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Fibromyalgia

Figuring out Fibromyalgia!

Fibromyalgia Syndrome (FMS) is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. The net result is that individuals experience pain sensations 24/7, sometimes without warning, sometimes for days on end before there is a relative improvement.

What is the Incidence of FMS?

The true incidence of FMS is difficult to estimate but a European Study in 5 countries in 2008 Branco et al. showed a prevalence of 4.7%.

We also know that women are 9 times more likely to develop fibromyalgia than are men. At present there is no one test or investigation that can make the diagnosis the diagnosis of FM is often one of exclusion so the true incidence is difficult to estimate. We also know that it is a condition that can effects anyone at any time.

LADY GAGA had to recently cancel her European tour due to symptoms of fibromyalgia. She has made a Netflix documentary to raise awareness about living with this complex and disabling condition.

“Gaga: Five Foot Two” was released on September 22 2017 and was directed by Chris Moukarbel. He described working with Gaga: “It was basically hard on a fundamental human level to be near someone who was experiencing pain like that and knowing that there is nothing you can do.”

The lyrics from her 2015 song “Til it happens to you” aptly describe the experience of living with this invisible condition: “Til it happens to you, you don’t know how it feels, how it feels.”

What are the Symptoms of FM?

The key symptoms of fibromyalgia include:

Widespread Pain

The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

Fatigue

People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnoea.

Cognitive Difficulties

A symptom commonly referred to as "fibro fog" impairs the ability to focus, pay attention and concentrate on mental tasks.

Co-existing with other painful conditions
  • Irritable bowel syndrome
  • Migraine and other types of headaches
  • Interstitial cystitis or painful bladder syndrome
  • Temporomandibular joint disorders
  • Sometime individuals can associate the symptoms after a physical trauma, surgery, infection or significant psychological stress
  • In other cases, symptoms gradually accumulate over time with no single triggering event

What causes FM?

Unfortunately we don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include:

Genetics

FM tends to run in families so there may be certain genetic mutations that may make you more susceptible to developing the disorder.

Infections

Some illnesses appear to trigger or aggravate fibromyalgia.

Physical or emotional trauma

Fibromyalgia can sometimes be triggered by a physical trauma, such as a car accident. Psychological stress may also trigger the condition.

Who is at risk of developing Fibromyalgia?

Potentially we are all at risk for the development of fibromyalgia. It is however seen at higher rates in individuals that have had traumatic injuries, hormonal variations, are under high and chronic stress, history of depression or other mental health issues and those that have irregular and poor sleep patterns.

Universally the highest rate of fibromyalgia is in women. This ratio is not just a slight increase for women: it is actually 9:1 for women and men.

Researchers are not clear why women have higher rates of diagnosis of fibromyalgia but hormonal factors, behavioural differences, environmental issues and the pathways of development and appearance of the symptoms of fibromyalgia may be different between men and women.

Fibromyalgia is also more commonly diagnosed in people between the ages of 20 to 50, however those much younger, including children, and those older than 50 can also be diagnosed. Ethic background and social-economic groups may also influence the presentation of the disease.

Since diagnosis is typically made around the age of menopause for women the actual number of adults that have fibromyalgia rises as the population ages. It is estimated by the American College of Rheumatology that approximately 8% of the population at or over the age of 80 has fibromyalgia.

Unfortunately because we do not truly understand the pathological mechanism that drives FM there is no cure for fibromyalgia. Never the less a variety of medications can help control symptoms. Combined with exercise, relaxation and stress-reduction measures many individuals can maintain a reasonable quality of life.

Are there any Radiological Investigations needed?

Sometime it is appropriate to undertake X-ray of joints or MRI scan to exclude muscle or tendon injury. This would depend on the nature of the signs and symptoms you report to your doctor.

Are Blood tests helpful?

While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include:

  • Complete blood count
  • Erythrocyte sedimentation rate
  • Rheumatoid factor
  • Thyroid function tests

What are the treatment options?

Certainly there is no “one-fits-all” treatment for FM. In general treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. Combined therapy is certainly. No one treatment works for all symptoms.

