Fibromyalgia

Fibromyalgia is a long-term (chronic) condition that can cause widespread muscle pain. There aren’t usually any outward signs of fibromyalgia, but the pain and tiredness associated with it are very real. In the past, other terms were used for fibromyalgia. These include muscular rheumatism or fibrositis and generally mean conditions that cause a lot of pain in muscles and soft tissues but don’t damage to bones and joints.

What is fibromyalgia?
Fibromyalgia is a chronic condition characterized by widespread pain in your muscles, ligaments and tendons, as well as fatigue and multiple tender points — places on your body where slight pressure causes pain.
Fibromyalgia is a long-term (chronic) condition that can cause widespread muscle pain. There aren’t usually any outward signs of fibromyalgia, but the pain and tiredness associated with it are very real. In the past, other terms were used for fibromyalgia. These include muscular rheumatism or fibrositis and generally mean conditions that cause a lot of pain in muscles and soft tissues but don’t damage to bones and joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, fatigue, anxiety, depression, and disturbances in bowel function. Fibromyalgia was formerly known as fibrositis.
Fibromyalgia also does not cause damage to internal body organs. In this sense, fibromyalgia is different from many other rheumatic conditions (such as rheumatoid arthritis, systemic lupus, and polymyositis)

What Causes Fibromyalgia?
Fibromyalgia can be triggered (or made worse) by a number of different factors, such as:  Overexertion, Stress, Lack of exercise, Anxiety, Depression, Lack of sleep or sleep disturbances, Trauma, Extremes of temperature and/ or humidity, Infectious illness or Physically Unfit Muscle. Immune system problems – Certain immunologic abnormalities are common among people with fibromyalgia. Some suggest that fibromyalgia is the result of toxins accumulating in the muscles from lactic acid build-up.

Disturbance in brain chemistry – Many people who develop fibromyalgia have a history of clinical depression, Sleep Disturbances or Insomnia. Many researchers have noticed that fibromyalgia sufferers have a low level of serotonin. They suggest that the central cause of the pain of fibromyalgia is due to this low level of serotonin.
Food allergy (dairy products, wheat, fermented foods, and nightshades-potatoes, eggplant-are most common).
Who does fibromyalgia affect?
Fibromyalgia affects predominantly women (over 80% of those affected are women) between the ages of 35 and 55. Rarely, fibromyalgia can also affect men, children, and the elderly. It can occur independently or can be associated with another disease, such as systemic lupus or rheumatoid arthritis. The prevalence of fibromyalgia varies in different countries. In Sweden and Britain, 1% of the population is affected by fibromyalgia. In the United States, approximately 2% of the population has fibromyalgia.

What are symptoms of fibromyalgia?
Common signs and symptoms of fibromyalgia include:

• •       Widespread Pain
• •       Morning Stiffness
• •       Fatigue
• •       Vision Problems
• •       Nausea
• •       Sleep Disorders
• •       Urinary and Pelvic Problems
• •       Weight Gain
• •       Dizziness
• •       Chronic Headaches
• •       Cold Symptoms
• •       Temperomandibular Joint Dysfunction Syndrome
• •       Multiple Chemical Sensitivity Syndromes
• •       “Fibrofog”: Cognitive or Memory Impairment
• •       Skin Complaints
• •       Chest Symptoms
• •       Anxiety
• •       Depression
• •       Dysmenorrhea
• •       Aggravating Factors
• •       Myofascial Pain Syndrome
• •       Muscle Twitches and Weakness
  
• •       Weather Changes
• •       The Menstrual Cycle
• •       Troubles Breathing

The universal symptom of fibromyalgia is pain. As mentioned earlier, the pain in fibromyalgia is not caused by tissue inflammation. Instead, these patients seem to have an increased sensitivity to many different sensory stimuli and an unusually low pain threshold. Minor sensory stimuli that ordinarily would not cause pain in individuals can cause disabling, sometimes severe pain in patients with fibromyalgia. The body pain of fibromyalgia can be aggravated by noise, weather change, and emotional stress.

