Q 1: What is fibromyalgia?
Fibromyalgia (FM) is a medical condition characterized by chronic widespread aches and pain. Pain is felt in and around the joints and muscles. It affects women more than men.
Q 2: What are the symptoms of fibromyalgia?
Pain which is felt all over the body, including in the joints, is the most common symptom. Fibromyalgia is also characterized by many symptoms that are often difficult to localize to one system or ‘generalized’ and also involves other organs. They are: (see figures)
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Q 3: Who gets fibromyalgia? Is it related to stress?
Even though FM is much more common in women of childbearing age group, it can occur in men and children too. It is a low pain threshold state where one would hurt little more easily than others. Many factors contribute to the development of FM. They include genes, female gender, trauma, and stress. It may be associated with depression and/or anxiety. But it is not always associated with stress or psychological illness. Having to live with chronic pain may cause depressive symptoms. Fibromyalgia also occurs in persons who experience significant adverse childhood experiences like abuse or bullying.
Q 4: Is fibromyalgia the same as arthritis?
Fibromyalgia is not the same as arthritis. Arthritis is inflammation of the joints. It is characterized by pain and swelling in the joints. It is associated with limitation of movements as well. There are many causes of arthritis. Osteoarthritis and rheumatoid arthritis are two types of arthritis.
In contrast to arthritis, the pain in the case of FM is felt in the joints as well as in the surrounding muscles. The joints are generally normal in FM. The problem lies in the sensitization of the nervous system, resulting in a low pain threshold state.
Q 5: Is this a symptom of a serious disease?
Though FM is a chronic painful condition, it is not serious or life-threatening. Fibromyalgia will not result in joint deformities. Fibromyalgia can result in functional loss and loss of work though.
Q 6: Will fibromyalgia damage my joints or nerves?
No! Fibromyalgia will not result in damage to the joints or muscles.
Q 7: How is fibromyalgia diagnosed? Can any blood tests confirm this diagnosis?
Fibromyalgia is diagnosed based on the clinical symptoms and the combination of symptoms after ruling out other causes for the pain.
There is no fibromyalgia blood test. Tests are generally done to rule out the causes of other causes of pain.
Q 8: Is an MRI or CT scan necessary for diagnosis?
No. As explained in the previous answer, the diagnosis is based on what the patient tells the doctor and on what the doctor finds in the patient after a physical examination. There is no need to do a CT scan or MRI. Often, we see patients carrying a whole lot of test reports. But we cannot blame the patients because in order to find the cause of their pain, they land up getting a number of tests and making a number of hospital visits, but fortunately or unfortunately most of the tests are normal.
Q 9: Can fibromyalgia be cured? Will it shorten my life?
There is no cure for fibromyalgia. People can lead a near-normal life with medical and nonmedical treatments.
Q 10: What is the treatment for fibromyalgia?
In the absence of a cure, it is important to manage the patient’s symptoms on a long-term basis. Treatment can be divided into medical and non-medical treatments. Painkillers and steroids are not effective in FM. So they are not used. Medications can give moderate relief from the symptoms. The focus of treatment is to reduce pain, improve sleep, and treat depression and anxiety, if present.
Low-dose antidepressants like duloxetine and amitriptyline and antiepileptics like pregabalin and gabapentin work to elevate the pain threshold and thus reduce the pain. Many of these drugs also treat sleep difficulties. Some patients require other sleep medicines.
Even in the absence of psychological symptoms, CBT (cognitive behaviour therapy), which is offered by clinical psychologists, helps people to cope with the illness better. Patient education helps the patient to understand the pain and allay fear about the presence of more serious illnesses like arthritis or malignancy.
Q 11: What lifestyle modifications or diet can help me?
Lifestyle modifications are the cornerstone of managing FM. Two major lifestyle modifications which will help are:
Sleep hygiene involves avoiding stimulants like coffee, tea, or colas after 2 pm. Sleeping and waking up at the same time. Avoiding daytime napping. Other sleep disorders like restless leg syndrome and sleep apnea have to be identified and addressed.
Exercises have to be started slowly with low-intensity exercises and for a short period. For example, start walking for 5–10 min and increase every 1–2 weeks by 5 min. Other exercises like swimming, cycling, and weight training may be introduced slowly. Pacing is an important technique to help get through daily chores. Taking micro breaks is a pacing technique.
There is no such things as an FM diet. But a balanced diet will help. Avoid processed food and simple sugars and encourage a plant-based diet with increased fiber-rich vegetables. Patients with IBS may require special expert advice. If any food items are identified to increase symptoms, it is better to avoid them.
Q 12: Does yoga or aerobic exercise or meditation help?
Supervised yoga training under a yoga therapist can be very helpful in FM. Yoga gently stretches the painful muscles and prevents stiffness from appearing. Tai chi is another technique shown to help FM.
Walking is the best aerobic exercise along with swimming, cycling, and gentle jogging. Exercise principles were discussed in the previous answer.
Various meditation techniques, including breathing meditation, listening to soothing music, and mindfulness can be of use to FM patients to calm the hyperactive mind and nervous system. This helps patients to deal with pain and chronic illness in a much better way. Positive coping is encouraged by these techniques.
Dr. Dharmanand BG, MD, DM Consultant Rheumatologist, Vikram hospital Bangalore. |