All that pains is not arthritis – “Understanding Fibromyalgia”
Contrary to what many believe, arthritis is not the commonest cause of aches and pains. There can be many reasons for the same, viral fever being a common cause where there are transient symptoms. Other very common cause of aches and pains is vitamin and mineral deficiencies, hormonal imbalances and effects of ageing. However, there are some who complain of terrible body aches and joint pains. They constitute a type of non inflammatory musculo-skeletal pain syndrome, variously known as Fibromyalgia, pain augmentation, chronic widespread pain syndrome and so on.
Even though it is a less known counterpart of its Rheumatology siblings like Rheumatoid arthritis, it is by no means less common nor less painful.
So here are a few FAQs regarding Fibromyalgia:
What causes Fibromyalgia?
The exact cause of Fibromyalgia is not known, however, it is believed to be due to some dysregulation of the central and peripheral nervous system. It causes muscle tenderness and pain, joints pain and fatigue. This is due to central and peripheral sensitization of the nervous system in medical terms. Simply put, imagine, if a normal individual requires 50 pain signals from the nerves to perceive pain, these patients require only 25 pain signals to perceive the same amount of pain. This means that the pain threshold is reduced in Fibromyalgia, so patients may perceive even normal touch as pain. Other genetic and environmental causes also contribute.
How can one recognize Fibromyalgia?
Fibromyalgia usually causes pain in the muscles and joints without any signs of inflammation like swelling or warmth. However, many-a-times, patients have a feeling of swelling or bloating of the body. They may also complain of symptoms of frequent headaches, un-refreshing and disturbed sleep or insomnia, irritability, forgetfulness, disorientation or “fibro-fog”, abdominal symptoms of indigestion, bloating, diarrhoea or constipation and painful periods. Many also suffer from anxiety and depression. These patients also complain of profound fatigue or tiredness. Rarely patients have intolerance of touch from other people, clothes or bedding and pain worsens when they carry heavy loads. Mental or physical stresses are common precipitating factors.
How is Fibromyalgia treated?
It is important to rule out other medical conditions which present in a similar fashion like vitamin D deficiency, hypo or hyperthyroidism and inflammatory conditions like myositis and other connective tissue diseases. Medicines have less of a role than other modalities, but some medicines, which are pain modulators that increase the pain threshold or modify chemicals in the brain, are advised. Painkillers like NSAIDs and other opoid medications are rarely beneficial.
Are there any therapies without medicines?
Non pharmacological management is an important therapeutic strategy in Fibromyalgia. Research has shown that the most effective therapy for Fibromyalgia is exercise. It is important to start graded exercises and stress relieving techniques like Yoga and meditation. Cognitive behaviour therapy (CBT) focuses on modifying ones thoughts and consequent feeling and actions which help to control Fibromyalgia symptoms. Other complementary therapies like acupuncture, acupressure and massage therapy can be tried but have not been widely studied. Having a good family support is equally important and participating in social activities and functions helps one to cope, be mentally active and happy.
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MD (Medicine), DNB (Rheumatology)
Consultant: Arthritis, Joint Pain & Rheumatology Clinic