Fibromyalgia Fibromyalgia is a syndrome characterized by fatigue, diffuse musculoskeletal pain and stiffness, sleep disturbance, and the presence of tender points on physical examination. There is no known etiology, but theories have suggested a variety of possible pathophysiologic mechanisms, such as neural-hormonal disturbance, antecedent physical trauma, viral infection, immune dysregulation, psychiatric disturbances and heightened sensitivity to pain. Complications include disability and inability to maintain functional roles. Symptoms of fibromyalgia include: * Chronic muscle pain, muscle spasms or tightness Moderate or severe fatigue and decreased energy * Insomnia or waking up feeling just as tired as when you went to sleep * Stiffness upon waking or after staying in one position for too long * Difficulty remembering, concentrating, and performing simple mental tasks (“fibro fog”) * Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome) * Tension or migraine headaches * Jaw and facial tenderness * Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold * Feeling anxious or depressed Numbness or tingling in the face, arms, hands, legs, or feet * Increase in urinary urgency or frequency (irritable bladder) * Reduced tolerance for exercise and muscle pain after exercise * A feeling of swelling (without actual swelling) in the hands and feet Fibromyalgia has multiple symptoms that commonly occur together, including widespread pain, decreased pain threshold or tender points, incapacitating fatigue, and anxiety or depression. Pain and tenderness are located at specific sites in the back of the neck, upper chest, trunk, low back, and extremities.
These tender points are also known as trigger points and can typically be palpated to elicit pain in a predictable, reproducible pattern. The most common causes of fibromyalgia are overuse, injury or stress. However, it can also be caused by diseases, disorders, and medications as a response to vaccination Several common causes of fibromyalgia include injury or trauma including sprains and strain, overuse of muscle too much, too soon, or too often, and tension or stress. Muscle pain may also be due to certain drugs including ACE inhibitors for lowering blood pressure, cocaine and statins for lowering cholesterol.
Fibromyalgia is also due to Dermatomyositis, electrolyte imbalances like too little potassium (hypokalemia) or calcium (hypocalcemia), fibromyalgia, infections including influenza, Lyme disease, Malaria, Dengue Fever, Hemorrhagic fever, Muscle abscess, Polio, Rocky Mountain spotted fever, Trichinosis (roundworm), Lupus, Polymyalgia rheumatic, Polymyositis, and Rhabdomyolysis. Fibromyalgia can be described in two different ways: a deep, dull, and steady ache, and a quick, random, and sharp ache. The pain may be focused in a specific area or it may be all over your body.
The pain may range from mild and manageable to severe and debilitating. Muscle pain is often accompanied by joint pain. Muscle pain can cause fatigue and can sometimes lead to depression if the pain is constant. Muscle weakness in fibromyalgia normally occurs when the nerves in the patient’s muscles are unable to perform their duty. That means that the nerves fail to stimulate the muscles as the brain tells them to. As a result, the muscles don’t move, and do not contract or relax as they are supposed to. The most prominent among the myalgia symptoms is pain in the affected muscle.
Some other symptoms of cervical myalgia are heaviness of the head with intermittent headaches. If heart muscles are under effect of myalgia, one may suffer from irregular heartbeats. He is also at a risk of cardiac arrest. The bones become more prone to fractures. Impaired vision, swallowing and hearing can also be observed. If respiratory muscles are affected with myalgia, the patient may experience respiratory distress. The patient can even suffer from complete loss of breathing, if the disease has taken a serious form.
Other symptoms include mild to severe fatigue, sleep disturbances, numbness or tingling in their extremities, sensitive to noxious odors, loud noises, and bright lights, headaches, jaw pain, abdominal pain, diarrhea, constipation, heartburn, dysuria, urinary frequency, urgency, and pelvic pain, dyspnea, chest pain and dysrhythmias. Risk factors for fibromyalgia include: * Your sex. Fibromyalgia is diagnosed more often in women than in men. Female reproductive hormones may play a part in how women experience pain. * Family history. You may be more likely to develop fibromyalgia if a relative also has the condition. * Rheumatic disease.
If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia. * Coming from a very stressful culture or environment, having a psychological vulnerability to stress and having had difficult experiences in childhood. In 1990, the American College of Rheumatology (ACR) established two criteria for the diagnosis of fibromyalgia: * Widespread pain lasting at least three months * At least 11 positive tender points — out of a total possible of 18 But fibromyalgia symptoms can come and go. And many doctors were uncertain about how much pressure to apply during a tender point exam.
