Fibromyalgia – a treatable problem

Pain occurring at various sites in absence of specific cause and induced by mental stress is what constitutes fibromyalgia. This is a condition seen in young adults affecting more women than men. The condition is poorly understood. No known underlying cause has been found. Despite extensive investigations no structural, inflammatory, metabolic or endocrine abnormality has been found in cases of fibromyalgia. Two abnormalities have however been consistently reported, first is sleep abnormalities. Those suffering from fibromyalgia find it difficult to sleep well. Either they do not get sleep or it is disturbed. Deprivation of sleep in normal persons induces features of fibromyalgia.A reduced perception and tolerance to pain is seen in women suffering from fibromyalgia. At the slightest touch they feel pain. This is seen in the form of pain on pressing various sites in the body. Mental tension is a strong precipitating factor for fibromyalgia. Divorce, marital discord, work place tensions poverty, alcoholism e.t.c. are life events that are seen to be associated with this condition. Clinical symptoms seen in fibromyalgia are, pain in multiple sites, often in the neck and back. Pain occurs on pressing these sites. As the months go by pain will spread over arms, legs, chest and other parts. Common sites of pain are junction of shoulders with neck, upper ribs, near the elbows, lower back, buttocks. This pain is associated with early morning stiffness. Sometimes numbness and tingling of fingers and toes may be present. Pain typically occurs on pressing the specific sites. There is no response or poor response to the commonly used pain killers. and is made worse by physiotherapy. Marked fatigue is also an associated feature of the disease and can also occur because of sleep deprivation. Irritability, forgetfulness, poor concentration, may occur as a consequence. Rarely the patients of fibromyalgia also suffer from headache, abdominal bloating and pain, painful intercourse and polyurea. At times the symptoms are so severe that one is forced to give up employment, finding it difficult to continue with the ongoing sickness and disability. Fibromyalgia is diagnosed after excluding other conditions which can cause body ache, notably anemia, osteoporosis, arthritis, hypothyroidism and chronic infections, both clinically and by suitable investigations. It is essential to diagnose fibromyalgia for the proper management. Since the clinical examination and tests are often normal, these patients are often labeled as hypochondriacs and left to their fate or referred to psychiatrists. Both approaches are not very correct. This is a specific condition. As pain killers have no response they should be best avoided, especially if no response is seen in one or two weeks. Physiotherapy is known to aggravate the symptoms and therefore should be avoided. Education of the patient regarding the nature of the problem is vital. Discussion about the personal life of the affected person, her problems and anxieties is also very helpful. Sometimes just unburdening one’s mind to a stranger is useful. In addition the patient should be taught, “self help” techniques. Relaxation techniques for the mind and body, keeping the mind cool at all times and trying to cope up with the personal problems as well as fibromyalgia would certainly help the person. Patient should be encouraged to build up a sleep schedule. That is trying to sleep and wake up at fixed times so that body clock gets habituated to it. Sleeping pills to induce sleep may be used for few days but long term use should be avoided as there is risk of habituation and addiction. Low doses of antidepressants help to overcome severe symptoms. Though no anemia or malnutrition is present in these cases but improving nutritional status improves the sense of well being and helps the patient to cope with the problems.Addictions should be avoided by all means as they would aggravate the symptoms. Fibromyalgia should be kept in mind whenever a person specially a woman has persistent body ache not responding to medical therapy. It is a problem caused by mental problems. Good counseling, mental relaxation and antidepressant medicines are helpful in the management. E-mail: rachna212002@yahoo.co.uk