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Fibromyalgia

What is Fibromyalgia?

Fibromyalgia is a chronic pain syndrome diagnosed by the presence of widespread body pain. The disease is characterised by generalized body pain, fatigue, sleep disturbance, memory and mood difficulties. The prevalence of fibromyalgia is estimated at 2%–4% in the general population, being more frequent in women than in men, with age between 30 and 50 (American College of Rheumatology).

What causes Fibromyalgia?

Fibromyalgia is a condition with unknown aetiology (the causes or origin of disease). The pathophysiology of the disease is not clearly understood, although abnormality in pain processing at various levels, sleep impairment, and abnormalities of the autonomic nervous system (a component of the nervous system that regulates heart rate, blood pressure, respiration, etc.)  have been identified as contributory factors.

 

How is Fibromyalgia diagnosed?

Despite our increased understanding of the condition, there are no objective diagnostic tests. Diagnosis is often made by exclusion of other conditions such as neurological syndromes and depression. Usually, the diagnosis of fibromyalgia may take years to be completed, with people visiting several medical specialists in that time.

Diagnostic Criteria for Fibromyalgia (AAPT 2019):

  • 6 or more pain sites from a total of 9 possible sites: head, left arm, right arm, chest, abdomen, upper back & spine, lower back & spine (including buttocks), left leg and right leg;
  • Moderate to severe sleep problems or fatigue;
  • Fibromyalgia plus fatigue or sleep problems must have been present for at least 3 months;
  • trouble concentrating, forgetfulness, and disorganized or slow thinking;
  • muscle stiffness, typically more severe in the early morning and improves as the day goes on. It is not responsive to corticosteroids;
  • Environmental sensitivity or hypervigilance, manifesting as intolerance to bright lights, loud noises, perfumes and cold.

 

How is Fibromyalgia treated?

In general, the treatment of fibromyalgia should take the form of a graduated approach. . Initially, we should focus on non-pharmacological therapies. There is a strong recommendation for the use of exercise, particularly given its effect on pain, physical function and well-being, availability, relatively low cost and lack of safety concerns. We don’t know which type of exercise is more effective: strength and/or aerobic training (e.g. walking, running, cycling).

There is a weak recommendation for other non-pharmacological therapies, such as cognitive behavioural therapies (CBT), acupuncture, hydrotherapy, yoga, and tai chi.

Fibromyalgia often requires a multidisciplinary approach with a combination of non pharmacological and pharmacological treatment, even though, there is a weak recommendation for the latter.

Pharmacological therapies should be considered for those with severe pain (duloxetine, pregabalin, tramadol) or sleep disturbance (amitriptyline, cyclobenzaprine, pregabalin).

Pharmacological therapies which are not recommended are NSAIDs (e.g. Ibuprofen), MAOIs (antidepressants), SSRIs (antidepressants), o growth hormone, sodium oxybate, strong opioids and corticosteroids. (EULAR 2016)

Living with Fibromyalgia

With proper treatment and self-care, you can get better and live a more normal life. Here are some self-care tips for living with fibromyalgia (American College of Rheumatology):

  • Make time to relax each day. Deep-breathing exercises and meditation will help reduce the stress that can bring on symptoms.
  • Set a regular sleep pattern. Go to bed and wake up at the same time each day. Getting enough sleep lets your body repair itself, physically and mentally. Also, limit caffeine intake, which can disrupt sleep. Nicotine is a stimulant, so those fibromyalgia people with sleep problems should stop smoking.
  • Exercise often. This is a very important part of fibromyalgia treatment. Regular exercise often reduces pain symptoms and fatigue. You should follow the saying, “Start low, go slow.” Slowly add daily fitness into your routine. It takes time to create a comfortable routine. Just get moving, stay active and don’t give up!
  • Educate yourself. Nationally recognized organizations like the Arthritis Foundation and the National Fibromyalgia Association are great resources for information. Share this information with family, friends and co-workers.
  • Look forward, not backward. Focus on what you need to do to get better, not what caused your illness.

 

References:

  • American College of Rheumatology website;
  • EULAR revised recommendations for the management of fibromyalgia, 2016;
  • AAPT Diagnostic Criteria for Fibromyalgia, 2019.