Fibromyalgia, the second most common condition affecting bones and muscles

At a Glance:

What is fibromyalgia?

Fibromyalgia, also called Fibro or fibromyalgia syndrome (FMS) is a medical condition in which a person experiences chronic and widespread musculoskeletal pain. The pain in this condition is associated with fatigue and issues related to memory, sleep, and mood.

Although there is no definitive cure for fibromyalgia, it is possible to manage the condition well by consulting an expert rheumatologist and regular follow up care under the guidance of a rheumatologist and pain management physician in a pain management clinic. Symptoms of fibromyalgia can be managed by a variety of medications, exercise, relaxation and stress-management techniques customized to a person’s medical and personal needs.

What are the symptoms of fibromyalgia?

In certain cases, symptoms of fibromyalgia appear after physical or psychological triggers like surgery, trauma, infection or significant stress. In some cases, symptoms appear gradually over some time. Some of the commonly reported symptoms include:

• Widespread musculoskeletal pain:The pain in fibromyalgia occurs bilaterally, i.e on both sides of the body and above and below the waist. It is usually described as a constant dull ache that lasts at least three months. Pain can be located in areas like the back, neck or a non-cardiac chest pain.
• Restless legs syndrome: It is a tingling, uncomfortable feeling in the legs, especially at night
• Daytime Fatigue:Despite adequate sleep, people with fibromyalgia often experience tiredness after they awaken. They may complain of disruption in sleep due to pain. Some people may experience trouble falling asleep or staying asleep.
• Fibro fog:Impairment in the ability to focus and concentrate on mental tasks, cognitive difficulties and loss of attention to detail, is referred to as fibro fog.
• Sensitivity to touch: Overt sensitivity to touch and temperature may be experienced by certain persons.
• Mood swings: Fibromyalgia may sometimes be associated with depression and anxiety
• Headaches: Though not very common, migraine, stress and tension headaches can be triggered in persons with fibromyalgia by various stimulants like sounds, odors like perfumes, etc.
• Irritable bowel syndrome and digestive issues: Bloating, abdominal pain, constipation, and irritable bowel syndrome (IBS) can sometimes occur alongside fibromyalgia.
• Interstitial cystitis and pelvic floor dysfunction: Chronic pain or pressure in the bladder and pelvis may be experienced by persons with fibromyalgia in some cases.
• Jaw and facial pain: Some persons may experience temporomandibular joint disorder leading to pain in the jaws and facial area.

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What are the causes and risk factors of fibromyalgia?

 The exact underlying cause of fibromyalgia is uncertain, however, scientists believe that there could be a variety of factors that cause an effect. These factors may include:

• Genetics: Certain genetic mutations may render a person susceptible to get this condition.
• Infections: Sometimes fibromyalgia seems to get triggered by certain illnesses.
• Psychological stress and trauma: A physical trauma, like an accident or psychological stress like divorce, marital discord, etc can act as triggers of the condition.

Some common risk factors for fibromyalgia include:

• Gender: Women are more prone to develop fibromyalgia as compared to men.
• Family history: Fibromyalgia is often observed to run in families. A person with first degree relatives having the condition is susceptible too.
• Certain disorders: Persons having osteoarthritis, rheumatoid arthritis or lupus, may be more prone to developing fibromyalgia.
• Age: Though it can affect people of any age, including children and the elderly, the condition usually develops between the ages of 30 and 50.

Why does it pain in fibromyalgia?

It is believed by the scientific community that repeated nerve stimulation alters how the brain processes the pain signals and the pain sensations get amplified. This change is associated with an abnormal increase in levels of the neurotransmitters or chemicals within the brain that signal pain. The receptors of pain in the brain also become over-reactive to pain signals as they develop a memory of the pain, thereby making them more sensitive.

How do doctors diagnose fibromyalgia?

Diagnosis of fibromyalgia is made by a rheumatologist based on medical history, physical examination, and medical tests. Fibromyalgia is suspected if a person has a history of widespread pain that lasts for more than three months and there is no assignable medical cause of the pain. Some of the commonly performed medical tests are:

Blood tests: While none of the investigations is a confirmatory test for the diagnosis of fibromyalgia, imaging tests, and blood tests are often advised by rheumatologists to rule out other conditions that present with similar symptoms. Some of these blood tests may include:

• Complete blood count
• Cyclic citrullinated peptide test
• Erythrocyte sedimentation rate
• Rheumatoid factor
• Thyroid function tests

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Is fibromyalgia different from lupus and arthritis?

 Even though fibromyalgia has certain symptoms that may be common to lupus or arthritis and it’s not uncommon for fibromyalgia to be misdiagnosed as lupus or arthritis, they have distinct causes and treatment. All of them are chronic diseases that may take a long time before the diagnosis is made.

Lupus is an autoimmune disorder which means that the immune system of the body mistakenly attacks the body’s healthy tissues as if they were foreign substances. This leads to a widespread inflammation that can damage joints and other areas in the body. Widespread chronic pain and tenderness, muscle and/or joint pain, brain fog, and fatigue are also common symptoms of these conditions. However, unlike lupus and arthritis, fibromyalgia is not an autoimmune disorder or inflammatory disorder and it does not damage joints. Some people may have these conditions at the same time. Persons having conditions like osteoarthritis, rheumatoid arthritis, and axial spondyloarthritis are also at an increased risk of also developing fibromyalgia.

Which specialist treats fibromyalgia?

If a person is suspected to have symptoms suggestive of fibromyalgia, it is usually desirable to seek consultation from a rheumatologist, who is a physician specializing in diagnosing and treating diseases of the musculoskeletal system i.e muscles and bones system. The diagnosis of fibromyalgia is made by excluding other conditions with similar symptoms, hence a rheumatologist would likely perform a thorough physical exam and advise blood tests and imaging tests to determine the cause. Once a diagnosis of fibromyalgia is confirmed, the rheumatologist may recommend the person to join a pain management program at a designated pain clinic within the hospital for better management of pain and reducing its effect on the quality of life of a person.

