Fibromyalgia: What is Fibromyalgia?, Symptoms, Signs, Causes, Diagnosis and Treatment - Page 11 of 11

Fibromyalgia is one of the most misunderstood conditions by both the public and inexperienced medical personnel. It is one that causes severe morbidity and alters daily activities. Its sufferers are rarely understood and more rarely treated adequately. Understanding fibromyalgia not only improves the lives of patients suffering from it, but also allows healthy people understand that many conditions may not be as explicit in their manifestations and yet cause much distress for those who suffer from them. Unfortunately, many patients suffered for decades with their symptoms either completely neglected or treated by inappropriate medications owing to the faulty understanding of how fibromyalgia develops. In this article, we will discuss how fibromyalgia occurs, what symptoms suggest it, how it is diagnosed and how it can be treated.

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What is fibromyalgia?

Fibromyalgia is a condition of persistent, recurrent, widespread and, sometimes, intolerable pain. Such pain can affect any place in the body from head to toes. At first, it was thought to be a psychological condition and therefore given either no treatment at all, thinking it would go on its own, or psychotropic medications that offer little and expose the patient to unnecessary side effects. Recent research has found that fibromyalgia is, in fact, a disorder of pain perception.

Pain perception is quite complex. At first, our pain receptors (also called nociceptors) feel the pain whether due to trauma, heat, chemical or inflammation, then nerve fibers transmit such sensation to the spinal cord and from there to the thalamus -a collection of nerves in our brain and finally to the cortex of our brain. Pain perception is not absolute, since a pain threshold exists and differs between individuals. What’s on people can consider as intolerable pain, others can endure for hours. In fibromyalgia, many of these mechanisms are affected. Patients can feel pain from non-painful sensations like touch or simple pressure. They can also feel exaggerated pain and pain in sites that are in affected at all. Fibromyalgia also affects other aspects than pain including depression, anxiety, altered sleep pattern and general wellbeing.

Symptoms of fibromyalgia

Fibromyalgia symptoms – Thelifetoday.com

Fibromyalgia is a disorder of pain. Unlike most other pain-related conditions, pain from fibromyalgia is characterized by being:

Affecting all the body both above and below the waist, especially the backbone.
Chronic, lasting for months.
Associated with tenderness, where pain increases on pressing the affected part.

Other symptoms related to fibromyalgia include:

Depression: Depression is one of the known symptoms of fibromyalgia. It is considered to be independent from the chronic pain. Patients suffer from depression owing to the decreased level of the hormone serotonin in the brain.
Altered sleep pattern: Our sleep and wakefulness are controlled by different parts of the brain, and patients suffering from fibromyalgia tend to have abnormal sleep cycles and timing. The end result is chronic headache and fatigue.
Anxiety: Anxiety is one of the complications of fibromyalgia which results from chronic pain, which activates our sympathetic nervous system.
Cognitive problems: Fibromyalgia can affect memory and concentration. Patients often report defective short-term memory and ability to do tasks that require prolonged concentration. It is not clear whether this results from the altered sleep pattern or because of parallel affection of other sites in the brain.

How is fibromyalgia diagnosed?

Unfortunately, there are no specific tests for fibromyalgia, and the diagnosis is achieved by excluding other known conditions that present similarly. This may require months of lab tests and imaging studies before a final diagnosis is reached, which adds to the patient’s uncomfortable lifestyle.

Your doctor will listen to your complaints and may ask you a few questions to exclude other conditions associated with arthritis or mental problems. Then, they will perform a physical examination which includes examining each tender joint for the site of pain and localizing the sites of your discomfort. This is usually followed by ordering a number of investigations including laboratory tests and, sometimes, imaging studies. Recently and to speed up diagnosis, a questionnaire has been developed that quickly screens for symptoms suggestive of fibromyalgia, but it is not in practice in many centers and many doctors may not agree that such questionnaire is enough to exclude all other conditions. It can still help exclude many disorders without the need for more testing.

Laboratory tests

There is no special test for fibromyalgia, and laboratory tests are usually guided to test for other conditions depending on the patient’s symptoms or examination findings. Commonly done ones include:

A complete blood count is essential to rule out anemia and infection, both of which can cause symptoms similar to fibromyalgia.
Thyroid hormone levels: Thyroid stimulating hormone can help exclude thyroid problems.
Vitamin D level: Vitamin D deficiency notoriously causes muscle and bone pain.
Vitamin B12 level: Vitamin B12 is essential for healthy functioning of the nerves, and its deficiency can cause pain and numbness all over the body.
Mineral levels: Some minerals including iron and magnesium can be deficient and cause muscle spasms or general fatigue. They are especially common in middle-aged females who are the greatest population suffering from fibromyalgia. Iron can be detected by serum iron level, iron binding capacity and transferrin levels.
Autoimmune antibodies tests including ANA (antinuclear antibodies) and anti-dsDNA for lupus, rheumatoid factor and anti CCP for rheumatoid arthritis, and HLA-B27 for ankylosing spondylitis.
Inflammatory markers: Inflammatory markers are chemical substances resulting from tissue damage. They can result from any inflammatory disorder whether autoimmune, infection or even trauma. If they are elevated, it means that another disorder than fibromyalgia is more likely to be the cause of pain. Commonly measured inflammatory markers include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Fibromyalgia questionnaires

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Due to the subjective nature of most fibromyalgia manifestations, several questionnaires have been developed to help patients better describe their symptoms, and therefore help doctors reach a more accurate diagnosis. They are not yet an alternative to other tests as mentioned above, but more refined versions of such questionnaires have shown a significant sensitivity in detecting patients with fibromyalgia early on.

