Fibromyalgia

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What is fibromyalgia?

Fibromyalgia is a disorder that causes achy pain, tenderness, spasm, and stiffness of the muscle, areas of the tendons and ligaments. These tender points are common around the neck and shoulders, in the front of the knees, elbow, hip joints, chest, low back, thighs and calf (lower leg) muscles.

What is Primary Fibromyalgia Syndrome?

Abbreviated as PFS, the typical pattern of this condition is generalized, idiopathic (of unknown cause) fibromyalgia accompanied by anxiety, fatigue, impaired sleep and irritable bowels, with no evidence of underlying diseases contributing to the symptom complex. PFS afflict healthy young or middle-aged women who are anxious, stressed, tense, depressed. Children and adolescents (usually females) and older adults who have PFS may also have osteoarthritis of the spine. Men usually have localized fibromyalgia which is related to recreational or occupational strain.

How common is PFS?

About 5% of the population, including children, have fibromyalgia, and some of this may be hereditary, with similar symptoms among family members.

What are the symptoms?

The onset of the pain and stiffness is gradual and diffuse. The pain may be a deep ache or burning, is worsened by straining and overuse, and may be constant but varies in severity in response to weather changes, stress and activity. The pain may move around the body. There may be spasms or muscle tightening. Most sufferers feel fatigued or out of energy, have problem sleeping and a few may have diarrhea/constipation, difficulty swallowing, gas, heartburns and abdominal cramps. There may be sensation of tingling or numbness in various parts of the body. Many patients have super sensitivity to odor, loud noise, bright lights, or even to medicines. Headache and pains in the jaws may also be present. Sometimes, they have dry eyes or problem focusing on objects that are near, imbalance or dizziness. Others may have palpitation or shortness of breath. Women with fibromyalgia may have urinary complaints, pelvic pains, painful menstrual periods, or even painful sexual intercourse.

Does stress really aggravate the condition?

Yes, stress and anxiety do aggravate the symptoms. Many persons with fibromyalgia have obtained relief when stress and anxiety were reduced from their lives. Sleep is also very important for these individuals.

How about depression?

Depression in this situation can be a cause and/or effect of fibromyalgia. The cycle can be vicious. The medications prescribed for this condition also soothes the depression. Sometimes psychiatric may be necessary for these persons to be reassured about their condition.

Could fibromyalgia be due to some illnesses?

Yes, the following may cause the same symptoms: generalized osteoarthritis, rheumathoid arthritis, polymyalgia rheumatica, polymyositis, and other connective tissue diseases, and hypothyroidism. A minority of fibromyalgia cases may be caused by psychophysiologic abnormality.

Does fibromyalgia lead to cancer?

Most definitely no, it does not lead to cancer or any other organic illnesses. This is a benign condition, and tissue biopsies do not show any histopathologic abnormalities.

Does any permanent damage result?

No permanent damage to any organ in the body results from fibromyalgia. The condition, while chronic and causing many bothersome symptoms, is not life-threatening either.

Does exercise aggravate fibromyalgia?

No. As a matter of fact, exercise is one of the best therapies for fibromyalgia. Starting with gentle, low-impact, stretching exercises, like walking, bicycling, and aerobics, this physical regimen should be performed daily and gradually increased. At first, there will be muscle soreness, as could be expected, but the exercise becomes more comfortable as days go by. Example: walking or bicycling (indoor or outdoor) 5 minutes daily for the first day and increasing it by one to two minutes a day, until a full hour of ambulation daily becomes comfortable. The type of exercise does not matter as long as the person enjoys it and does it religiously.

Are there medications for this?

Yes, there are several that can minimize the symptoms of fibromyalgia. Many of these drugs, such as Flexerill (cyclobenzaprine) or Elavil (amitriptyline), are taken before bedtime to improve sleep and alleviate the pains and other symptoms. We strongly advise against self-medication because a proper diagnosis is a must before treatment is initiated. Besides, these medications, like any other drugs, have potential side-effects that could be serious.

What are the side effects of these drugs?

Some of the side effects of these medications include drowsiness, dryness of the eyes and the mouth, increased appetite, constipation, and nightmares. These symptoms are usually worse at the beginning and diminish with time.

So, what is the treatment for fibromyalgia?

The comprehensive management of fibromyalgia includes ruling out or treating diseases causing the symptoms, reassurance from the attending physician that the condition is benign and not hopeless, stretching and aerobic exercises, local application of heat and gentle massage, improvement in sleep, low-dose tricyclic antidepressant drugs. If drowsiness is encountered with one drug, an alternative drug may be used. Paroxitene HCl (a serotonin-specific reuptake inhibitor) may be given as a morning medication. Some of the drugs may also aggravate the insomnia. Aspirin and NSAIDS (non-steroidal anti-inflammatory drugs) have generally not been found to be of any help. For severe persistent tenderness, local injection with 1% lidocaine (alone or in combination with hydrocortisone) has been effective.

Which physician handles this condition?

There are specialists who manage fibromyalgia, but one can start with his/her family physician, who will do the initial evaluation and tests, and if necessary, consultation and referral will be made with the appropriate specialist(s).

What is the prognosis?

Functional prognosis is usually very good with aggressive and comprehensive treatment. Fundamental in the success of therapy is patient-motivation, involvement and discipline. Armed with these three, the person with fibromyalgia is soon on her way to a more comfortable, happier, more productive and a fulfilling life.

©2003Raoul R. Diez, M.A.O.D.