Fibromyalgia - The Invisible disease

Introduction:

Fibromyalgia or Fibromyalgia syndrome (FMS) is a fairly commonly encountered painful disorder that affects muscles all over the body. and is accompanied by fatigue. Sufferers experience muscle pain, numbness, stiffness and sleep disorders. Patients tire easily and are usually women between 25 and 45 year old.

Causes:

The cause of fibromyalgia is still unknown, and many triggering events have been reported to precede it. Disordered sleep has been theorized to play a significant role in triggering the disease. Other triggering events include; surgery, trauma, thyroid disease and emotional stress. Recent research has reported that injury to the cervical spine substantially increases the odds of developing Fibromyalgia. Fibromyalgia has been reported to occur in patients with Lyme disease, even after appropriate antibiotic treatment and has been described in certain HIV patients.

It has been suggested that fibromyalgia results from imbalances in brain chemicals that transmit nervous impulses (neurotransmitters such a norepinephrine, serotonin and other chemicals.)

Signs and Symptoms:

The diagnosis of Fibromyalgia is usually made if an individual complains of widespread pain in all four quadrants of the body for a minimum of three months.

Most patients experience pain and stiffness around the hips, shoulders and trunk.

The quality of pain varies, with people describing it as deep muscular aching, burning, throbbing, shooting and stabbing. The stiffness usually improves as the day goes on. Patients have difficulty sleeping and are tired all the time.

The fatigue is not relieved by rest, has an identifiable onset. and varies from mild to incapacitating.

Some people have described the fatigue as being a "brain fatigue" totally draining them of energy with a feeling of having lead like heavy arms and legs.

The patients with fibromylagia do not have problems in falling asleep but their deep level sleep is constantly interrupted by bursts of awake-like brain activity

The symptoms are worsened by both increased exertion and inactivity, air drafts and cold weather and improve with rest and warm weather. The link to stress is reinforced by the fact that another syndrome also linked to stress tends to be seen in many Fibromyalgia patients, that being Irritable Bowel Syndrome. The latter is associated with symptoms of constipation, diarrhea, frequent abdominal pain, abdominal gas and nausea.

A characteristic finding in patients with fibromyalgia is that of tender sites. These are various sites that are much more tender than adjacent areas when pressed. These tender areas tend to occur in very similar areas from person to person. There are at least 18 such sites usually located on the top of the back of the neck, upper back, shoulders, chest, hips , knees and elbows and the upper and lateral areas of the buttocks.

Other associated symptoms include: poor unrefreshing sleep, chronic headaches (tension-type or migraines), jaw pain (the so called TMJ the temporo-mandibular joint disease) , concentration and/or memory problems, malaise and muscle pain after exertion, morning stiffness, menstrual cramping, numbness and tingling sensations, dizziness and lightheadedness and allergies. Patients with Fibromyalgia often show excessive clumsiness, suddenly dropping objects and frequent tripping or running into objects.

Finally the presence of chronic pain and associated symptoms exacts a considerable "psychological toll" on most Fibromyalgia patients.

The diagnosis of fibromyalgia is a clinical one as there are no characteristic physical findings or laboratory tests.

As a matter of fact it is very frustrating and depressing for patients with myalgia to be doubted about the severity of their pain or symptoms by family or friends, because they may look well and show no apparent injury or disease. Thus Fibromyalgia has been described by some as an invisible ongoing nightmare that cannot truly be substantiated.

Finally, before making a diagnosis of Fibromyalgia, the treating physician must exclude other conditions that could cause musculoskeletal pain, such as arthritis or inflammatory muscular conditions.

Treatment:

The treatment is directed toward reducing pain and improving the quality of sleep.

Several different drugs, antidepressants, particularly those which boost the body’s levels of neurotransmitters (e.g. of norepinephrine and serotonin) have been used. Muscle relaxants (e.g. Flexeril) and antidepressants such as Elavil, Sinequan, Paxil, Serzone, Xanax and Klonopin, when used at bedtime, help these patients get better sleep and lead to improvement in symptoms. Drugs like Aspirin and Ibuprofen have had limited results. Steroids are not recommended. A combination of Xanax or Prozac and Ibuprofen has been fairly effective in alleviating some of the symptoms. Stress reduction along with regular exercise are also helpful in easing symptoms on a long term basis.

A number of patients have reported improvement with a variety of treatments including trigger point injection with lidocaine (a local pain reliever), physical therapy, relaxation techniques, acupuncture, osteopathic or chiropractic manipulations, therapeutic massages etc.

Patients should also change their lifestyle by avoiding circumstances which trigger or aggravate their symptoms.

Prognosis (Outlook)

The condition is rather chronic and can last for years, but the symptoms may wax and wane as patients do show individual variation in their responses to different therapies.

The related disability also varies from slight to severe. Follow-up of patients with Myalgia indicate that although as many as 40% improve, few recover completely from this syndrome.

A preliminary follow up study of individual with chronic fatigue syndrome by the national Center for Disease Control (CDC) in Atlanta, has reported that for those individuals with chronic fatigue syndrome who do not recover or significantly improve after five years, their most prominent symptom changes from fatigue to muscle pain with concentration problems, a condition strongly resembling Fibromyalgia.