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Fibromyalgia

Fibromyalgia represents a chronic disorder that manifests with widespread musculoskeletal pain as well as significant fatigue, difficulty sleeping and issues with mental processes. Apparently, people with fibromyalgia have areas of tenderness on their bodies where even gentle pressure can provoke them a feeling of pain, which made specialists believe that the disease affects the way patients brain processes pain signals by amplifying painful sensations. Because this condition does not have a clear and specific cause and the symptoms are subjective, doctors not only often misdiagnose it as another disease, but they question its existence. Thus, a stigma became associated with fibromyalgia. However, because many researches have led to a better understanding of the condition, doctors now believe that changes in the patient’s lifestyle are more efficient than medications. In addition, due to the lack of a main cause, practically anyone can get fibromyalgia. Nevertheless, middle-aged women and people with autoimmune diseases like rheumatoid arthritis face a greater risk of developing it. Doctors use the points of tenderness on the patient’s body to narrow down the possibilities in terms of diagnosis. By using other characteristic and consistent symptoms along with several medical tests, they intend to determine a cause of fibromyalgia. Sometimes, a physical trauma, infection and surgery represent triggers for the condition.

 

Causes of Fibromyalgia

Unfortunately, doctors do not know the exact cause of fibromyalgia but they associate it with abnormal levels of chemicals in the patient’s brain and alterations in the central nervous system, which affects pain messages around the body. Low levels of certain hormones including serotonin and dopamine can lead to changes in appetite, behavior, sleep and response to stressing situations. Furthermore, with the passage of time, researchers began to recognize various factors that could cause the disease including genetics. Because fibromyalgia runs in the family, they believe that certain genetic mutations make a person more prone to developing the condition. In addition, some illnesses may trigger and even aggravate this chronic disorder. Because their hypersensitivity to physical pain, factors like stress, light, cold or noise can exacerbate the sensation of pain. Several theories appeared due to the controversy of fibromyalgia. Therefore, on one hand, specialists suggest that the brain lowers the pain limit and on the other hand, some think that nerves and receptors in the patient’s body present an increased sensitivity to stimulation resulting in overreaction to pain signals and unnecessary pain.

Risk factors for fibromyalgia refer to family history, gender, disease, sleep disorders and depression. Apparently, women have a higher chance of developing the condition in comparison to men because reproductive hormones like estrogen make them more sensitive to pain. A strong example is the fluctuation of pain levels during menstrual cycles. Menopause also represents a risk for the disease because it decreases the levels of estrogen. In terms of age, most people receive a diagnosis for fibromyalgia between 20 and 50 years of age. Already having a rheumatic disease, which affects bones, muscles and joints, represents a danger for getting fibromyalgia. Ultimately, this condition in combination with depression strikes the patient both physically and mentally because experiencing chronic pain can lead to depression while depression can worsen the pain, which results in a vicious circle.

 

Conditions Associated with Fibromyalgia

Generally, the conditions associated with fibromyalgia include:

• Osteoarthritis: This condition causes damage to the joints, thus leading to pain and stiffness in the respective area. Apart from these symptoms, some people experience a crackling sound when intending to move their joints.
• Rheumatoid arthritis: Patients with this disease experience pain and swelling in the joints because the immune system attacks healthy cells. Generally, patients with rheumatoid arthritis feel symptoms in their wrists, hands and feet.
• Lupus: Similar to rheumatoid arthritis, this complex and hardly understood condition affects several parts of the body as a result to the attack of the immune system on healthy cells. Symptoms usually vary, from mild at the beginning to life threatening if the disease progresses.

When diagnosing fibromyalgia, doctors usually test these and other conditions like temporomandibular disorder (TMD) and ankylosing spondylitis (AS).

 

Signs and Symptoms of Fibromyalgia

People with fibromyalgia experience various symptoms, which include widespread pain, extreme sensitivity, fatigue, stiffness, poor sleep quality, headaches, cognitive problems and irritable bowel syndrome (IBS), among others. Factors like physical activity, weather changes and stress levels can influence the amelioration or worsening of fibromyalgia symptoms.

Widespread pain: This represents the main and specific symptom of fibromyalgia because all patients with the condition feel pain throughout the body and in certain areas like the neck or back, can be even more intense. Even though usually the pain is constant, its intensity changes at different times. It can manifest as a burning sensation, a stabbing pain or an ache.

Extreme sensitivity: Fibromyalgia causes high sensitivity to pain so even a slightest touch on the patient’s body can be painful. If the patient accidentally hurts himself, like stubbing his toe, the pain lingers more time than it normally does. He may also show increased sensitivity to other factors that involve bright lights, food and smoke. When exposed to these factors, the symptoms immediately flare up. Doctors may use terms like hyperalgesia and allodynia to describe this condition.

Fatigue: People with fibromyalgia experience fatigue or extreme tiredness. Generally, it varies from a mild feeling of exhaustion, often caused by a flu-like illness to severe fatigue that appears all of a sudden practically draining the patient’s energy out of his body.

Stiffness: This represents another symptom of fibromyalgia. Patients may experience severe stiffness, especially when keeping their body in the same position for a long period, for instance in the morning. Muscles spasms may occur, which means that the muscles contract tightly causing pain.

Poor sleep quality: Fibromyalgia causes non-restorative sleep meaning that patients often wake up tired after an insufficiently refreshing sleep. Even though they have plenty of sleep over the night, the condition significantly affects its quality, which reflects on the patient’s mood.