While the 1990 guidelines may still be used by researchers studying fibromyalgia, less stringent guidelines have been developed for doctors to use in general practice. These newer diagnostic criteria include: * Widespread pain lasting at least three months * No other underlying condition that might be causing the pain Blood tests While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include: * Complete blood count * Erythrocyte sedimentation rate * Thyroid function tests
While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include complete blood count (CBC). This test measures the hemoglobin, red cells, white cells, and platelets. It can also find many common blood disorders such as anemia that can cause fatigue. Also, kidney and liver tests that check blood chemistries, levels of cholesterol and other fats in your blood, and calcium levels are included. In addition, thyroid tests will be done to see if your thyroid is overactive or underactive.
Clients that are diagnosed with fibromyalgia usually get tested for the red blood cell sedimentation rate. This test provides a rough index of inflammation in the body. In rheumatoid and other similar types of arthritis, this test is abnormal. It can also be abnormal with some infections. In cases of osteoarthritis and fibromyalgia, however, it is usually normal. Test for rheumatoid factor to measure an abnormal protein in the blood and is positive for 70% to 80% percent of patients with rheumatoid arthritis. But this blood test can also be positive in healthy individuals and is sometimes negative in people with rheumatoid arthritis.
Another one is a test for anti-nuclear antibody (ANA). Like rheumatoid factor, ANA is an abnormal antibody in the blood. It is commonly found with systemic lupus. Lupus is more common in women, especially younger women, and can cause pain and fatigue. Lupus may also cause internal organ problems, such as kidney disease, heart disease, or problems in the brain. How Is Fibromyalgia Treated? Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is.
Many family physicians, general internists, or rheumatologists (doctors who specialize in arthritis and other conditions that affect the joints or soft tissues) can treat fibromyalgia. Fibromyalgia treatment often requires a team approach, with your doctor, a physical therapist, possibly other health professionals, and most importantly, yourself, all playing an active role. It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these various professionals can help you improve your quality of life.
You may find several members of the treatment team you need at a clinic. There are pain clinics that specialize in pain and rheumatology clinics that specialize in arthritis and other rheumatic diseases, including fibromyalgia. Only three medications, duloxetine, milnacipran, and pregabalin are approved by the U. S. Food and Drug Administration (FDA) for the treatment of fibromyalgia. Duloxetine was originally developed for and is still used to treat depression. Milnacipran is similar to a drug used to treat depression, but is FDA approved only for fibromyalgia.
Pregaballin is a medication developed to treat neuropathic pain (chronic pain caused by damage to the nervous system). Analgesics Analgesics are painkillers. They range from over-the-counter products to prescription medicines. For a subset of people with fibromyalgia, narcotic medications are prescribed for severe muscle pain. However, there is no solid evidence showing that for most people, narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential that the person taking them will become physically or psychologically dependent on them.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) As their name implies, nonsteroidal anti-inflammatory drugs, including aspirin, ibuprofen, and naproxen sodium are used to treat inflammation. Although inflammation is not a symptom of fibromyalgia, NSAIDs also relieve pain. The drugs work by inhibiting substances in the body called prostaglandins, which play a role in pain and inflammation. These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia. Complementary and Alternative Therapies
Many people with fibromyalgia also report varying degrees of success with complementary and alternative therapies, including massage, movement therapies (such as Pilates and the Feldenkrais method), chiropractic treatments, acupuncture, and various herbs and dietary supplements for different fibromyalgia symptoms. Although some of these supplements are being studied for fibromyalgia, there is little, if any, scientific proof yet that they help. FDA does not regulate the sale of dietary supplements, so information about side effects, proper dosage, and the amount of a preparation’s active ingredient may not be well known.
If you are using or would like to try a complementary or alternative therapy, you should first speak with your doctor, who may know more about the therapy’s effectiveness, as well as whether it is safe to try in combination with your medications. What Can I Do to Try to Feel Better? Besides taking medicine prescribed by your doctor, there are many things you can do to minimize the impact of fibromyalgia on your life. These include: * Getting enough sleep. Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia.
Even so, many people with fibromyalgia have problems such as pain, restless legs syndrome, or brainwave irregularities that interfere with restful sleep. It is important to discuss any sleep problems with your doctor, who can prescribe or recommend treatment for them. * Exercising. Although pain and fatigue may make exercise and daily activities difficult, it is crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia.
People who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise and build their endurance and intensity slowly. * Making changes at work. Most people with fibromyalgia continue to work, but they may have to make big changes to do so. For example, some people cut down the number of hours they work, switch to a less demanding job, or adapt a current job. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job.
An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift. * Eating well. Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.
