Living with Fibromyalgia

Are you doing everything you can to manage your Fibromyalgia?

Fibromyalgia is a complex disorder, characterised by chronic, widespread pain and a heightened and painful response to gentle touch.  While it’s more common in women aged 20 – 50 years, it can strike men and children and impacts on millions throughout the world.  Fibromyalgia has also been linked to fatigue, morning stiffness, trouble sleeping, headaches, irritable bowel syndrome, impaired concentration, environmental sensitivities, depression and anxiety.

Fibromyalgia is considered a controversial diagnosis, with some scientists contending that the disorder is a ‘non-disease’ due in part to a lack of objective scientific tests or medical imaging studies to confirm the diagnosis.  While historically considered either a musculoskeletal disease or neuropsychiatric condition, evidence from research conducted in the last three decades has revealed abnormalities within the central nervous system affecting brain regions that may be linked both to clinical symptoms and research phenomena.  Although there is as yet no generally accepted cure for fibromyalgia, there are treatments that have been demonstrated, by controlled clinical trials, to be effective in reducing symptoms, including medications, patient education, exercise and behavioural interventions.

Symptoms can have a slow onset, and many sufferers have mild symptoms beginning in childhood that are often misdiagnosed as growing pains.  Symptoms are often aggravated by unrelated illness or changes in the weather.  They can become more or less tolerable throughout daily or yearly cycles.  However, many people with severe fibromyalgia find that the condition can be extremely debilitating and interferes with many basic daily activities.

CAUSE:

The cause of this disorder is currently unknown; however several theories have been developed.

• Genetic – Since many fibromyalgia sufferers have close family members with the disorder, there may be certain genetic mutations that may make a person more susceptible to developing the disorder.
• Physical or emotional trauma – such as an acute illness or injury, which may act as a trigger in the development of the disorder.
• Infections – Infectious illnesses, including certain viruses, may attack the central nervous system, inhibiting the production of neurotransmitters. This could cause fibromyalgia pain.
• Brain chemical & hormonal abnormalities – Researchers know people with fibromyalgia can have numerous abnormalities in their hormonal, metabolic and brain-chemical activity, but they’re not sure whether these are causes of fibromyalgia or the effect of pain and stress on the central nervous system.

DIAGNOSIS:

There is still debate over what should be considered essential diagnostic criteria.

The difficulty with diagnosing fibromyalgia is that, in most cases, laboratory testing appears normal and that many of the symptoms mimic those of other rheumatic conditions such as arthritis or osteoporosis.

In general, most doctors diagnose patients with a process called differential diagnosis, which means that doctors consider all of the possible things that might be wrong with the patient based on the patient’s symptoms, gender, age, geographic location, medical history and other factors. They then narrow down the diagnosis to the most likely one. In the US the most widely accepted set of classification criteria for research purposes was elaborated in 1990 by the Multicenter Criteria Committee of the Americal College of Rheumatology. These criteria, which are known informally as “the ACR 1990,” define fibromyalgia according to the presence of the following criteria:

• A history of widespread pain lasting more than three months-affecting all   four quadrants of the body, i.e., both sides, and above and below the waist.
• Tender points-there are 18 designated possible tender or trigger points (although a person with the disorder may feel pain in other areas as well). During diagnosis, pressure is exerted at each of the 18 points; and the patient must feel pain at 11 or more of these points for fibromyalgia to be considered.

This set of criteria was developed by the American College of Rheumatology as a means of classifying an individual as having fibromyalgia for both clinical and research purposes. While these criteria for classification of patients were originally established as inclusion criteria for research purposes and were not intended for clinical diagnosis, they have become the de facto diagnostic criteria in the clinical setting. It should be noted that the number of tender points that may be active at any one time may vary with time and circumstance.

Physicians should also rule out other causes of the symptoms before making a diagnosis of fibromyalgia.

PREVENTION:

There is no proven prevention for this disorder. However, over the years, the treatment and management of the disease has improved.

TREATMENT:

Since there is no known cure for the disorder, treatment focuses on relieving symptoms and improving function.

In mild cases, symptoms may go away when stress is decreased or lifestyle changes are implemented. A combination of treatments including medications, patient education, physical therapy, and counselling are usually recommended. Many fibromyalgia sufferers have also found support groups helpful.

In 2007, the Food and Drug Administration approved Pregabalin (Lyrica) as the first drug for the treatment of fibromyalgia.

In June 2008, a second drug, Cymbalta, which was previously approved for treating depression, was FDA approved for treating fibromyalgia as well.

In 2009 the FDA approved milnacipran (Savella) for the treatment of fibromyalgia.

Certain classes of antidepressant medications are sometimes prescribed for the disorder. Studies show that antidepressants in low doses can decrease depression, relax craniofacial and skeletal muscles, improve sleep quality, and release pain-killing endorphins. Other medications that are used include anti-inflammatory pain medications and medications that work on pain transmission pathways, such as Gabapentin.

Eating a well-balanced diet and avoiding caffeine may help with problems sleeping, and may help reduce the severity of the symptoms. Lifestyle measures to improve the quality of sleep can be effective for fibromyalgia.

Some reports indicate that fish oil, magnesium/malic acid combinations, or vitamins may be effective. Reducing stress and improving coping skills may also help reduce painful symptoms.

Improved fitness through exercise, gentle stretching and alternative therapies … such as massage, myofasical release, acupressure, relaxation techniques, acupuncture and chiropractic manipulation, may also be effective tools in managing fibromyalgia symptoms.

Severe cases of fibromyalgia may require a referral to a pain clinic.

LONG-TERM OUTLOOK: 

Although the disease in adults is chronic and life-long, it is neither progressive nor fatal, and remission can occur in many patients who participate in management programs. Patients with secondary fibromyalgia, particularly when it is caused by injury, tend to have a more severe and less easily treated condition than those with primary fibromyalgia.

Outlook in Children. Children with fibromyalgia tend to have better outlooks than adults do.

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The following links may also be helpful in your research.

National Fibromyalgia Association – USA – www.fmaware.org/
FIBROMYALGIA ASSOCIATION – UK – http://www.fibromyalgia-associationuk.org/
Books – http://www.fibromyalgia-information-relief.com/fibromyalgia-books.html