Fibromyalgia

Fibromyalgia, also known as fibromyalgia syndrome (FMS), is a chronic condition that characteristically causes pain all over the body, including muscle and joint pain, profound fatigue, disturbed sleep and a myriad of other symptoms.

  • Physical Sleep Dysfunction Disturbances
  • Multiple Chemical Sensitivity
  • Pain Stiffness
  • Sexual Dysfunction
  • Dyscognition
  • Mood Disturbances
  • Tenderness to touch
  • Fatigue
  • Anxiety/ Psychological Distress

The pain tends to be felt as diffuse aching or burning, often described as head to toe pain. It may be worse at some times than at others. It may also change location, usually becoming more severe in parts of the body that are used most.

The name fibromyalgia is made up from “fibro” for fibrous tissues such as tendons and ligaments; “my” indicating muscles; and “algia” meaning pain. The fatigue ranges from feeling tired, to the exhaustion of a flu-like illness. It may come and go and people can suddenly feel drained of all energy – as if someone just “pulled the plug”.

It can occur by itself or along with forms of arthritis or auto immune conditions like scleroderma. Although it is never fatal, it is usually difficult to manage and can cause significant disability and disruption of quality of life, it can also lead to depression and social isolation.

Fibromyalgia is a common illness, more common than rheumatoid arthritis* and can even be more painful. People with mild to moderate cases of fibromyalgia are usually able to live a normal life, given the appropriate treatment.

If symptoms are severe, however, people may not be able to hold down a paying job or enjoy much of a social life.

  • Fibromyalgia Symptoms
  • As well as widespread pain, people with fibromyalgia may also include
  • Increased sensitivity to pain
  • Fatigue (extreme tiredness)
  • Muscle stiffness
  • Difficulty sleeping/unrefreshed sleep – waking up tired and stiff
  • Problems with mental processes (known as “fibro-fog”) – cognitive problems including lack of concentration, temporary memory impairment and word mix up
  • Clumsiness and dizziness
  • Dryness in mouth, eyes and nose
  • Headaches – ranging from ordinary types to migraine
  • Irritable bowel syndrome (IBS) – a digestive condition alternating diarrhoea and constipation, sometimes accompanied by stomach pain, bloating or nausea
  • Allergies
  • Hypersensitivity to cold / heat changes in the weather and to noise, bright lights, smoke and other environmental factors

Fibromyalgia Diagnosis

FMS is not new, but for most of the last century it was difficult to diagnose. Part of the problem has been that the condition could not be identified in the standard laboratory tests or x-rays. Moreover, many of its signs and symptoms are found in other conditions as well – especially in chronic fatigue syndrome (CFS).

Two Canadian doctors developed a way of diagnosing fibromyalgia in the 1970s and in 1990 an international committee published requirements for diagnosis that are now widely accepted.

Once other medical conditions have been ruled out through tests such as a full blood count and a thyroid test the diagnosis depends on two main symptoms:

None
  • Pain in all four quadrants of the body for at least three months together with
  • Pain in at least 11 out of 18 tender point sites when they are pressed. The “tender points", or spots of extreme tenderness, are rarely noticed by the patient until they are pressed.
None


What is the standard treatment for fibromyalgia?

There is no cure for fibromyalgia, and there is no single treatment that will address all of the fibromyalgia symptoms. Instead a wide array of traditional and complementary treatments has been shown to be effective in treating this syndrome. A treatment programme may include a combination of medication, exercise, (both strengthening and aerobic conditioning) and behavioural techniques.

What Causes Fibromyalgia?

Fibromyalgia often develops after some sort of trauma that seems to act as a trigger, such as a fall or car accident, a viral infection, childbirth, an operation or an emotional event. Sometimes the condition begins without any obvious trigger. The actual cause of fibromyalgia has not yet been found. Over the past several years, however, research has produced some insights into this puzzling condition. For instance, it has been known that most people with fibromyalgia are deprived of deep restorative sleep. Current studies may find out how to improve the quality of sleep and some of the prescribed medicine is specifically aimed at addressing the lack of restorative sleep.

Research has identified a deficiency in Serotonin in the central nervous system coupled with a threefold increase in the neurotransmiter substance P, found in spinal fluid and which transmits pain signals.

The effect is disordered sensory processing. The brain registers pain when others might experience a slight ache or stiffness. It is hoped that more research will discover the cause and result in more effective treatment.

What medication is used to treat fibromyalgia?

Medication does not deal with the underlying cause or causes of fibromyalgia but does help to relieve the symptoms. Specific recommendations on treatments may include:

  • Tramadol, an opioid analgesic is recommended for the management of pain. Although other treatment options may include simple analgesics (such asparacetamol) and other weak opioids, nonsteroidal anti-inflammatory drugs (NSAIDS) have not been found to be effective. Corticosteroids and strong opioids are not recommended.
  • Antidepressants are recommended for the treatment of FMS because they decrease pain and often improve function. Appropriate options may include tricyclic antidepressants such as amitriptyline, as well as newer drugs such asfluoxetine, duloxetine and paroxetine.
  • Pramipexole, a treatment for Parkinson's disease and restless legs syndrome, has been found to reduce pain in FMS.
  • Pregabalin is an anti-epileptic drug that has also been found to help with pain in FMS patients.

Are there complementary treatments for fibromyalgia?

Complementary therapies, although they are not well-tested, can help manage the symptoms of fibromyalgia. For instance therapeutic massage manipulates the muscles and soft tissues of the body and helps ease deep muscle pain. It also helps relieve pain of tender points, muscle spasms and tense muscles. Similarly myofascial release therapy, which works on a broader range of muscles, can gently stretch, soften, lengthen and realign the connective tissue to ease discomfort.

Cognitive behavioural therapy (CBT), relaxation techniques and physiotherapy may help some patients. Moderately intense aerobic exercise at least two or three times a week can help FMS symptoms, and although the scientific evidence may not be strong, the benefits of exercise for general health and feelings of well-being suggest its use should be encouraged. Hydrotherapy in a heated pool may also be beneficial.

Techniques such as hypnosis, acupuncture and chiropractic manipulation may help pain in individual cases, but further evaluation of these methods is required.

Along with complementary therapies, it is important to allow time each day to rest and relax. Relaxation therapies such as deep muscle relaxation or deep breathing exercises can help reduce the added stress that can trigger fibromyalgia symptoms. Having a regular bedtime is also important.

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