Fibromyalgia is a disease of abnormal pain perception. It is one of the most common causes of chronic widespread pain. It is characterized by reduced pain thresholds and pain with normally innocuous stimuli. Fibromyalgia is common, affecting about 2% of the general population with females being 7 times more susceptible than men to the disease. Fibromyalgia is an independent syndrome, but it may often occur concomitantly with other conditions, such as rheumatoid arthritis and systemic lupus erythematosus and other chronic pain syndromes such as low back pain and headache.
Fibromyalgia syndrome(FMS)
Clinical features of Fibromyalgia:
- Widespread pain: patients usually complaint of “pain all over their body” though the severity of pain may vary between patients. Pain is often made worse by exertion or physical activity.
- Fatigue: fibromyalgia can cause extreme tiredness (fatigue). This may range from mild tiredness to severe exhaustion. Fatigue affects 80 – 90 % of patients suffering from fibromyalgia.
- Poor sleep quality: most patients of fibromyalgia have poor quality of sleep and do not wake up “refreshed” in the morning, even after having slept for sufficient number of hours. This is because the condition can sometimes prevent you from sleeping deeply enough to refresh you properly. In addition some people with fibromyalgia are sleepy during the day.
- Depression and anxiety: mood disturbance is common in fibromyalgia syndrome, however it is not universal. Generalized anxiety seems more common in fibromyalgia than depression.
- Impaired cognition: patients with fibromyalgia often describe having a “brain fog” that is cognitive impairment which includes problems with memory, an inability to focus on tasks, retain new information, do mental arithmetic or solve problems. Typically these periods are episodic and last for a few days, although in some cases they may be more prolonged.
- Morning stiffness: prolonged early morning stiffness is common in patients with fibromyalgia syndrome. In FMS stiffness is often not relieved by exercise unlike other inflammatory rheumatic conditions.
- Other symptoms: other common symptoms in FMS include nausea, vomiting, bloating, abdominal pain, diarrhea and constipation. Concomitant diagnosis of irritable bowel syndrome is very common. Uro-gynaecological symptoms are also common, especially urgency, frequency, incontinence, pelvic pain and dysmenorrhea.
Diagnosis of fibromyalgia:
Diagnosis of fibromyalgia is based on clinical signs and symptoms. There is no specific diagnostic laboratory test for fibromyalgia, but it is important to exclude other rheumatic diseases when assessing a patient who may have fibromyalgia syndrome, so blood test are used to exclude alternative diagnoses.
Risk factors:
Many studies have shown that psychological conditions such as depression, anxiety, panic disorder and mood disorders are risk factor for developing FMS. In addition to genetic associations, various external stimuli such as infection, hormonal changes, physical trauma (e.g. car accident) and stress have been associated with development of fibromyalgia syndrome.
Treatment:
Treatment of fibromyalgia tries to improve some of your symptoms and improve quality of life. As fibromyalgia is a complex syndrome associated with a wide range of symptoms, treatment is tailored according to the individual, dealing with their particular needs and targeting their most distressing symptoms. Both pharmacological and non pharmacological treatments are used for better results.
Non pharmacological treatment:
- Patient education: as fibromyalgia is a chronic condition without a permanent remedy, patient education is an important aspect of management as patients have to learn to manage their pain even if they also receive other treatment.
- Graded exercises: in patients with fibromyalgia exercise may not help in reducing pain and stiffness on the contrary initially after starting exercise pain and fatigue may worsen, but patients should be motivated to continue exercise and gradually increase it, because there is good evidence that it can lead to improvements in physical function.
- Physical therapy:A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful.
- Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.
Pharmacological treatments:
- Analgesics: NSAIDS (non-steroidal anti-inflammatory drugs) may be useful for short term pain relief when used in addition to other treatments. However they should be used for long term owing to their gastrointestinal side effects.
- Antidepressant drugs:
- Tricyclic antidepressants( TCA’S) such as amytryptyline are the most widely used in fibromyalgia syndrome. They can improve sleep, fatigue and pain in fibromyalgia syndrome.
- SNRI’S ( Serotonin nor epinephrine reuptake inhibitors) : they seem to have similar efficacy to TCA’s without the anticholinergic effects. They are usually well tolerated (headache and nausea are most commonly reported adverse effects). Milnacipran,duloxetine and venlafaxine have positive effects on pain, function, pain threshold, fatigue and quality of life.
- Selective serotonin reuptake inhibitors (SSRIs),such as fluoxetine and paroxetine.
- Anticonvulsants:You may also be prescribed an anticonvulsant (anti-seizure) medicine, as these can be effective for those with fibromyalgia.
The most commonly used anticonvulsants for fibromyalgia are pregabalin and gabapentin.
These are normally used to treat epilepsy, but research has shown they can improve the pain associated with fibromyalgia in some people.