Sleep is often disrupted by pain, restless legs syndrome and sleep apnea.
Cognitive difficulties: Cognitive difficulties that can occur with fibromyalgia are commonly termed as "fibro fog". It can manifest in different ways such as:
Sometimes difficulty of mental alertness can be more devastating than the pain and fatigue associated with fibromyalgia. Some patients also may have:
Tender points- There are certain points which are tender (pain with pressure).The fibromyalgia tender points are symmetrical; they are present on both sides of the body. These tender points are very small. All of them are around joints, (but fibromyalgia pain has nothing to do with the joints themselves).
The tender point locations are:
The exact cause of fibromyalgia is not clear. It is not an autoimmune, inflammatory, joint, or muscle disorder; though some factors such as spine problem, arthritis, injury, or other type of physical stress even emotional stress may trigger this illness.
More recently, fibromyalgia has been described as ‘central pain amplification disorder’, meaning the volume of pain sensation in the brain is turned up too high. There is abnormal pain processing particularly in the central nervous system rather than from dysfunction in peripheral tissues where pain is perceived. There is a change in the way the body communicates with the spinal cord and brain.
Though genes alone do not cause fibromyalgia, but there may be certain genes that can make people more prone to getting fibromyalgia. Fibromyalgia may run in families.
There is no diagnostic test for fibromyalgia; therefore disease is diagnosed by examining the patient, evaluating symptoms, and ruling out other conditions. There are some conditions that can be confused with fibromyalgia such as hypothyroidism, rheumatoid arthritis, systemic lupus erythematosus, polymyalgia rheumatica and other inflammatory and autoimmune disorders. Physical findings and blood tests will help the medical expert to differentiate these diseases.
A fibromyalgia diagnosis is often made when a patient has unexplained pain for at least 3 months; and at least 11 of 18 tender points in specific locations are tender (even light pressure can cause pain) (though the presence of tender points is not specific reason for making diagnosis); and no other health problem is detected that could explain the pain and other symptoms.
These tender points should not be confused with trigger points, which are associated with chronic myofascial pain. The primary difference between tender points and trigger points is that trigger points can produce referred pain (they can cause pain in other parts of the body).
When doctor tests tender points for pain, other non-tender places on body called control points are also tested to make sure the reaction of a person about tenderness.
Management of fibromyalgia involves a combination of medications, stress management, exercise and rest with enough sleep. There is no cure for fibromyalgia. However, symptoms can be treated with both non-drug measures and medication based treatments. Many times the best outcomes are achieved by using multiple types of treatments.
Non-Drug Therapies: People with fibromyalgia can use non-drug therapies as well as medicines suggested by their doctors. Following are some non drug therapy measures to manage fibromyalgia:
Patient’s self-care is an important aspect to improving symptoms and daily functions of a person having fibromyalgia. Healthy lifestyle behaviour can reduce pain, increase sleep quality, lessen fatigue and help to cope better with fibromyalgia.
Regular Exercise: It is reported that regular exercise is one of the most effective treatments for fibromyalgia. People with fibromyalgia who have too much pain or fatigue should begin with walking or other gentle exercise (water aerobics and/or stretching exercises) and build their endurance and intensity slowly. Patients should follow the saying, “Start low, go slow.” It takes time to create a comfortable routine. Just get moving, stay active and don't give up.
Make time to relax each day: Deep-breathing exercises and meditation will help reduce the stress that can bring on symptoms. It’s also important to manage daily schedule with time to rest and relax. Persons with fibromyalgia should avoid making too many commitments that can make them fatigue.
Set a regular sleep pattern: Patient should go to bed and wake up at the same time each day. Getting enough sleep will help body to repair itself, physically and mentally. Avoid daytime napping and limit caffeine intake, which can disrupt sleep. For those who smoke, they should stop smoking (nicotine is a stimulant and aggravates sleep problems).
Look forward, not backward: Person with fibromyalgia should focus on tasks need to do to get better, not what caused the illness. Do something that you find enjoyable and fulfilling every day.
Keep dietary habits healthy: Person should try to eat a healthy, balanced diet. Proper nutrition can help body stay healthy and provide a constant supply of energy and nutrients so that symptoms of fibromyalgia may not get worse.
Educate yourself about illness; and share the information with family, friends and co-workers.
Moist heat can be used to relieve deep muscle pain and stiffness like moist heating pad, warm bath or shower.
Cognitive behavioral therapy (CBT): CBT and related treatments, such as mindfulness, can help patients learn symptom reduction skills that lessen pain. CBT is based on understanding that how thoughts and behaviours can affect pain and other symptoms. Mindfulness is a non-spiritual meditation practice that cultivates present moment awareness and has been shown to significantly improve symptoms of fibromyalgia.
Other complementary and alternative therapies (sometimes called CAM or integrative medicine), such as acupuncture, chiropractic and massage therapy, yoga and tai chi can be useful to manage fibromyalgia symptoms (though many of these treatments have not been well tested in patients with fibromyalgia).
Manage risk factors-It is important to address risk factors and triggers for fibromyalgia including sleep disorders, such as sleep apnea, and mood problems such as stress, anxiety, panic disorder, and depression. This may require involvement of other specialists such as a sleep medicine doctor, psychiatrist.
Initial management of fibromyalgia involves patient education with focus on non-pharmacological therapies. Though in non-responsive patients, pharmacological therapies should be added especially to those with sleep or mood disturbances.
Drugs like pregabalin, gabapentin (which work by blocking the over activity of nerve cells involved in pain transmission) may be used for management of pain of fibromyalgia. These medicines may cause dizziness, sleepiness, swelling and weight gain.
The antidepressants duloxetine and milnacipran, which are used to relieve pain, fatigue, and sleep problems, are generally used at lower doses than for treatment of depression.
Several medications are avoided or used carefully. Opioids, hypnotics, anxiolytics, and certain skeletal-muscle relaxants are used with caution because of the potential for abuse and the risk of worsening fatigue and cognitive dysfunction.
Over-the-counter medicines such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are not effective for fibromyalgia pain. These drugs may be useful to treat the pain triggers of fibromyalgia such as arthritis.
For sleep problems, some of the medicines that treat pain also improve sleep. These include cyclobenzaprine, amitriptyline, gabapentin and pregabalin. Sleeping medicines like zolpidem or benzodiazepine medications are not recommended in patients with fibromyalgia.
Vitamin D supplements may reduce pain in people with fibromyalgia who are deficient in this vitamin.
A number of things that make symptoms worse can be avoided such as