Fibromyalgia

Fibromyalgia, a disease of pain perception, is a long-term chronic illness affecting 0.5-2% of the general population. Females are 3-7 times more frequently affected than males, and 10-16% of patients can have an associated rheumatologic condition. It can start at any age, and fatigue is an associated feature in almost 90% of patients. Diagnosis of this condition is often delayed, and patients usually consult many specialists before a definitive diagnosis is made.

Features: Pain all over the body, usually accompanied by fatigue and stiffness, is the most common feature of fibromyalgia. Pain is on both sides of the body. Patients describe pain in various ways, often emotionally. Pain often increases with exertion and does not respond to painkillers. Other painful conditions such as chest pain, headache, abdominal pain, and menstrual pain may accompany. Prolonged morning stiffness unrelieved by exercise is usually present.

Many more symptoms can be associated along with these complaints. These include -

  • Weakness, fatigue, ill health, failure to cope
  • Disturbed sleep, anxiety, depression, poor emotional function
  • Morning stiffness, numbness, subjective joint swellings
  • Numbness, intermittent diarrhea
  • Overlap with other psychosomatic disorders such as migraine, depression, chronic fatigue, and irritable bowel

Patients with fibromyalgia are generally classified based on the degree of tenderness, anxiety, depression, pain control, and catastrophizing (patient believes that there no cure for her disease, feels helpless, and gives up all attempts to manage the illness). At least three subsets can be recognized based on the severity of these symptoms.

Investigations: Pain on pressure at 11 out of 18 specified areas is required for clinical diagnosis of fibromyalgia. However, the diagnosis can also be established with a smaller number of tender areas and other classical features. In addition, other diseases causing generalized pain, especially anemia, diabetes, metabolic bone disease (vitamin D and Calcium deficiency) and thyroid disease, and a few other rheumatologic conditions, need to be ruled out with proper clinical examination and blood and other tests.

Treatment: Specialized multidisciplinary management can significantly improve the quality of life in fibromyalgia patients. Simple pain killers (paracetamol and tramadol) may be used for short-term pain relief. However, they may not be of any significant help. Depression needs to be suitably managed. All patients with fibromyalgia need to understand their disease, adopt a positive attitude, and cope with pain. Drugs, such as pregabalin and gabapentin, are usually prescribed for this condition. However, over-reliance on drugs is unlikely to help in the long run. Non-drug therapies such as graded exercises, cognitive behavioral therapy, heated pool therapy (balneotherapy), relaxation, and music therapy are beneficial in some patients to a certain extent. Difficult patients may require psychological assessment and expert management.

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