Fibromyalgia syndrome (FS) is a chronic and complex condition of unknown etiology, which is characterized by widespread musculoskeletal pain with multiple tender points, which commonly co-exists with depression; sleep disturbance, and significant fatigue.
Patients suffering from fibromyalgia often report high disability level and poor quality of life. There is no specific laboratory test to diagnose it but the accepted method for diagnosis is the 1990 American College of Rheumatology (ACR) criteria. According to ACR patient should have widespread pain for longer than three months duration, with pain on palpation of at least 11 of 18 specific tender points on body.
One of the most overlooked and under diagnosed debilitating health issue… 3.4% of females and 0.5% of males, complain of fibromyalgia symptoms.
Classification: It is classified based on psychological and autonomic nervous system profiles
- “Extreme sensitivity to pain but no associated psychiatric conditions” (may respond to medications that block the 5-HT3 receptor)
- “Fibromyalgia and comorbid, pain-related depression” (may respond to antidepressants)
- “Depression with concomitant fibromyalgia syndrome” (may respond to antidepressants)
- “Fibromyalgia due to somatization” (may respond to psychotherapy)
What causes fibromyalgia?
There are many speculations about the causes of Fibromyalgia. Researchers suggest that being a complex syndrome it cannot be caused by a single event but from a combination of many physical and emotional stressors. Some researchers believe that it is caused by reduced level of serotonin (neurotransmitter) leads to reduced pain threshold and anxiety. Increased levels of substance P may cause increased pain sensitivity. Some studies link fibromyalgia to sudden brain and spinal cord injury.
1. Stress and fibromyalgia are related
Chronic stress may be an important precipitating factor as fibromyalgia is frequently seen in people with stress related disorders such as chronic fatigue syndrome, irritable bowel syndrome and depression.
2. Insomnia and fibromyalgia
Many people suffering from fibromyalgia experience insomnia or non-restorable sleep which causes lower levels of serotonin, resulting in increased pain sensitivity.
3. Depression and fibromyalgia
Some researchers used to believe that low-grade depression causes fibromyalgia but recent studies negate this thought. However continuous pain can cause anxiety and depression, which can worsen symptoms of fibromyalgia.
4. Genetics and fibromyalgia
Some scientists theorize that people suffering from fibromyalgia may have gene or genes inherited from their parents, which cause adverse reaction to some stimuli. When these people are exposed to certain emotional or physical stressors there is a change in the body’s response to that stimulus. This causes higher sensitivity of entire body to pain.
5. Gluten sensitivity
There is an association seen between fibromyalgia and gluten sensitivity. Also patients have seen improvements in their symptoms by eliminating gluten from their diet.
Fibromyalgia: Management and Treatment
Although there is no cure for fibromyalgia, simple management and treatment can relieve most of its painful symptoms. A multidisciplinary fibromyalgia pain management approach should include medications, patient education, yoga asana stretches, breath-work, regular gentle low impact exercise and cognitive behavior therapy.
- Painkillers – Over the counter painkillers like acetaminophen, ibuprofenor naproxen sodium may be helpful. Some doctors prescribe opiods such as tramadol but in low doses only.
- Antidepressants like Duloxetine and milnacpran may be used to relieve pain and improve sleep quality
- Anti-seizure drugs – gabapentin is used sometimes to help relieve fibromyalgia symptoms
- Human growth hormone – addition of growth hormone to standard treatment is effective in reducing pain
- Muscles relaxants like tizanidine is prescribed sometimes to relieve symptoms
Fibromyalgia pain can be debilitating and what provide relief to one patient may not help other, so one should consider non drug treatment as they are generally safe and do not cause further harm.
2. Cognitive behavior therapy (CBT)
CBT along with exercises has proved to be effective in some sufferers. It helps in improving mood and self-efficacy or coping with pain and fatigue.
3. Exercises benefit for Fibromyalgia
- Reduced no. of tender points
- Decreased pain at tender points
- Decreased general pain
- Improved sleep and less fatigue
- Fewer feelings of helplessness & hopelessness
- More frequent & meaningful social interactions
- Lessened impact of the disease on daily activities.
- Long term aerobic activity such as aqua therapy and cycling has been proven beneficial to relieve symptoms
4. Yoga and Meditation
Yoga is a great antidote to stress, which can exacerbate fibromyalgia symptoms, says Camilleri. Most of the yoga posture involves stretching of muscle tissue which improves circulation to the affected tissue reduces tension, inflammation and pain.
Various breathing techniques, Pranayam and meditation stimulates vagus nerve which reduces stress , decreases tension and heaviness of affected muscle tissue ,promote good sleep and improves overall functioning of the body. One should start with simple asana and should not go in extreme positions as it may worsen their symptoms. Asana such as Garudasan (eagle pose), which stretches muscles around shoulder blade, Bhujangasan (cobra pose) extend back while opening chest can be done.
Use of fragrant herbs and oils for skin or inhalation induce sleep, reduce muscle pain and calms mind. Some patients may see improvement while for others symptoms may get worsen so it should be used carefully and under expert supervision.
It may not be gold standard treatment for fibromyalgia but worth trying. It increases blood flow to inflamed areas and promotes relief from stiffness and tension headaches.
It is another good way to reduce symptoms of fibromyalgia but one should go for an experienced therapist as patients may find it painful, as their muscle tissue is very sensitive. It should involve light force without triggering trigger points.
It is seen that patients suffering from fibromyalgia pain often have poor quality of sleep, which may be due to low levels of melatonin. So taking low dose melatonin may help to promote good sleep thereby reducing the pain effects.
9. Vitamin D
Vitamin d is virtually recommended for everybody and not just fibromyalgia patients. It can be taken by sun exposure or orally. Recommended dosage is 200-400 IU/day preferably taken with food for better absorption.
10. Tai Chi
It is a Chinese martial art, which involves mind body practice. It involves breathing techniques, various graceful movements and relaxation. A recent study compares Tai chi with standard fibromyalgia treatment showed a significant improvement in quality of life and settlement of other symptoms.