Fibromyalgia (FMG) is a disease with enormous suffering and chronic widespread pain especially in patients who are under stress and depressed. It is not uncommon. It affects almost 2 to 4% of the entire population. Most commonly affected are women between ages 20 to 50.
Symptoms include tender points in the neck, shoulders, sternum, lower back, hips, elbows, and knees. They also experience generalised fatigue, morning stiffness, sleep disturbances, numbness in hands and feet, depression and anxiety. Pain can increase with activity, cold or damp weather and stress.
Cause of FMG is unknown. Most important factor that seems to play a role is physical or emotional stress. There is strong evidence that major depression is associated with FMG.
Diagnosis requires at least three months of widespread pain and tenderness in 11 of 18 tender points sites. It can mimic Chronic Fatigue Syndrome, Post Traumatic Stress Disorder, or Irritable Bowel Syndrome.
Prognosis is good. It is a chronic problem that doesn’t cause increase in death rate. There is no proven preventive method available. Just treatment of known disease should alleviate the problem.
The treatment of FMG incorporates multiple approaches. It involves decrease in stress, lifestyle changes, medication, education, and physical therapy. It is common to develop frustration with the physician due to treatment failure resulting in frequent changes in doctors. There is no one approach that fits all. Trial and error can determine the best treatment plan for individual patients. The patient has a tendency to ask for more medications resulting in poly pharmacy.
Reducing stress and improvement in coping skills may help reduce painful syndromes. Eating a balanced diet and avoiding caffeine may help with sleeping. Improved fitness through swimming or low impact exercises like walking may be the best initial treatments. Exercises should be started in short sessions and increased as tolerated. High impact exercises and weight lifting can aggravate the discomfort, and are therefore not suggested.
Depression can be improved with low dose anti-depressants which relax the musculoskeletal system, and improve sleep quality. Tricyclic anti-depressant can also be effective against pain, fatigue, and sleep disturbances. Other specific medications are also available which are disease specific and are an FDA approved. Muscle relaxants could also be used to relieve skeletal muscle spasm and associated pain.
In summary, FMG is a widespread problem causing enormous pain and suffering. Treatment requires patience, perseverance. Low impact exercise must be tried with low dose medications in order to achieve the desired goal.