Fibromyalgia is a condition that causes diffuse body pains over a long period of time. Many other symptoms can be associated with this quite frequently encountered condition. So what exactly is Fibromyalgia? Read on to find out about causes, symptoms, diagnosis and treatment.
Fibromyalgia in simple terms is a condition which causes pain all over the body. Besides, diffuse muscle and joint pains, it can also be associated with problems like tiredness, emotional and mental distress, and lack of sleep. Fibromyalgia is very common. As per CDC, it affects about 5% of the adult population. It affects women more than men. Also, the severity of symptoms may be more in women as compared to men. Fibromyalgia generally appears in between 30 to 35 years of age group.
Causes of Fibromyalgia
Despite being so common, fibromyalgia remains a poorly understood and a difficult to diagnose condition. The exact underlying causes of this problem is not yet well understood. It is perhaps associated with the pain-processing pathways in the brain. Certain individuals become hypersensitive to pain due to some underlying physical or emotional events. Certain common risk factors have been seen repeatedly in patients with Fibromyalgia.
- Disorders like Rheumatoid arthritis have high degree of association with Fibromyalgia
- Family history of bodily pains
- Obesity- Being overweight is considered an important risk factor
- Stressful physical or emotional events like accidents or loss of loved ones have been associated with this problem.
- Illness- Certain viral illnesses have been postulated to trigger Fibromyalgia.
Symptoms of Fibromyalgia
Fibromyalgia is characterized by multiple symptoms. Therefore, it is also known as Fibromyalgia syndrome(FS). The most common symptoms attributed to fibromyalgia include
- Pain and stiffness- Diffuse body pains involving both right & left sides, above and below the waist, lasting more than 3 months is considered typical of this problem. The pain may be a constant dull ache or may have certain “tender points” where pain is sharp.
- Fatigue and tiredness- Patients with Fibromyalgia often wake up fatigued despite getting adequate hours of sleep. The sleep may get distured due to bodily pains leading to poor quality of sleep.
- Depression and anxiety- Fibromyalgia and depression have close linkages. The stress from chronic pains, lack of activity leads to social withdrawal and depression. In fact depression is three times more common in individuals with Fibromyalgia than those without.
- Sleep problems- Certain sleep disorders like Restless leg syndrome and sleep apnoea have been associated with Fibromyalgia.
- Cognitive problems like poor concentration, thinking, and memory impairment.
- Headaches, including migraines
How is Fibromyalgia diagnosed?
Fibromyalgia is essentially a clinical diagnosis. It means that there are no definite pathological or biochemical tests that may point to the diagnosis. The main factor on which a doctor makes a diagnosis of Fibromyalgia is the presence of diffuse body pains for more than three months.
Earlier physicians would base their diagnosis on the presence of “Tender points” in muscles. But this practice has been stopped.
As there is no definite biochemical or pathological marker for this condition, the criteria advised by American College of Rheumatologist in 2010 is used to ascertain this diagnosis.
- Presence of pain and symptoms over the past one week, based on the total of number of painful areas out of 19 different parts of the body described by the society.
- Waking up unrefreshed
- Memory or thought problems
- Presence of symptoms for at least three months
- Absence of any other medical problem that can explain the symptoms like Vitamin D deficiency.
These points are recorded in the form of a questionnaire and given points according to their severity.
Treatment of Fibromyalgia
The first thing to understand is that there is no permanent cure for Fibromyalgia. The treatment aims at reducing the severity of symptoms. This may not be achievable using a single modality. Therefore, one may need multiple forms of intervention simultaneously. The below mentioned lines of treatment have been the most studied. The treatment modalities can be broadly divided into non-medicinal and medicinal.
Non drug therapies
One of the most widely advised and successful treatment options for Fibromyalgia is exercise. Regular aerobic exercise gives the best results. It may seem contradictory to start exercise with pain, but it has been proven beneficial in many studies. One can start with low impact exercises and gradually increase as per tolerance.
Cognitive behavioral therapy
This is focussed on understanding how a person’s thoughts and behaviors affect pain. This includes techniques like meditation and mindfulness which help in stress reduction and have been shown to significantly improve symptoms of fibromyalgia.
Avoidance of aggravating factors
Another important factor is to address risk factors and triggers for fibromyalgia. Over a period of time any individual can ascertain the causes that make the pain worse. The common factors attributed to Fibromyalgia are sleep disorders, mood problems, stress, anxiety, panic disorder, depression, obesity, smoking and many others. This may require involvement of other specialists like a Psychologist, Sleep Medicine doctor, and physiotherapist.
Drug based or pharmacological therapies
Amitriptyline in low doses has been the traditional mainstay of alleviating symptoms of Fibromyalgia. However, it is not very effective and pain may improve by a modest 50% in only one out of four patients treated.
Two drugs, Duloxetine and Milnacipran, act by modulating certain brain chemicals(Serotonin and Norepinephrine) which are involved in pain controls. These medicines are approved by the FDA for use in Fibromyalgia.
The third drug approved by the FDA for fibromyalgia is pregabalin. Pregabalin and Gabapentin are two related medicines that work by blocking the over activity of nerves. Therefore, they reduce the over-sensitivity of nerves involved in transmission of pain. These are perhaps the most commonly prescribed medicines for nerve and muscle pains. Side effects may include dizziness and sleepiness.
Some of the commonly available pain medicines like Paracetamol and Diclofenac are not effective in Fibromyalgia pain directly. However, they may give indirect benefit by suppressing trigger factors, like joint pains. Certain other medicines may also be used to improved sleep, depression or other related factors that are associated with Fibromyalgia.
A single medicine does not work for all and will not work as a standalone therapy. Medicines are usually given as a part of multimodal treatment protocols along with non-drug therapies mentioned above.
Best practices for Fibromyalgia patients
Self-care is important for all patients with Fibromyalgia. A healthy and balanced lifestyle is crucial to improving symptoms and quality of daily life. A few self-help tips for living with fibromyalgia are given below.
- Destress- Take time off each day. Meditation helps in reducing stress. Engaging in some group activity or hobby is a very good way of busting stress.
- Ensure good sleep practices- Both enough duration of sleep and good quality of sleep are important. Have a regular sleep pattern. Avoid daytime naps, excess caffeine and late night outs.
- Increase physical activity- As mentioned earlier, this is perhaps the most important intervention. Try to get involved in some group activities to keep yourself motivated. Exercises can be in the form of fun routines as well, like Zumba.
- Identify and remove triggers that worsen your symptoms.