For people living with generalized musculoskeletal aches and pains activities usually taken for granted -- lifting a gallon of milk, peeling potatoes, or washing dishes -- may cause diffuse pain. What if you suffer such aches, and your physician is having difficulty coming up with an explanation? Could you have fibromyalgia?
DEFINITION AND DIAGNOSIS
Fibromyalgia syndrome is a common condition associated with widespread aching, stiffness and fatigue. (A syndrome is defined as several signs and symptoms which occur together.) Although many patients feel that pain originates in the joints, fibromyalgia mainly affects muscles, ligaments and tendons. Despite the symptoms, inflammation is not an important part of this condition.
A diagnosis of fibromyalgia is based on patient complaints; unfortunately, no laboratory tests are helpful. Generalized pain is the most prominent feature. Most patients complain of aching and stiffness in areas around the neck, shoulders, upper back, lower back and hip areas. Discomfort may start on one area, then spread to others over time. The pain is often affected by weather conditions, sleep patterns, activity level, and stress. The general physical examination is usually normal, but careful musculoskeletal examination reveals specific localized "tender points." Tender points are usually found on both sides and in the upper and lower portions of the body. The presence and pattern of tender points, in association with widespread pain, distinguish fibromyalgia from other generalized musculoskeletal conditions.
Several complaints may be seen in association with fibromyalgia, including tension and migraine headaches, abdominal pain, bloating, with alternating constipation and diarrhea suggestive of irritable bowel syndrome, as well as bladder spasms and irritability causing urinary urgency or frequency.
Changes in mood and thinking are common in fibromyalgia. Some people may feel anxious and depressed. It is important to remember that people with many chronic illnesses suffer "reactive" depression. People with fibromyalgia may report difficulty concentrating when performing simple mental tasks. Many experience a sleep disorder in which they wake up feeling unrefreshed, even though they may fall asleep without difficulty. Frequent awakenings with a non-restorative quality to the sleep are commonplace. Research has shown that disruption of deep sleep alters many body functions and pain perceptions.
Occasionally, fibromyalgia patients may feel the sensation of numbness and tingling in various body parts, specifically the hands and the feet.
Most people with fibromyalgia experience moderate to severe fatigue along with decreased exercise endurance. Some people with fibromyalgia have symptoms of chronic fatigue syndrome and because there is an overlap between fibromyalgia and chronic fatigue, it may be difficult at times to separate the two.
It is not unusual for patients with fibromyalgia to suffer symptoms for months to years and undergo many tests and specialist evaluations before the diagnosis is made. Because various tests are normal and patients look well to family, friends, and even health care providers, many are considered to have no "real" condition. Feelings of guilt, anger, anxiety, and depression may result.
TRIGGERS
Many different factors, alone or in combination, may trigger fibromyalgia. Stressors such as viral illnesses and emotional or physical trauma may lead to the generalized pain and fatigue associated with this condition. Patients subsequently become inactive and anxious about their health, further aggravating the disorder. Research has focused on whether certain chemicals and hormones that alter pain, sleep, and mood play a role.
TREATMENT
Physicians should tailor a treatment plan to for each individual’s needs. Some patients with fibromyalgia have mild symptoms and need very little treatment, once they understand what the condition is and what worsens it. Often, just knowing that fibromyalgia is not a progressive, degenerative disease leads to improvement. The more patients know about their condition, the more they take an active role in finding the best ways to lessen their symptoms and better their outcome. Support groups and educational classes help many people.
Physical rehabilitation consisting of postural education, stretching, and low-level aerobics is beneficial in treating fibromyalgia. Taking part in an exercise program usually increases endurance and decreases pain. Low-level aerobic exercise has been shown to be especially beneficial. For patients reluctant to exercise because they are already feeling pain and fatigue, low-level aerobic activities such as walking, biking, swimming, or gentle water aerobics, are generally the best way to start an exercise regimen. Exercise on a regular basis such as every other day with slow, gradual increments in activity enable patients to reach a better level of fitness. Oftentimes, a physical therapist can help design a specific exercise program to improve, posture, flexibility, and fitness.
The non-steroidal anti-inflammatory medications used to treat many rheumatic conditions do not have a major benefit in fibromyalgia, though some patients report modest pain relief with these compounds. Cortisone-based drugs are ineffective and should be avoided because of potential side effects. Medications which promote deep sleep, improve pain, and relax muscles may help patients with fibromyalgia get more rest. These include amitriptyline (Elavil), doxepin (Sinequan), cyclobenzaprine (Flexeril) and other medications which increase central nervous system serotonin levels. Although these medications are also used to treat depression, they are prescribed in lower doses for use at bed time. Many of these medications can cause dry mouth, increase appetite, constipation, and drowsiness. These side effects are rarely severe and often diminish over time.
Relaxation techniques such as meditation, mental imagery, progressive muscle relaxation, yoga, or biofeedback often play an important role in the management of fibromyalgia, in conjunction with medicinal intervention. Some people with fibromyalgia have such severe symptoms they are unable to function either at work or socially. These individuals may benefit from a comprehensive program that comprises physical and occupational therapists, medical social workers, rheumatologists, physical medicine physicians, mental health professionals, rehabilitation counselors, and sleep specialists.
Most people with fibromyalgia improve and are able to manage their condition effectively. A thorough understanding of the causes of fibromyalgia as well as aggravating and relieving factors is needed to help tailor better treatment and even preventive measures.
The therapies mentioned here are by no means all-inclusive. Also keep in mind that even the non-medicinal treatments can lead to problems if they are used incorrectly. If you think you have fibromyalgia or your aches and pains are not going away, please see your doctor. It’s important that you maintain an active role in managing your symptoms. Although the pain can emotionally wear you down, you can still fight back.
