Fibromyalgia: Causes, Symptoms, Tests, Treatment

Fibromyalgia is a syndrome of severe bodily pain associated with several psychological symptoms. This is fairly common with a prevalence of 2-5% and a female predominance. The condition is a challenging one to face as it is chronic and difficult to manage effectively. The disease is thought to arise as a result of abnormal processing of pain in the central nervous system.

Symptoms of Fibromyalgia

• Pain all over the body: Maximum pain and tenderness over the head, neck, chest. The pain may be severe and cause difficulty in carrying out activities of daily living.
• Fatigue and body stiffness
• Feeling dull with slowed thought processes
• Depressed mood
• Anxiety
• Sleep disturbance: difficulty falling asleep, maintaining sleep and early morning awakening, feeling unrefreshed.
• Episodes of diarrhea and constipation or irritable bowel syndrome

Diagnosis and Tests for Fibromyalgia

This is a diagnosis of exclusion. As the symptoms can mimic various other musculoskeletal diseases, lab tests are carried out primarily to rule them out. All tests are found to be normal in Fibromyalgia.

• History and Clinical Exam: A full history of the pain and associated features is noted with a thorough examination to look for tender points.
• Blood tests for complete blood count, Erythrocyte Sedimentation Rate (ESR), thyroid hormones may be done to rule out other potential diagnoses.
• Additional tests may be done for specific musculoskeletal diseases depending on the history and clinical features

Management of Fibromyalgia

It is important to understand the mechanism by which pain is caused in Fibromyalgia. There is no definitive treatment and complete relief from symptoms is difficult to achieve. The physician will help in the identification of reasonable goals to improve functional capacity and improve daily quality of life.

• Physical exercise: slowly advancing aerobic exercise, yoga, Tai Chi or water-based programs have shown benefit
• Acupuncture, chiropractic therapy, and massage may help in the relief of symptoms
• Sleep hygiene maintenance: following a regular sleep schedule through behavior modification
• Behavioral therapy: this helps with underlying anxiety and depression, and also helps in coping with the chronic pain
• Medications: Certain drugs have been shown to be useful in controlling symptoms. These are amitriptyline, duloxetine, milnacipran, gabapentin, and pregabalin. Only one drug is recommended for use at a time and is chosen based on the symptoms of the individual.

It is important to stress that opioid pain killers must be avoided completely in Fibromyalgia as they have been known to aggravate the pain symptoms.

Prognosis of Fibromyalgia

This is a chronic disease with no definitive treatment. Lifestyle modifications and appropriate management strategies can help in leading a functionally independent life.

References:

• Leslie J. Crofford, Fibromyalgia, Harrison’s Principles of Internal Medicine, 19th Edition, 2015
• Nancy Garrick DD. Fibromyalgia [Internet]. National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2017 [cited 2018 May 29].