Fibromyalgia

Symptoms

The primary symptoms of Fibromyalgia include:

• Widespread pain. The pain associated with Fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

• Fatigue. People with Fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with Fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.

• Cognitive difficulties. A symptom commonly referred to as "fibro fog" impairs the ability to focus, pay attention and concentrate on mental tasks.

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Fibromyalgia often co-exists with other conditions

• Irritable Bowel Syndrome

• Chronic Fatigue Syndrome

• Migraine and other types of headaches

• Interstitial Cystitis or Painful Bladder Syndrome

• Temporomandibular Joint Disorders (TJD)

• Anxiety

• Depression

• Postural Tachycardia Syndrome

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Causes

Researchers believe that the reason behind this condition is the repeated stimulation of nerves which causes the brain and spinal cord to undergo changes. These changes are characterized by an abnormal increase in the levels of specific chemicals in the brain that signal pain. Moreover, the pain receptors in the brain become sensitized due to the development of pain memory. This means that these receptors overreact to both painful and non-painful signals, leading to persistent pain and discomfort for the sufferers of fibromyalgia.

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There are likely many factors that lead to these changes, including:

• Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.

• Infections. Some illnesses appear to trigger or aggravate fibromyalgia.

• Physical or emotional events. Fibromyalgia can sometimes be triggered by a physical event, such as a car accident. Prolonged psychological stress may also trigger the condition.

 

Risk factors

Risk factors for fibromyalgia include:

• Your sex. Fibromyalgia is diagnosed more often in women than in men.

• Family history. You may be more likely to develop fibromyalgia if a parent or sibling also has the condition.

• Other disorders. If you have osteoarthritis, rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.

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Complications

Fibromyalgia is a chronic condition that causes widespread pain, fatigue, and sleep disturbances. The pain can be described as a dull ache that lasts for at least three months and occurs in various areas of the body. This chronic pain can greatly affect daily activities and make it difficult to complete tasks at home or on the job. In addition to the physical symptoms, fibromyalgia can also lead to depression and anxiety due to the frustration of living with a misunderstood condition.

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Diagnosis

Previously, physicians used to assess 18 specific points on a patient's body to determine how many of them caused pain upon firm pressure. Nowadays, for a fibromyalgia diagnosis, the crucial factor is experiencing widespread pain throughout the body for a minimum of three months.

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To meet the criteria, you must have pain in at least four of these five areas:

• Left upper region, including shoulder, arm or jaw

• Right upper region, including shoulder, arm or jaw

• Left lower region, including hip, buttock or leg

• Right lower region, including hip, buttock or leg

• Axial region, which includes neck, back, chest or abdomen

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Tests

Your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include:

• Complete blood count

• Erythrocyte sedimentation rate

• Cyclic citrullinated peptide test

• Rheumatoid factor

• Thyroid function tests

• Anti-nuclear antibody

• Celiac serology

• Vitamin D

 

If there's a chance that you may be suffering from sleep apnea, your doctor may recommend an overnight sleep study.

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Treatment

When it comes to treating fibromyalgia, a combination of medication and self-care techniques are usually employed. The goal is to reduce symptoms and enhance overall health. As there is no one-size-fits-all solution, it's important to try different treatment methods, as they can have a cumulative effect

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Medications

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

• Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Opioid medications are not recommended, because they can lead to significant side effects and dependence and will worsen the pain over time.

• Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep.

• Anti-seizure drugs. 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 by the Food and Drug Administration to treat fibromyalgia.

 

Therapies

A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include:

• Physical therapy. A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful.

• Occupational therapy. An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body.

• Counselling. Talking with a counsellor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.

Self-care

Self-care is critical in the management of fibromyalgia.

• Stress management. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.

• Sleep hygiene. Because fatigue is one of the main components of fibromyalgia, getting good quality sleep is essential. In addition to allotting 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. Do not use tobacco products. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.

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Alternative medicine

Complementary and alternative therapies have been used for thousands of years to manage pain and stress. In recent years, their popularity has increased, particularly among individuals with chronic illnesses like Fibromyalgia. Some of these therapies have been proven to safely alleviate stress and pain, and a few are gaining acceptance in mainstream medicine. However, many of these practices lack sufficient research and evidence to prove their effectiveness.

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• Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit.

• Massage therapy. This is one of the oldest methods of health care still in practice. It involves the use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety.

• Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.

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Preparing for your appointment

Because many of the signs and symptoms of fibromyalgia are similar to various other disorders, you may see several doctors before receiving a diagnosis. Your family physician may refer you to a doctor who specializes in the treatment of arthritis and other similar conditions (rheumatologist).

 

What you can do

Before your appointment, you may want to write a list that includes:

• Detailed descriptions of your symptoms

• Information about medical problems you've had in the past

• Information about the medical problems of your parents or siblings

• All the medications and dietary supplements you take

• Questions you want to ask the doctor

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What to expect from your doctor

In addition to a physical exam, your doctor will probably ask you if you have problems sleeping and if you've been feeling depressed or anxious.

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