Pain clinics are specialized multidisciplinary care centers that provide customized treatment or rehabilitation therapies for persons with chronic conditions like fibromyalgia. They have a wide range of professionals  such as:

• Specialist pain management consultants
• Occupational therapists
• Physiotherapists
• Psychologists

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What are the treatment options for fibromyalgia?

For a person with fibromyalgia, a rheumatologist may advice different treatments and therapies to tackle specific symptoms for the person, which includes drug treatments, physical and psychological therapies in varying combinations.

Medications

Drug therapy can help reduce the pain associated with fibromyalgia and improve sleep. In addition to prescription medicines that are specifically approved to treat fibromyalgia, some of the commonly advised medications include:

• Pain relievers: Over-the-counter pain relievers may be helpful. Stronger pain relievers may be taken only after a prescription by an authorized medical practitioner.
• Antidepressants: Chronic pain and fatigue associated with fibromyalgia may often lead to depression in a person. A rheumatologist may prescribe antidepressants to help promote sleep and manage stress.
• Anti-seizure drugs: Drugs for the treatment of epilepsy are often useful in reducing certain types of pain.

Therapy

Different physical therapies can help in reducing the effect of fibromyalgia on a person’s body and quality of life. Some of the commonly advised therapy options include:

• Physical therapy: Exercises to improve strength, flexibility, and stamina can be customized by a physical therapist as per the person’s needs.
• Occupational therapy: An occupational therapist can help a person in making adjustments in office ergonomics and work area or in the way certain repetitive tasks are performed to reduce stress on the body.
• Counseling: Talking with a counselor can help a person in dealing with emotional stress.

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What lifestyle and home remedies can a person with fibromyalgia adopt?

Self-care is important in the management of fibromyalgia. There are many things that a person with fibromyalgia can do to have a good quality of life. Some of these include:

Exercise: Remaining physically active is an important aspect of the management of fibromyalgia and can also prevent other health problems. A combination of aerobic exercise and strengthening and stretching exercises that improve flexibility and strength can not only help improve symptoms and general health but also help in improving fatigue and the ability to control pain.

Sleep: Poor sleep is considered to be a significant cause of fibromyalgia. Getting enough good-quality sleep is an important aspect of the management of fibromyalgia. Not only does it help with tiredness and fatigue, but it may also improve the pain.

Some of the ways to get a better night’s sleep can be:

Do’s

• A warm bath before bedtime can help in easing pain and stiffness.
• Develop routine by going off to sleep and getting up at the same time every day.
• Listening to some soothing music before going to sleep.
• Doing some light exercise to help reduce muscle tension. However, high energy exercise too close to bedtime should be avoided.

Don’ts

• Have caffeine in the night, at least eight hours before sleep time.
• Drink alcohol around bedtime.
• Eat heavy meals before bedtime.
• Smoke close to bedtime.
• Sleep during the day.
• Watching TV and using digital devices like tablets, or smartphones during sleep time.
• Keep checking the time during the night.

As the symptoms of fibromyalgia may vary from person to person, some of the following tips can be tried to see what works:

• Make oneself aware of the condition. Understanding of one’s condition can help alleviate fears and anxiety.
• Find a support group for people with fibromyalgia on social media or the local community. Talking about own experiences with other people who experience the same condition can help.
• Seek counseling and find ways to talk about your feelings, such as anxiety or anger. Counseling can help
• Mental exercises like sudoku, crosswords or jigsaw puzzles are considered to be helpful by some people for ‘fibro fog’. Engaging in such exercises stimulates the brain.
• Pacing oneselfby breaking tasks into smaller activities and giving oneself time to rest in between.
• Stress and unhappiness can worsen the pain in fibromyalgia. Limiting overexertion and avoiding emotional stress, relaxation with stress management activities like yoga, deep-breathing exercises or meditation can all help.

Conclusion:

Fibromyalgia is a common syndrome of musculoskeletal origin. It is characterized by a heightened sensitivity to pain, fatigue, disturbance of sleep and widespread pain in the body. While at the moment, an exact cause of the condition remains uncertain, many theories are under investigation. Although there is no certain cure for the condition, persons with fibromyalgia can lead their lives with improved quality and reduce pain with the availability of proper treatment under the care of a well-informed rheumatologist and pain management specialist. A variety of newer techniques and agents for pain management have shown the capability of beneficially improving the symptoms of persons with fibromyalgia. Many treatment options are currently available to assist persons with fibromyalgia in relieving their symptoms and preventing flare-ups. However, holistic management can be successful only if a prompt diagnosis is made and timely treatment is initiated. Consequently, it is highly recommended that treatment should be sought at a center of excellence that offers services of expert rheumatologists with vast experience in the diagnosis of fibromyalgia and differentiating it from other conditions. With regular follow up in pain management clinics under the care of expert pain management specialist persons with fibromyalgia can experience substantial improvement in the quality of their life.

Reference:

• Mayo Clinic. Fibromyalgia. Available at. https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780. Accessed on February 07, 2020
• Johns Hopkins Arthritis Center. Fibromyalgia Overview. Available at:  https://www.hopkinsarthritis.org/arthritis-info/fibromyalgia/. Accessed on February 07, 2020
• S. National Library of Medicine. Fibromyalgia.Available at https://medlineplus.gov/fibromyalgia.html. Accessed on February 07, 2020

About Author –

Dr. I. Rajendra Vara Prasad, Consultant Rheumatologist, Yashoda Hospital, Hyderabad
MD, DM (Rheumatology)