We all experience sore muscles or pains and aches at some point or the other. But when the pain is consistent, severe enough to stop you from living a normal life, you may suffer from what is called the Fibromyalgia Syndrome [fibromyalgia for short]. Fibromyalgia is a chronic condition of widespread pain and profound fatigue. ‘Fibro’ stands for fibrous tissues such as tendons and ligaments; ‘my’ indicates muscles; and ‘algia’ means pain. So, fibromyalgia is pain and fatigue in the muscles and fibrous tissues of our body.
Since fibromyalgia is recognised as a collection of symptoms rather than by one specific symptom or malfunction, it is a syndrome.
The most prominent feature of fibromyalgia is pain—a diffused aching or burning, often from head to toe. It may worsen at times and change location, usually becoming more severe in the most used parts of the body.
The fatigue ranges from simply feeling tired to feeling exhausted like in flu. The fatigue is not always constant; it may come and go and suddenly you feel drained of all energy—as if someone has just “pulled the plug”.
You will be surprised to know that fibromyalgia is a common illness. In fact, it is as common as rheumatoid arthritis and can even be more painful. With appropriate treatment, however, those with mild to moderate fibromyalgia can lead a normal life.
Fibromyalgia predominantly seems to affect women between the age 30 and 50. Although, increasing experience indicates that it can even affect males and individuals of all age groups.
Collection of symptoms
Besides pain and fatigue, fibromyalgia symptoms often include:
- Un-refreshing sleep—waking up tired and stiff
- Headaches—ranging from ordinary types to migraine
- Irritable bowel—frequent diarrhoea or constipation, sometimes accompanied by gas in the abdomen or nausea
- Cognitive disturbances including lack of concentration and word mix up
- Clumsiness and dizziness
- Sensitivity to changes in the weather and noise, bright lights, smoke and other environmental factors
What causes fibromyalgia?
Fibromyalgia often develops after some sort of a trauma, which seems to act as a trigger, such as a fall or a 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 is yet unknown, but over the last few years, research has produced some insights into this puzzling condition. For instance, we now know that most people with fibromyalgia are deprived of deep restorative sleep.
Research has identified a deficiency in serotonin in the central nervous system and a resulting imbalance of substance P, a spinal fluid that transmits pain signals. It is hoped that more research will help discover the exact cause for more effective treatment.
Making a diagnosis
Although fibromyalgia is not a new condition, for most of the last century, it was difficult to diagnose because of the difficulty in identifying it through standard laboratory tests or X-rays. Moreover, many of its signs and symptoms are common to other conditions—especially chronic fatigue syndrome [CFS].
The breakthrough came only in 1970, when two Canadian doctors developed a way of diagnosing fibromyalgia, a way that is now widely accepted. Fibromyalgia is diagnosed once other medical conditions are ruled out through tests and the patient’s history.
The patient also displays two main symptoms:
- Widespread pain for more than three months and
- Pain in at least 11 out of 18 tender point sites when they are pressed.
‘Widespread pain’ means pain above and below the waist and on both sides of the body. The ‘tender points’, or spots of extreme tenderness, are rarely noticed by the patient until they are pressed.
Course of treatment
At present, treatment for fibromyalgia is symptomatic: it aims at reducing pain and improving sleep. In other words, the symptoms are treated rather than the condition itself. Medications most often prescribed for fibromyalgia are tricyclic drugs also used to treat depression—although doses for fibromyalgia are much lower than they are for depression. In some cases, these drugs ease pain as well as help the patient sleep.
Over-the-counter medications help relieve pain to some extent. Severe pain may require the expertise of a pain clinic. It is best to discuss any form of pain relief with your specialist or GP [general practioner]. Some people may require professional counselling to cope and take an active part in their own treatment.
Learning to manage the condition seems, so far, the most successful way of dealing with fibromyalgia. A combination of heat therapy, rest, exercise and reducing stress can enable some people with fibromyalgia to maintain a productive life.
A number of alternative techniques are helpful in easing pain.
- Relaxation is a technique that works well for almost everybody with fibromyalgia. It reduces tension in the mind and body. The results are calming for all the symptoms, particularly, the pain.
- A hot water bottle and hot baths or showers, ease the pain and morning stiffness. Soaking hands and feet in hot water can diminish the ache.
- No particular diet directly helps patients with fibromyalgia. It is best, however, to avoid or at least cut down on your coffee, tea and alcohol intake. Some sufferers have a tendency to gain weight and this can be distressing in itself. Following a diet with protein, vitamins and minerals helps to control your weight and build strength.
- Family and friends can help the person deal with fibromyalgia by learning as much as possible about the condition. Discussing problems and working together can make big a difference.
The life of a person with fibromyalgia is a combination of good days and bad days. On a good day, it is important to pace yourself and rest; overdoing may simply make matters worse. Listen to your body when it tells you to slow down.
By Mark Pellegrino, MD
Individuals with fibromyalgia are faced with an exercise dilemma. Because the muscles are tight and painful, they often aggravate by any attempt to exercise. On the other hand, if muscles aren’t used enough, they can easily flare up with activity. Often, the person with fibromyalgia will experience increased pain or full-blown flare up when attempting to increase activity. Stretching and a light conditioning programme are two components of exercise that when used in combination, work best for patients.
This form of exercise is readily available wherever we are. Because fibromyalgia muscles are tight, they are more vulnerable to sprains and strains. Hence, it is important that this tightness is counteracted by stretching. You can stretch in bed, in the shower, at work, at home and just about anywhere. It is a vital part of the person’s home programme and should be done regularly.
A light conditioning programme means enough exercise to stimulate the cardiovascular system and strengthen the muscles without overworking or exhausting them and increasing pain. Light conditioning does not mean intense aerobic activity but involves stretching, strengthening, relaxation and conditioning of muscles. A good warm up, proper breathing techniques, correct postures, cooling down and awareness of the body’s response to exercise some of its components.
Light conditioning exercises include walking, cycling, aquatics, dancing and low-impact aerobics. As a rule, try to perform light conditioning exercises at least three times a week for 20-30 minutes. Starting this programme until you are comfortable with a regular daily stretching programme is not recommended.
Mark Pellegrino, MD, is uniquely qualified to help patients with fibromyalgia. Dr Pellegrino is Board Certified in Physical medicine and Rehabilitation. He is the author of Inside Fibromyalgia
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