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Fibromyalgia

Overview

Fibromyalgia is a chronic disorder in which a person feels pain at multiple locations throughout the body, accompanied by tiredness, disturbed sleep, stiffness of the muscles, anxiety or depression, etc.
It is most commonly found in middle-aged females, although it can affect any age group and sex. The exact cause is unknown, but it involves the problems with pain perception and sensitivity triggered by external factors in genetically susceptible people. Though the illness is incurable, a combination of medicines to relieve symptoms and other therapies has been proved helpful.

Cause

The exact cause of the disease is unknown; however, it is thought to result from a combination of genetic and environmental factors. Initially, fibromyalgia was supposed to be a psychological disorder because no physical lesions were found according to the symptoms present. However, in light of focused research, it is now considered a neurosensory disorder in which there are abnormalities in pain perception and processing in genetically susceptible people.
Fibromyalgia is found to imbricate other central sensitivity disorders like chronic fatigue syndrome, irritable bowel syndrome, chronic pelvic pain syndrome, etc.
The presence of negative psychological emotions like anxiety, depression, and negative cognitive beliefs have seen to precipitate the symptoms of fibromyalgia due to the reason that pain processing is an interplay of inputs from pain receptors of the spinal cord plus the regions of the brain controlling the emotional, motivational and cognitive aspects of pain. The chemicals involved are serotonin, substance P, NMDA, growth hormone, cortisol hormone.

Epidemiology

 It is the second most common complaint to be presented to rheumatology clinics. The cases have emerged globally. There is no age and race predilection. It is found in all ages and all races. However, It is more prevalent in middle-aged females rather than in males.

Risk Factors

The following factors will make you susceptible to having fibromyalgia;

  • Female gender
  • Family history
  • Suffering from some other inflammatory disorders like rheumatoid arthritis, SLE, chronic hepatitis
  • Having negative disorders of sadness like depression, anxiety
  • Physical and mental stress.

Signs And Symptoms

Fibromyalgia is a chronic syndrome that is characterized by having a combination of one or more of the following symptoms;

  • Pain or tenderness is present for more than three months throughout the body on both sides, above and below the waist, and in the paraspinal region.
  • Stiffness
  • Disturbed sleep
  • Fatigue ( tiredness)
  • Anxiety/ depression
  • Problems with cognitive functions (attention, focus, concentrate)
  • Functional impairment of activities of daily life.

Diagnosis

There are no specific tests to diagnose fibromyalgia. Its diagnosis is made after all other possible causes of the symptoms have been excluded. Your doctor may take a detailed history of your symptoms, may ask questions about the possible causes, psychological history, co-existing illnesses, and stressors.
 Your doctor may advise the following tests to exclude other diseases;

  • Complete blood picture
  • ESR and CRP
  • Serum electrolytes
  • Urinalysis
  • Vitamin B12 and vitamin D levels
  • Thyroid hormone levels

The doctor may ask you to fill out questionnaires to help diagnose other psychological disorders like depression, anxiety, and functional impairment of daily activities. Some of them are;

  • Fibromyalgia Impact Questionnaire
  • The Physician Health Questionnaire–9 for depression
  • Checklist of current symptoms
  • The Generalized Anxiety Disorder–7 questionnaire for anxiety
  • Social Support Questionnaire
  • The Mood Disorder Questionnaire to screen for bipolar disease
  • Sickness Impact Profile

Differential Diagnosis

A couple of other disorders may present as fibromyalgia and must be ruled out to treat the correct disease.

  • Polymyalgia rheumatica
  • Chronic fatigue syndrome
  • Sick building syndrome
  • Atypical chest pain
  • Malingering
  • Hypothyroidism
  • Hyperparathyroidism
  • Post-traumatic stress disorder

Treatment

Fibromyalgia is an incurable disease, although patient education, lifestyle changes, and medicines to control the symptoms and psychotherapies can help a patient cope with the disorder.
Patients must be educated about the disease and should be encouraged to adopt lifestyle changes like eating a healthy diet, maintaining a sleep routine, performing gentle exercises, and managing stress.
Other therapies involve cognitive behavioral therapy, psychotherapy, relaxing exercises, etc.

Medications

Medications used are;

  • Analgesics like acetaminophen, ibuprofen, NSAIDs
  • Antidepressants like SSRIs, TCAs, SNRIs
  • Antianxiety medicines like alprazolam, buspirone
  • Skeletal muscle relaxants like cyclobenzaprine, tizanidine
  • Anticonvulsants like pregablin, gabapentin
  • Other agents like multivitamins, antioxidants, amino acids

Prognosis

Fibromyalgia is a chronic, incurable disease. The symptoms can never be eliminated entirely. The condition itself is not life-threatening; however, if not diagnosed and treated can make a patient’s life quite miserable. The person will continue to have sleep disturbances due to pain, further precipitating the symptoms and hampering the person's ability to perform daily activities. Therefore it must be
treated, and a multi-specialty approach should be followed.
When appropriately treated, it has a favorable outcome. A person can easily cope with the help of medicines and other therapies mentioned above.

Lifestyle Changes

To cope with the disease, following lifestyle changes must be adopted to have a peaceful life.
Diet improvement: a person is advised to take a healthy balanced diet that must have vitamins, minerals, amino acids, antioxidants, etc.
Stress management: exercises and therapies to manage stress must be done.
Exercises: a person is advised to perform aerobic exercises, water aerobics, cycling, etc
Sleep therapy:  education must be given about sleep hygiene, and a regular sleep-wake schedule should be followed.
Psychological therapies: a person should undergo cognitive behavioral therapy or psychotherapy to control the symptoms of anxiety and depression and to learn to adapt to stress.

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