How is fibromyalgia diagnosed?
No medical test or x-ray can provide a definitive diagnosis of fibromyalgia.
Doctors typically use the American College of Rheumatology’s 1990 criteria for classifying fibromyalgia. According to these criteria, a person is considered to have fibromyalgia if he or she has widespread pain for at least 3 months in combination with tenderness in at least 11 of 18 specific tender point sites.
Pain is considered widespread when it occurs in both the left side of the body and the right side, and both above and below the waist. Cervical spine, anterior chest, thoracic spine or low back pain must also be present.
The “tender points” are precise areas of the body which, when pressed, generate pain. The 18 tender point sites include:
1.   The area where the neck muscles attach to the base of the skull, left and right sides ( Occiput).
2.   Midway between neck and shoulder, left and right sides ( Trapezius).
3.   Muscles over left and right upper inner shoulder blade, left and right sides ( Supraspinatus).
4.   2 centimeters below side bone at elbow of left and right arms ( Lateral epicondyle).
5.   Left and right upper outer buttocks ( Gluteal).
6.   Left and right hip bones ( Greater trochanter).
7.   Just above left and right knees on inside.
8.   Lower neck in front, left and right sides (Low cervical).
9.   Edge of upper breastbone, left and right sides (Second rib).
To be considered painful, pressure on the tender point must generate actual pain, not just tenderness.
Some physicians also conduct blood work looking at levels of serotonin, substance P, adenosine triphosphate (ATP), free cortisol, glucose, growth hormone, and other factors.

What is the treatment for fibromyalgia?
Other treatment options
As well as medication, there are some other treatment options that can be used to help cope with the pain of fibromyalgia. These include:
•       Swimming, sitting or exercising in a heated pool or warm water
•       An individually tailored exercise programmed cognitive behavioral therapy (CBT) – a talking therapy that changes the way you think about things so you can deal with problems more positively
•       Psychotherapy- a talking therapy that helps you understand and deal with your thoughts and feelings
•       Relaxation techniques physiotherapy – when techniques such as massage are used to improve any physical problems, such as muscle stiffness or weakness
•       Psychological support – any kind of counseling or support group that helps you deal with the issues caused by fibromyalgia

Fibromyalgia medications
Traditionally, the most effective medications in the treatment of fibromyalgia have been the tricyclic antidepressants, medications traditionally used in treating depression. In treating fibromyalgia, tricyclic antidepressants are taken at bedtime in doses that are a fraction of those used for treating depression. Tricyclic antidepressants appear to reduce fatigue, relieve muscle pain and spasm, and promote deep, restorative sleep in patients with fibromyalgia. Scientists believe that tricyclics work by interfering with a nerve transmitter chemical in the brain called serotonin. Examples of tricyclic antidepressants commonly used in treating fibromyalgia include amitriptyline (Elavil) and doxepin (Sinequan).
Studies have shown that adding fluoxetine (Prozac), or related medications, to low-dose amitriptyline further reduces muscle pain, anxiety, and depression in patients with fibromyalgia. The combination is also more effective in promoting restful sleep and improving an overall sense of well-being. These two medications also tend to cancel out certain side effects each can have. Tricyclic medications can cause tiredness and fatigue, while Prozac can make patients more cheerful and awake. Even more recently, study of patients with resistant fibromyalgia found that lorazepam (Ativan) was helpful in relieving symptoms. Prozac has also been shown to be effective when used alone for some patients with fibromyalgia.
In 2007, pregabalin (Lyrica) became the first medication approved specifically for treating fibromyalgia. Lyrica may be work by blocking nerve pain in patients with fibromyalgia. Lyrica has advantages of flexible dosing that can be adjusted according to persisting symptoms.
More recently, drugs that simultaneously increase the amount of two brain nerve transmitters, serotonin and norepinephrine, have been approved to treat fibromyalgia in adults. These drugs include duloxetine (Cymbalta) and milnacipran (Savella). Research studies have shown significant effectiveness in decreasing pain and improving function in patients with fibromyalgia with these drugs. Cymbalta has been effective in treating depression and relieving pain in people with depression and is also used to treat anxiety.

Written By: Rehan Gul