The Pain Of Fibromyalgia

 By: Dr Adnan Siddiq
Fibromyalgia is a disease of unknown cause usually suspected when patients complain of multiple tender points.

A theory is postulated that in fibromyalgia the threshold for pain is lowered because of increased sensitivity of pain signals in the brain. Researchers believe that when repetitive pain signals repeatedly stimulate the brain centers, the concentrations of the chemical substances called neurotransmitters increases in the brain. This causes the brain centers to become sensitive to even minute signals of sensations which are ultimately perceived as pain. The reason behind this sensitization and the reason why it affects some individuals while sparing others is still unknown.

The age group usually affected is early and middle adulthood but children and elderly may also be affected. It has also been observed that a familial association of the disease is present because patients of fibromyalgia tend to have a first degree relative also suffering from the same disease. There has also been an association that patients of fibromyalgia also tend to have Rheumatoid arthritis or Ankylosing Spondylitis.

As previously discussed, fibromyalgia has no definite cause, but there are some conditions or risk factors that are associated with fibromyalgia or which may precipitate the condition.

A patient of fibromyalgia may come to the doctor with following set of complaints:

- Generalized weakness and easy fatigability.

- Increased sensitivity to pain at specific points on the body called "Tender points".

- Pain is of aching type and is usually constantly present with less severity, but suddenly becomes severe on activity or pressure at tender points.

- Patients of fibromyalgia also complain of sleep disturbances.

- Back pain.

After a complete history and thorough physical examination, some of the following tests may be performed to exclude other diseases with similar symptoms:

- Complete blood count.

- ESR (Erythrocyte sedimentation rate).

- Rheumatoid factor.

- Serum Antinuclear antibodies.

- X-ray of affected area to exclude pain due to fractures.

- Serum Ferritin to rule out hemochromatosis.

- Thyroid hormones to rule out thyroid disease.

- Sleep assessment tests.

There is no specific treatment of fibromyalgia. Therefore the main aim of treatment of fibromyalgia is to improve the quality of life of the patient. Following are some of the possible treatment options:

Medications:

- Painkillers (non-steroidal anti-inflammatory drugs).

- Antidepressants.

- Muscle relaxants.

Behavior therapy:

- Individual counseling to solve psychosocial issues may be beneficial.

Other types of therapy:

- Acupuncture is also one of the possible therapies and may yield both physical benefits and well being.

- Physiotherapy under the supervision of a good physiotherapist may be a good option to consider.
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Fibromyalgia is a chronic disorder characterized by inflammation of muscles, tendons and joints. The fibromyalgic tissues pain a lot and turn stiff and tender. The pain may be quite disabling, inhibiting movement in day to day life. But fibromyalgia is otherwise harmless for it does not cause any kind of body damage or deformity. Women are more affected by fibromyalgia than men. Patients with fibromyalgia are increasingly sensitive to external sensory stimuli that trigger pain.
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