What Is Fibromyalgia?
Fibromyalgia is a chronic condition that causes pain, stiffness and tenderness of muscles, tendons, and joints. It may also be associated with un-refreshing sleep, pain, chronic fatigue, nervousness, depression, and disturbances in bowel function. It can interfere significantly with the ability to do daily activities
What Is Fibromyalgia?
Fibromyalgia is a chronic condition that causes pain, stiffness and tenderness of muscles, tendons, and joints. It may also be associated with un-refreshing sleep, pain, chronic fatigue, nervousness, depression, and disturbances in bowel function. It can interfere significantly with the ability to do daily activities.
Fibromyalgia is often considered as a condition associated with arthritis. However it is not a form of arthritis (a disease of the joints) as there is no inflammation of the joints, muscles or other tissues nor does it cause damage, deformity, or injury to internal body organs. It is rather a disorder related to the muscles and probably nerves.
Who Does Fibromyalgia Affect?
80% of people affected are women between the ages of 35 and 55. Less frequently, fibromyalgia can affect men, children and the elderly.
It can occur as a disease on its own or may be associated with another disease, such as systemic lupus erythematosus (SLE) or rheumatoid arthritis.
The incidence in Ghana is unknown but in Sweden and Britain, 1% of the population is affected by fibromyalgia. In the United States, about 4% of the population has fibromyalgia.
What Causes Fibromyalgia?
The cause is not known. Studies show that those who have it experience pain in response to stimuli that are normally not perceived as painful by other people. Researchers have found higher levels of a nerve chemical signal called substance P and nerve growth factor in the spinal fluid of fibromyalgia patients.
Levels of the brain chemical serotonin which reduces depression are also relatively low in patients with fibromyalgia. Studies of pain in fibromyalgia have suggested that the central nervous system (brain) may be somehow supersensitive. Also, patients with fibromyalgia have an impaired non-rapid eye movement, or non-REM, sleep phase which may account for the common complaint of waking up fatigued and unrefreshed in these patients.
What Are Symptoms and Signs of Fibromyalgia?
Symptoms often begin after a physical trauma, surgery, infection or significant psychological stress. The symptoms may progressively accrue over time with no single initiating event.
Fibromyalgia is not always easy to diagnose because symptoms vary from person to person. Many of the symptoms may mimic other diseases; there are no clear cut signs that a physician can see, and there is no definitive laboratory test for fibromyalgia.
The common symptom is pain. As stated previously, the pain in fibromyalgia is not caused by tissue inflammation. Instead, patients seem to have an increased sensitivity to many different sensory stimuli and an unusually low pain threshold. The pain of fibromyalgia is usually widespread affecting the neck, buttocks, shoulders, arms, the upper back, and the chest. The pain can be worsened by noise, weather change and emotional stress.
Other symptoms include anxiety, depression, migraine and tension headaches, numbness or tingling of different parts of the body, abdominal pain related to irritable bowel syndrome (“spastic colon”) causing constipation or diarrhea, and irritable bladder, causing painful and frequent urination.
How Is Fibromyalgia Diagnosed?
Fibromyalgia ‘tender points’ are localized areas of the body that are tender to light touch. Fibromyalgia tender points, or pressure points, are commonly found around the elbows, shoulders, knees, hips, back of the head, and the sides of the breastbone and are typical signs of fibromyalgia.
According to the American College of Rheumatology, before the diagnosis of fibromyalgia can be made, the muscle pain must be present for longer than three months.
There are no blood tests or X-rays that specifically point the doctor to the diagnosis of fibromyalgia. Tests are often done to exclude other possible diagnoses. Usually, the diagnosis of fibromyalgia is made on clinical grounds based on the doctor’s history and physical examination.
In patients with chronic widespread body pain, the diagnosis of fibromyalgia can be made by identifying point tender areas. Characteristically, but not always, patients will have at least 11 of the 18 classic fibromyalgia tender points. A diagnosis can also be made by finding no accompanying tissue swelling or inflammation, and by excluding other medical conditions that can mimic fibromyalgia.
What Is the Treatment for Fibromyalgia?
Although there is no cure for fibromyalgia, treatment can relieve some of the symptoms. Since symptoms are numerous and vary among patients, treatment programs must be individualized for each patient. Treatment includes patient education, stress reduction, regular exercise and medications.
Medications can help reduce the pain of fibromyalgia and improve sleep.
Analgesics like Paracetamol may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies. Tramadol is a prescription pain reliever may be helpful as well as nonsteroidal anti-inflammatory drugs (NSAIDs) – such as Ibuprofen or Naproxen sodium in conjunction – with other medications.
Antidepressants like Duloxetine (Cymbalta) may help ease the pain and fatigue associated with fibromyalgia. Amitriptyline or Fluoxetine (Prozac) also help to promote sleep.
Anti-seizure drugs such as medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while Pregabalin (Lyrica) was the first drug approved to treat fibromyalgia.
Lifestyle and alternative care
Self-care is critical in the management of fibromyalgia.
Reduce stress. Avoid or limit overexertion and emotional stress as much as possible. Try stress management techniques, such as deep-breathing exercises or meditation.
Get enough sleep. Getting sufficient sleep is essential. As well as allowing enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not “overdoing it” on your good days, but likewise it means not self-limiting or doing “too little” on the days when symptoms flare.
Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake.
Alternative medicines such as acupuncture, massage therapy, Yoga and tai chi may help relieve pain as well.
The writer is a Physician Specialist & Rheumatologist
0244 672 343