Identifying Fibromyalgia – A common pain problem in females
Fibromyalgia is a chronic pain condition that causes widespread diffuse body pains. It is the most common cause of generalised musculoskeletal pain in women between 20 and 55 years. Many patients also experience fatigue, sleep disturbances, headaches and mood disturbances such as depression and anxiety. Although some degree of muscle pain is always present, it varies in intensity and is aggravated by conditions such as anxiety or stress, poor sleep, exertion or exposure to cold or dampness. Muscle stiffness is typically present upon awakening and tends to improve as day progresses.
Persistent fatigue occurs in more than ninety percent people along with complains of unusually light non-refreshing or non-restorative sleep. Patients may also feel numbness, tingling or unusual crawling sensations in arms and legs. Other pain syndromes such as migraines or muscular headaches, irritable bowel syndrome or urinary complaints such as bladder pain and urinary urgency and frequency are commonly seen.
Fibromyalgia is thought to be the result of change in pain perception, a phenomenon termed ‘Central sensitisation’, which might be due to genetic predisposition, stressors including physical or emotional trauma, sleep disturbances or other medical conditions. There is no specific laboratory or imaging test used to diagnose fibromyalgia as no abnormalities are detected in underlying muscles or other tissues.
The objectives of FMS treatment are to reduce pain, improve sleep, restore physical function, maintain social interaction and re-establish emotional balance. To achieve these goals patient will need a combination of social support, education, physical modalities and medication. ADEPT is a six step outline of strategy which stands for attitude, diagnosis, education, physical modalities, treatment with medication and living.
While a positive attitude change is needed in patients, the attitude of family members, employers, policy makers all have an impact on patient’s condition. Clinicians must be prepared to accept fibromyalgia syndrome as a real condition that exerts a tremendous impact on the patient’s life and must approach with empathy. Patients need to be educated and understanding is power when it comes to maintaining a proper attitude, adapting to limitations and taking active role in therapeutic program. Aerobic exercises not only helps to maintain function in everyday activities but also to reduce pain, improve sleep, balance mood, restore cognition and facilitate a sense of well- being. The application of heat in the form of hot bath, hot water bottle, electric heat pad or sauna can relax muscles, facilitate exercise and improve a sense of well-being. There have been new medications that have been developed and tested for this condition which include analgesics, antidepressants in low doses and a few anticonvulsant medications which are useful in managing this condition.
Fibromyalgia is thus not a diagnosis of exclusion. A correct diagnosis along with a multidimensional approach to management and with patient and family education and participation can help these patients’ lead better lives.