Examples of these questionnaires include:

Modified Health Assessment Questionnaire
Fibromyalgia Impact Questionnaire
Checklist of current symptoms
Scales for helplessness and cognitive performance
The Physician Health Questionnaire–9 for depression
The Generalized Anxiety Disorder–7 questionnaire for anxiety
The Mood Disorder Questionnaire to screen for bipolar disease

The last three questionnaires are also used for psychiatric conditions, but the difference here is that they are not used alone for assessing fibromyalgia, and symptoms like pain are no longer taken lightly as a part of a psychiatric condition as was done in the past. The combination of the above questionnaires provides the best diagnostic accuracy.

Will fibromyalgia affect my work after treatment?

One of the commonest questions asked by chronic patients with fibromyalgia is its impact on their daily life including their work. Patients tend not to notice their cognitive impairment like their physical pain, but figures from several countries have shown that fibromyalgia is one of the leading causes of disability and sick leaves for workers. In the past, workers were advised to avoid work to improve their symptoms, but recent studies have shown that stopping work only worsens symptoms both physical and psychological and therefore, patients are better off resuming their daily activities, including work, as best they could.

It is almost impossible to reverse all of fibromyalgia’s symptoms regardless of the method of treatment chosen, but patients cope differently, and many patients can reach satisfactory levels of daily activities if they adhere to treatment.

Can fibromyalgia get worse or cause mortality?

Pain is the worst symptom experienced in medicine, and patients with chronic pain are victims to bad thoughts. Therefore, psychological support is essential, and the first step of such support is assuring patients that they are not going to die from fibromyalgia. In fact, fibromyalgia as a disease doesn’t get worse. Chronic patients may notice that their symptoms are worsening, but it is most likely due to the increased anxiety and sleep deprivation that give the illusion of increasing pain. Fibromyalgia also doesn’t affect bone or joints, and patients are not at an increased risk of cancer or other terminal diseases just because they have fibromyalgia. Other conditions that occur with fibromyalgia like irritable bowel syndrome may need to be differentiated from malignant disorders before establishing diagnosis, but that’s the closest relation between both conditions.

Treatment of fibromyalgia

The first successful step in managing any condition is knowing what to expect. In curable diseases, cure is the ultimate result, while in chronic relapsing conditions, control of symptoms is the goal. In the case of fibromyalgia, all patients should know that the disease is incurable and that the ultimate goal is reaching manageable symptoms to improve the quality of life. Reaching this goal can take months of treatment, and trials are necessary to achieve best results using the fewest medications possible to avoid any unnecessary side effects.

Fibromyalgia is treated by a combination of:

Good understanding of the disease
Lifestyle changes
Medications

Some patients can be satisfied only by lifestyle changes, while others may need medications if their symptoms are severe. It is important to understand that medications aren’t always potent enough to stop all symptoms, and their cautious use is key to achieving best results.

Good understanding of the disease and patient education

Patient education regarding fibromyalgia cannot be understated. Medications are unlikely to give any result without patient education and cognitive behavioral therapy. Patients should understand:

How the disease develops
How to cope with the pain
The psychological manifestations of the disease
Lifestyle changes needed including diet and exercise.
How long treatment will take and what to expect

These steps are followed by providing help through cognitive behavioral therapy and teaching patients about flare-ups and pharmacological options. Relaxation techniques and understanding how to reduce pain through distraction strategies are also essential. Regular follow-up can also improve symptoms by making sure that patients stick to treatment and not lose hope or interest, which is one of the commonest causes of flare-ups and worsening of the psychological wellbeing of the patient.

Lifestyle changes

Lifestyle changes are essential in the treatment of all patients with fibromyalgia. Lifestyle changes do not only improve physical and psychological symptoms of fibromyalgia, but also increases confidence among those suffering from it. Like education and behavioral therapy, patients should not take medications until they try all lifestyle changes possible. Lifestyle changes include:

Regular exercise and stretching, both of which have shown to decrease the intensity of pain and improve the general wellbeing of the patient.
Dietary changes may be needed. Although there is no concrete evidence as to its efficacy. Several reports indicate that some dietary changes may be beneficial including stopping caffeine -gradually-, alcohol and preservative-rich food like fast food, ready-made meals and any food containing artificial sweeteners or flavors. A balanced diet rich in carbohydrates, proteins and unsaturated fats is ideal for patients with fibromyalgia.
Controlling your sleep, for even though most patients have an altered sleep pattern owing to their chronic pain, others have an already messed-up sleep schedule on their own. Sleep has a major role in nervous system regeneration and pain modulation. Controlling sleep pattern alone can control most symptoms of fibromyalgia.

Medications

Even though they are the last resort in fibromyalgia, medications remain critical in controlling the disease in some patients. Medications are never used alone in fibromyalgia and the above-mentioned measures are always done in all patients. Patients are also weaned off medications as soon as they improve, and they are typically started on the lowest dose possible. Several medications have been prescribed in the past and have shown little effect -except for their placebo effect- in controlling fibromyalgia symptoms. Nowadays, only two classes of drugs are approved for fibromyalgia which are:

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Analgesics: A special type of analgesics called Pregabalin is used in cases of fibromyalgia. Unlike other analgesics like aspirin or narcotics like morphine, pregabalin works on the nerves specifically, blocking pain signals and improving sleep. It has no psychological effect and does little to improve the psychological effects of fibromyalgia.
Antidepressants: Regardless of their name, antidepressants have many other uses than treating depression disorders. They act on a special chemical substance known as serotonin which also modulates pain. The commonly used antidepressants used in fibromyalgia are Duloxetine and Milnacipran. Both medications can improve mood, sleep, and pain. They are used in lower doses than in cases of depression to limit their side effects.