Medications

Medications can help reduce the pain of fibromyalgia and improve sleep. The overall goal should be to use the least medication possible to achieve the optional results. Common choices could include:

Pain relievers. Over-the-counter pain relievers such as Paracetamol, and non-steroid anti-inflammatories are often very useful. In general opioids are not advised, because they can lead to dependence, increase the risk of addiction and may even worsen the pain over time.

Antidepressants. Duloxetine (Cymbalta) or amitriptyline may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe a trial of these products.

Other agents. Some medications designed to treat chronic neuropathic pain are often useful in reducing the symptoms. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Steroid / Botox Injections. There may be a role of ultrasound guided injection therapy to specific muscle groups that are not settling and that are impairing rehabilitation.

Therapy

A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include:

Physical Therapy. A physical therapist can teach you exercises Aerobic Rehabilitation are very important and that these will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful. This is very important. Hydrotherapy, pool work, pilates to yoga are all very important both physically and psychologically. Using TENS machines and massage can also provide the sense of relief that is required

Occupational Therapy. An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body.

Counseling. Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.

Mindfulness

Cognitive Behaviour Therapy

Coping skills

Involving family members and partners. This can provide the individual with the extra support mechanisms

Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit.

Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety.

Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.

The ultimate Goal at Pain Relief Ireland is that you control your pain not your pain controlling you!

Other Lifestyle and General Improvements

Self-care is critical in the management of fibromyalgia.

Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.

Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.

Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.

Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare.

Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.

Other Questions

Is Fibromyalgia related to other Systemic or Autoimmune Diseases?

Fibromyalgia syndrome (FMS) has been confused with or misdiagnosed as various other “similar” diseases. These similar diseases include several systemic or autoimmune disorders such as rheumatoid arthritis, lupus and Jorgen’s Syndrome. Yet, despite similarities between these medical conditions and the existence of co-morbidities in many cases, fibromyalgia is a separate medical condition.

Why does fibromyalgia “hurt” so much?

Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.

Prevalence and Statistics Concerning Fibromyalgia

Various organizations and agencies report different possible ranges for the prevalence of fibromyalgia in the general population. In the United States in a study completed in 1995 it was found that 2% of the 3,006 random people interviewed in Wichita, Kansas had fibromyalgia. The female reports were approximately 3.4% of the total surveyed and men accounted for 0.5% of those that had fibromyalgia.  Women tended to have higher reports with both genders reporting fibromyalgia more often as they aged. 1

More recent studies tend to indicate that the prevalence of fibromyalgia is increasing worldwide. In a recent study in five European countries a screening questionnaire had individuals respond to questions about pain and fatigue. In those rheumatology outpatients 46% reported positive for chronic widespread pain and 32% reported for both pain and fatigue. Of these patients there were 14% confirmed diagnoses of fibromyalgia. In the more general population the researchers estimated from the data collected that the prevalence of fibromyalgia was 4.7% and was age and gender related.2

In the United States a study on fibromyalgia and other rheumatic conditions which included gout, carpal tunnel syndrome, osteoarthritis, polymyalgia rheumatic and other conditions including neck and back pain, showed that an estimated 5 million have fibromyalgia with up to 59 million having lower back pain and 30.1 million reporting neck pain within the previous three months of the survey. 3

Other more general approximations indicate that the global estimates for fibromyalgia range between a low of 0.7% to as high as 4.5%. Other organizations, including the National Fibromyalgia Association have the range narrower and higher at between three and six percent of the worldwide population.

There are More Questions than Answers

Fibromyalgia is a complex syndrome which is separate from other medical conditions like autoimmune diseases and systemic disorders. It is common, however, for it to be co-morbid with these other medical issues. Among the more common comorbidity is rheumatoid arthritis. The resultant blend of fibromyalgia with this autoimmune disease results in serious and deleterious effects on a person’s life. The medical expenses incurred by someone with fibromyalgia are typically higher than those incurred by an individual with rheumatoid arthritis. When someone has two medical conditions, the demands made on the medical system and the economic costs are more than doubled– whether in terms of personal finances, lost work days or the cost of government disability payments. It is essential to find the correct diagnosis and discover a treatment that will control symptoms as effectively as possible.