Fibromyalgia


Ajay K. Mathur, M.D.Fibromyalgia is a chronic painful condition. The words fibroma means fibrous tissue and myalgia means, muscle pain. It used to be known as bursitis. This is a condition which has abnormal pain perception with diffuse accentuated sensation of pain all over the body.

Fibromyalgia is predominantly seen in women. The prevalence of fibromyalgia and the general adult U.S. population is three to four percent. The average age of onset is 30 to 55 years.

Fibromyalgia is a complex symptom comprising of trouble to sleep patterns, fatigue, widespread pain, and cognitive difficulties called fibro fog, as well as an exaggerated sensitivity to weather changes and stress.

The symptoms of fibromyalgia are chronic and can make a person very anxious, frustrated and upset, as they tend to affect activities of day-to-day life. Multiple other subjective problems, such as migraine headaches, irritable bowel syndrome, temporomandibular joint pain, chronic fatigue syndrome, anxiety, depression, sleep abnormalities, and cognitive dysfunction at times, can be seen in association with fibromyalgia.

Despite ongoing research, the exact cause of fibromyalgia has not yet been ascertained. Various hypotheses exist. Viral infections such as Epstein-Barr virus infection, physical or mental trauma, changes in hormonal status, as well as certain chronic medical conditions can act as inciting factors or precipitating this chronic painful condition.

It is important to establish a diagnosis of fibromyalgia, so as to avoid unnecessary investigations and treatment with toxic drugs that may cause more harm than good.

There is no single test that establishes the diagnosis of fibromyalgia. Symptoms of generalized pain, lasting at least 3 months with no other clear diagnosis to explain the symptoms is usually deemed the criteria for the diagnosis. Fibromyalgia tender points spread all over the body, there is no conclusive blood test that will confirm the diagnosis. Once the diagnosis is established, the most important treatment modality is education. The patient needs to understand that they are dealing with a chronic painful condition with waxing and waning symptoms.

It is also extremely important to reassure the patient that it is not in their head and there is definitely an established medical problem which is causing all the symptoms. Fibromyalgia is not a serious disease in the sense of damaging the joints or organs in the body such as rheumatoid arthritis or systemic lupus. Also by itself it has not shown to be fatal like cancer.

In most people the symptoms will not completely resolve, but certain drugs and other measures can help cope with the problem and stay functional.

The Food and Drug Administration has approved three drugs for the treatment of fibromyalgia, namely duloxetine (Cymbralta), pregabalin (Lyrica) and Milnacipran (Savella).

Other medications, such as NSAIDS, which are used for pain and other drugs, such as amitriptyline, cyclobenzaprine or gabapentin, can also be used judiciously.

All these drugs have potential risk of side effects and need to be closely monitored by the treating physician.