Wednesday, February 23, 2005

FIBROMYALGIA

Fibromyalgia

Fibromyalgia is a long-term condition that affects more women than men. People affected have widespread aches and pains in their muscles, tendons and ligaments. It is also known as "muscular rheumatism", "soft tissue rheumatism" and "neurasthenia".

What is fibromyalgia?
Fibromyalgia is a condition that's hard to define. There isn't an obvious physical explanation for the persistent aches and pains. But it is clear that the symptoms can make it hard to cope with daily activities like employment and housework.
Fibromyalgia is sometimes considered to be like chronic fatigue syndrome (which used to be called ME). It is a real illness and not something that is simply in the mind of people who have it.
Causes
Nobody is quite sure what causes fibromyalgia. There are many theories, but there is no clear evidence of the cause. It doesn't seem to be inherited from parents and it doesn't appear to be caused by a virus.
People with fibromyalgia appear to be more likely to have sleeping problems, such as insomnia, than usual. One theory is that the production of hormones, essential for maintenance of the body's cells, is reduced by abnormal sleep rhythms. But doctors aren't sure whether the sleep problems cause the fibromyalgia, or the other way round.

Symptoms
The aches and pains of fibromyalgia affect many of the muscles around the body, although not necessarily all at the same time. The pain is usually worse in the neck and the upper part of the back, and it's unlikely to be fully relieved by everyday painkillers - paracetamol, aspirin or ibuprofen.

People with fibromyalgia may also have symptoms including:
  • waking up feeling totally unrefreshed
  • constant fatigue
  • feeling very stiff in the morning
  • numb hands or tingling fingers
  • finding everyday noise irritating and painful
  • loss of ability to concentrate
  • forgetfulness
  • irritability
Some people also complain of tension headaches, stomach cramps and of having to get up repeatedly at night to pass urine.
People who have fibromyalgia often find that their condition is affected by the weather. When it is cold and damp, their symptoms may be worse and they feel especially unwell.
Fibromyalgia is a condition that sometimes lasts for several years. People often become depressed and this may make the condition more difficult to treat.

Diagnosis
The GP will ask about the symptoms and carry out a physical examination.
If the doctor suspects fibromyalgia, he or she will probably apply pressure to various "trigger" points throughout the body. This pressure would be no more than a little uncomfortable to most people. But someone who has fibromyalgia will find it much more painful. The affected muscles and soft tissues will probably appear normal on examination, which suggests that there no simple physical cause for the pain.

Before diagnosing fibromyalgia, other conditions that have similar symptoms may need to be ruled out with investigations such as X-rays or blood tests.
These conditions include:
  • arthritis
  • systemic lupus erythematosus (SLE) - a soft-tissue disease due to an immune system disorder
  • under- or overactive thyroid

Your doctor may refer you to a rheumatologist or hospital pain clinic for further, more specialist, assessment.

Treatment
Often the reassurance that the bone and muscle pains are not caused by a life-threatening disease, such as cancer, can bring a huge sense of relief - and may even lead to some improvement in sleep problems or pain.
Lifestyle changes, medicines and psychological therapies can help. Complementary therapies such as osteopathy and acupuncture are popular.


Physical Activity
If you have painful muscles and joints, exercising may be the last thing you feel like doing. But a gentle programme of aerobic exercise - exercise that increases your heart rate and makes you feel slightly out of breath - can make a big difference.
Taking a daily walk or going swimming two or three times a week can be a good way to begin.
When these are no longer difficult, a low-impact aerobics class that will not put too much strain on your joints and muscles could be a next step.
Relaxation
An essential component of coping with fibromyalgia is reducing stress in your life to a managable level. If it is possible you may need to cut down your workload or get some help at home.
There are also other relatively simple steps you can take to help you manage your condition:
  • make sure that the chairs you sit on at home and at work encourage good posture
  • check that your mattress is firm and supportive - this should help your muscles relax at night and prevent joint problems from getting worse
  • you may also find a specially shaped pillow will support your neck better than a regular pillow
  • learn some basic relaxation techniques, such as deep breathing and "positive visualisation", to help relieve stress or reduce anxiety caused by everyday events
  • a weekly massage can be very soothing (but can't cure the condition)
  • regular breaks to "get away from it all" will give you something good to look forward to, and may help you cope in the interim.

Medicines
Strong painkillers (eg tramadol), muscle relaxants (eg baclofen) and steroids (eg prednisolone) are sometimes recommended, although they may have side-effects which must be balanced with their possible benefits.

Antidepressants such as amitriptyline and prothiaden are sometimes used to treat chronic pain, including fibromyalgia. The dose taken is generally much lower than that used to treat depression. Antidepressants take several weeks to have any effect.
Psychological Therapies
Cognitive behavioural therapy can help people with fibromyalgia to understand the thoughts (cognitions) they have about their pain and to develop new ways of coping with it (behaviours).
Outlook
There is no cure for fibromyalgia, although ongoing medical research is trying to understand the condition better.

People who continue with active treatments, such as a graded programme of exercise and medicines do generally recover.

It can take a while to start feeling better, though. Support from people who have experience of the condition can be very helpful.