Fibromyalgia FM, a contentious and enigmatic disorder, affects 2% of Americans and is 7 times more prevalent in women than in males. While many people doubt that this condition even exists, Fibromyalgia unambiguously identifies a group of people who have persistent muscular pain and sleep disturbances that are typical in the general community.
Despite the fact that a portion of these people may also have inflammatory illnesses like lupus or rheumatoid arthritis, FM itself is not linked to joint or muscle damage, inflammation, lab abnormalities, or x-ray alterations. Then what really is FM? The majority of researchers now believe that there is a fundamental issue with how pain is handled in the brain.
FM is characterized by alterations in blood flow in certain regions of the brain as seen in imaging investigations like positron emission tomography (PET) scans. Additionally, FM patients' spinal fluid samples include higher levels of substance P, a molecule thought to be implicated in pain, and FM patients' brain hormone production patterns are irregular. To put it another way, those who have FM are "wired" differently.
Nobody is aware of what causes FM. Although there are speculations that diseases, injuries, stressful situations, and hereditary variables may be at play, none of these hypotheses have been demonstrated to be true. Many have tried to claim that FM is only a manifestation of depression because roughly 2/3 of FM patients experience depression. This argument has a flaw in that it ignores the fact that one-third of patients do not have depression and also that, of those who do, roughly half had depression prior to the onset of FM symptoms and half got it afterward.
The main FM symptoms are hard to quantify and exclusively depend on the patient's self-report. The three main symptoms of FM are widespread musculoskeletal discomfort, sleep disturbances, and exhaustion.
The muscles are frequently sensitive to light to gentle pressure that would otherwise not hurt. Even while a lot of these tendons may feel tight, a physical examination reveals no other obvious abnormalities. Many people with FM will experience a sensation of swelling in their hands, but when examined by a skilled doctor, the joints themselves shouldn't be swollen unless another condition is also present along with FM.
Patients with FM generally have irregular sleep patterns. When recorded in sleep labs, the pattern of brain waves is hampered during the deep periods of sleep. The majority of FM sufferers state that their sleep is not restorative as a result. It is typical to wake up frequently during the night. The fact that healthy individuals participating in sleep research exhibit the same symptoms of muscular soreness when their sleep is disturbed suggests that this issue is crucial to FM development. The causes of fatigue are many and multifaceted. Fatigue can result from lack of sleep, sadness, an unhealthy lifestyle, and other unrelated issues like anaemia, thyroid disease, or inflammatory disorders. The great majority of FM patients suffer this symptom, making it one of the most challenging to treat.
Chronic tension headaches, irritable bowel syndrome, and chronic fatigue syndrome are further related diseases. The majority of people just have FM without an inflammatory sickness associated with it; however, up to 25% of patients with systemic lupus erythematosus (SLE) & 15% of patients with Sjögren's syndrome (SS) (see sections on these conditions) exhibit characteristics of FM.
As was already indicated, neither laboratory nor x-ray testing can help doctors diagnose FM. To rule out illnesses like SLE, SS, rheumatoid arthritis, polymyalgia rheumatica, thyroid disease, or a variety of other conditions that potentially mimic FM in some patients, some of these studies may be required. But for the most part, a thorough interview & physical examination can rule out these conditions.
The presence of more than 11 of the 18 "sensitive points"—tender muscle groups—is a requirement for FM diagnosis. The shoulder, neck, & hip/buttock areas are where the majority of these painful sites are found. These sore muscles' presence or absence may change from day to day, although they are frequently quite reproducible. A patient's diagnosis of FM can be verified if they exhibit a significant number of painful sites above and below the waist lacking tenderness over "control points" (muscles that aren't meant to be tender), as well as the normal sleep disturbance.
Sadly, there is no effective treatment for FM despite the best efforts of doctors treating patients with this illness in both office and research settings. Many well-meaning medical professionals who are desperately trying to relieve FM patients' symptoms find themselves inclined whether to add a new medicine or up the dose of an already-prescribed medication when the patients' symptoms persist. As a result, there may be an increase in drug expenses and adverse effects for a negligible gain. The majority of patients appear to have the best outcomes when they combine medical therapy, physical activity, and attention to "sleep hygiene."
Tricyclic antidepressants like amitriptyline (Elavil) as well as muscle relaxants like cyclobenzaprine (Flexeril), both of which can be used at bedtime in an effort to promote undisturbed sleep, are effective medications for treating many of the symptoms of FM. Other drugs that might be helpful for certain patients includes trazodone (Desyrel), fluoxetine (Prozac), venlafaxine (Effexor), and a novel drug called duloxetine that has showed promise in recent trials (Cymbalta). While several of these drugs are categorised as antidepressants, by restoring peaceful sleep and lowering muscular tenderness, they seem to provide some assistance to FM patients who aren't sad as well.
Although they are occasionally used, analgesics like tramadol (Ultram), sedatives like diazepam (Valium), as well as seizure drugs like gabapentin (Neurontin) have less conclusive proof of their benefits. The management of FM does not appear to involve the use of corticosteroids or non-steroidal anti-inflammatory medications (NSAIDs). The use of opioids, or narcotic analgesics, to treat FM is debatable. Even though these treatments are often used, no well-designed study has ever shown that they enhance FM patients' functioning or quality of life. Our observations of FM patients who explore these therapies have been incredibly discouraging.
Another popular treatment for FM is trigger point injections into specific painful muscles, although again, well-designed studies showing a benefit are lacking. Nevertheless, it is worthwhile to try a trial injection into a single tender site, but it shouldn't be done again if no improvement is seen.
Treatment for FM with exercise has been shown to be beneficial. Even though it may seem challenging to exercise sore muscles or to put effort when already worn out, aerobic exercise can frequently lessen these symptoms if done appropriately. The fundamental rule is to "start low and go slow." In the event that symptoms worsen after the exercise, the exercise should be reduced. Studies have shown that low-impact workouts like water aerobics might lessen sensitive spots' sensitivity compared to high-impact sports like basketball or simple flexibility training. We have seen firsthand that people with FM who pursue and maintain a regular exercise plan get the best results.
Patients with FM need to prioritise their sleep. Smoking and drinking alcoholic or caffeinated beverages close to bedtime can frequently worsen FM's sleep disturbances and should be avoided. While watching television is frequently unhelpful to getting a pleasant night's sleep, taking a warm bath or reading a book prior bed are both favourable to restful sleep. A solid 7 to 8 hours of sleep every night should be allowed for, if scheduling permits.
In FM, the rheumatologist's function can vary. Whether a specialist or primary care doctor coordinates treatment for patients, patient results are comparable. A rheumatologist is frequently the most helpful in confirming the diagnosis, excluding other illnesses, and providing the referring physician with treatment options. The majority of FM sufferers do not gain anything from routine trips to a specialist's office. The patient is ultimately the most important participant in the management of the condition because there are so few medicinal treatments for FM that are effective.
