Fibromyelgia

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FIBROMYELGIA
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HEALTH CARE DIVISION
09
FIBROMYELGIA
It is a soft fibrous tissue affection with pain in muscles, ligaments and tendons
of the body producing widespread pain, disturbed sleep, exhaustion from head to toe.
Although muscles all over the body are affected, they are not the only cause of pain. The
widespread symptoms are greatly manifested by nervous system malfunction.
Regional muscle pain not having any relation with arthritis or nervous system
also occurs in majority of cases. Patient describes it as firm knot in the belly of muscles
resulting in restricted activity. It is also associated with medically unexplained symptoms
from other systems and shows considerable overlap.
The symptoms are very unpredictable and make the patient frustrated by
physical exhaustion. Muscles feel like overworked or pulled, sometime they twitch or
cramp. Every muscle is painful, feel devoid of energy and skin may also feel sunburned.
The symptoms are similar to a bad viral flu. Experts believe that fibromyelgia and
chronic fatigue syndrome are one and the same disease.
THE RISK FACTORS :-

 SEX :- A strong female dominance of around 10 :1 ratio is seen though males are
also found to suffer from the disease.
 AGE :- Though any age group including the teenagers may be affected but a
maximum prevalence of 7% is seen among women above 70 yrs age.
 PSYCHOSOCIAL DISTRESS :- Divorce, marital disharmony, alcoholism in
family, traumatic injuries or assault and childhood abuse has important role.
AETIOLOGY :-
The disease is yet very poorly understood and despite careful investigation, no
structural, inflammatory, metabolic or endocrine abnormality has been identified. Two
abnormalities are though constantly reported.
 SLEEP ABNORMALITY :- Delta sleep usually occurs in first few hrs of sleep
and is known as the deep stage of non rapid eye movement(Non REM) sleep. It is
thought to have restorative function. The people suffering from fibromyelgia have
difficulty in quickly entering the delta sleep and obtain reduced amount during
night.
 ABNORMAL PAIN PROCESSING :- Reduced threshold to pain perception and
tolerance at characteristic sites of the body is the central feature of the disease.
Both these abnormalities may interrelate each other. Chronic pain may interrupt sleep and
poor sleep may also produce hypersensitivity to pain. Distressing life events may explain
initial sleep disturbance and disruption of restoration.
PRESENTING FEATURE :-
Multiple regional pain is the most common presentation with some other
features. Pain may dominate upon one or few regions at the beginning but in next few
months pain affects all the four limbs, back and neck. This pain is unresponsive to
traditional measures like pain killers and NSAIDS. Physiotherapy may also make the
things worse.
THE COMMON SYMPTOMS :-
 Multiple regional pain.
 Marked unexplained fatigue.
 Marked disability to perform daily tasks even up to dropping from employment.
 Broken non restorative sleep.
 Irritability, weeping disposition and low affect.
 Poor memory and concentration.
OCCATIONAL OTHER SYMPTOMS:-

 Early morning stiffness.
 Swelling of hands and fingers.
 Numbness, tingling of fingers.
 Abdominal colic, bloating and irritable bowel syndrome.
 Non throbbing tension headache.
 Bladder fullness and nocturnal frequency.
 Dyspareunia and hyperacusis.
 Common side affects with drugs.
MINIMUM INVESTIGATIONS TO BE DONE :-

It is only to exclude some other most common conditions producing similar features.
TEST CONDITONS TO SCREEN OUT

Full blood count Anaemia, lymphopenia of lupus.
ESR, CRP Inflammatory disease.
Thyroid function Hypothyroidism.
Calcium, alkaline phosphates Hyperparathyroidism, osteomalacia.
Antinuclear antibody Lupus.
MANAGEMENT :-
The aim is to educate party about the nature of the problem, pain control and sleep
improvement measures. Education is central, i,e including the spouse, family members
and friends. That the chronic pain does not reflect any inflammation, damage or disease is
the most vital information to spread. It is a condition we can recognize but still can’t give
any clear medical explanation. Stress is thus given upon improving sleep pattern as poor
sleep perpetuates the condition.
A gradual increase in aerobic exercise to improve sleep quality and well being
is often helpful in some individuals if done under supervision. Anxiety related life events
should be explored and addressed by proper counseling.
PROGNOSIS :-
Hospital diagnosed cases usually have poor prognosis as they don’t lose their
symptoms over five years though their quality of life may improve. Early diagnosed cases
may have better result with proper management, especially if anxiety related problems
are carefully dealt with.

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THE RISK FACTORS :-

OCCATIONAL OTHER SYMPTOMS:-

MINIMUM INVESTIGATIONS TO BE DONE :-

TEST CONDITONS TO SCREEN OUT

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