Headaches: Because fibromyalgia leads to pain and stiffness in the neck and back area, the patient also experiences frequent headaches. Similar to the other symptoms, headaches can vary from mild to severe as well as including nausea or feeling sick.

Cognitive problems: Because fibromyalgia negatively affects mental processes including thinking and learning, patients may experience attention and concentration issues, confused speech and difficulties in memorizing or learning new information.

Irritable bowel syndrome (IBS): People with fibromyalgia are prone to developing this common digestive disorder known for causing pain and bloating in the stomach. They also have constipation and diarrhea.

Other symptoms of fibromyalgia include dizziness and the inability to regulate the body’s temperature properly, numbness, tingling or burning sensation in the hands or feet, anxiety and depression as well as painful periods for women.

 

 

Tests and Diagnosis for Fibromyalgia

In the past, doctors would carefully examine certain points on the patient’s body by applying pressure on them in order to determine the presence of pain. However, according to new guidelines, persistent widespread pain alone represents a solid clue that doctors must consider for establishing a proper diagnosis. Still, they need to eliminate the possibility of other diseases including multiple sclerosis (MS), chronic fatigue syndrome (ME) and rheumatoid arthritis that can manifest with similar symptoms. Urine and blood tests are necessary and the doctor can include X-rays for certainty and peace of mind. Blood tests include thyroid function test, complete blood count and rheumatoid factor, among others. It is possible for the patient to have both fibromyalgia and another condition at the same time.

Furthermore, receiving a diagnosis for fibromyalgia requires meeting certain criteria. Thus, the patient must show severe pain in multiple areas of the body, the symptoms must have the same intensity for a long period, more precisely three months and the doctor cannot find other reason that might explain the symptoms.

 

Treatment for Fibromyalgia

Even though specialists have not yet discovered a cure for fibromyalgia, receiving a medical treatment can ease the symptoms and improve the patient’s quality of life. Generally, several healthcare professionals engage in the patient’s care including a neurologist, specialized in the central nervous system, a psychologist, specialized in mental health and knowledgeable in terms of psychological treatments as well as a rheumatologist, specialized in diseases that usually affect the joints and muscles. The same treatment will not be equally efficient for all the patients with this condition, taking into consideration that fibromyalgia manifests with different symptoms. For this reason, the patient may have to try multiple treatments in order to discover a combination suitable for his specific needs.

Medications have the purpose to ease the pain caused by fibromyalgia and improve the quality of sleep. Common types of medications for patients with this disease include:

• Painkillers: Although over the counter painkillers including paracetamol can sometimes help the patient deal with the pain, they do not work for everyone so reading the manufacturer’s instructions before taking them becomes imperative. Those patients for which over the counter painkillers do not provide satisfying effects can receive something stronger from a healthcare professional. Nevertheless, patients cannot use these medications constantly because apart from being addictive, their effect loses in time, which means that the doctor must gradually increase the dosage and if the patient stops using them, he may experience symptoms like insomnia or restlessness, emotional instability, appetite changes, irritability and even fatigue or diarrhea.
• Antidepressants: These medications have the same purpose as painkillers, namely relieving the pain for those with fibromyalgia. They act by increasing the levels of neurotransmitters, which represent chemicals that have the mission to send messages to and from the brain. When prescribing antidepressant to the patient, the doctor must keep in mind the severity of his symptoms and possible side effects. Medication treatment for fibromyalgia with antidepressants may include duloxetine, amitriptyline and paroxetine. Their side effects involve dry mouth, dizziness, feeling sick or agitated, weight gain and constipation.
• Anti-seizure drugs: Even though doctors use these medications for epileptic patients, they can prove to be very beneficial for those with fibromyalgia because they reduce pain. Gabapentin and pregabalin are the most common anticonvulsants doctors prescribe for this type of situations. Their side effects include weigh gain, drowsiness, dizziness and oedema, referring to the swelling of hands and feet.
• Antipsychotics: These types of medicines, also known as neuroleptics, can fight the pain people with fibromyalgia experience. Even though researchers have proven their efficiency, only further studies can really confirm this statement. They include possible side effects like restlessness, shaking and drowsiness.

Apart from medication, doctors can encourage other treatment options for fibromyalgia to help the patient deal with the pain, such as relaxation techniques, a personalized exercise program, hydrotherapy, cognitive behavioral therapy (CBT), psychotherapy and psychological support. A physical therapist can intervene and introduce the patient to various exercises with the goal to increase his flexibility, endurance and strength. An occupational therapist can advise the patient with fibromyalgia concerning activities and tasks at the workplace as well as helping him make needed changes when performing those tasks in order to lessen the amount of stress on the body. A counselor also plays an important role because he can inform the patient regarding various strategies that will help him deal with stressing situations and improve his self-confidence.

Alternative medicine: Acupuncture, massage therapy, yoga and tai chi represent complementary solutions for helping the patients cope with pain and stress. Even more, these methods are very popular among people with fibromyalgia, thus gaining more and more acceptance in mainstream medicine.

• Acupuncture consists in inserting fine needles through the patient’s skin in order to change the blood flow and increase the levels of neurotransmitters. Moreover, certain studies show that it also relieves fibromyalgia symptoms.
• Massage therapy is an old method for health care that consists in applying different manipulative techniques that have the purpose to stimulate the patient’s muscles and soft tissues. Apart from eliminating anxiety and stress, this type of massage relaxes the muscles, reduces heart rate and helps the body produce natural painkillers.
• Yoga and tai chi represent helpful practices because they control fibromyalgia symptoms though meditation, deep breathing and relaxation.