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Wednesday, January 14, 2015, Magh 1, 1421, Robiul Awal 22, 1436 Hijr

Fibromyalgia: An elusive illness
Published : Wednesday, 14 January, 2015,  Time : 12:00 AM,  View Count : 18

Dr Nazma Akter
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Women are much more likely to develop fibromyalgia than are men. The vast majority of affected women are in their mid-30s to late-50s. Many people who have fibromyalgia also have tension headaches, irritable bowel syndrome, anxiety and depression. Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Risk factors
Risk factors for fibromyalgia include:
Sex: Fibromyalgia is diagnosed more often in women than in men.
Family history: You may be more likely to develop fibromyalgia if a relative also has the condition.
Rheumatic disease: If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.

The main symptoms of fibromyalgia are:
Widespread pain: Deep or burning widespread pain in your trunk, neck, low back, hips, and shoulders. Tender points (or trigger points) on the body that hurt when pressed.
Fatigue: People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.
People with fibromyalgia may have other problems, such as:
m Anxiety and depression. These can make you feel worse.
m Sleep problems and tiredness.
m Headaches.
m Morning stiffness.
m Trouble concentrating.
m Irritable bowel syndrome.
m Pain or cramping in the lower abdomen.
Symptoms tend to come and go. Some people find that their symptoms are worse in cold and damp weather, during times of stress, or when they try to do too much.

Fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months on both sides of your body above and below the waist with no underlying medical condition that could cause the pain. Before the diagnosis, your doctor will make sure that you don't have other conditions that cause pain. These include rheumatoid arthritis, polymyalgia rheumatica, lupus, and other diseases. While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include:
m Complete blood count
m Erythrocyte sedimentation rate
m Thyroid function tests
When to seek medical care
Call your doctor if you have symptoms of fibromyalgia. If you have already been diagnosed and your pain is getting worse, call for a follow-up visit. Some new treatments may have been discovered since your last visit.

Treatment is focused on managing pain, fatigue, depression, and other symptoms. You may be able to control your symptoms by:
Getting regular exercise: This is one of the best ways to manage the pain.
Taking medicine: If your symptoms bother you.
Going to counseling: This can help you cope with long-term (chronic) pain.
Taking care of yourself: Good self-care includes finding better ways to handle stress, having good sleep habits, and talking to your doctor if you have symptoms of depression.

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:
m Your doctor might suggest a prescription pain reliever such as tramadol.
m Antidepressants eg, Duloxetine and milnacipran may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or fluoxetine to help promote sleep.
m Gabapentin is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Lifestyle and home remedies
Self-care is critical in the management of fibromyalgia.
Reduce stress: Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
Get enough sleep: Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
Exercise regularly: At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
Pace yourself: Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare.
Maintain a healthy lifestyle: Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.

The pain and lack of sleep associated with fibromyalgia can interfere with your ability to function at home or on the job. The frustration of dealing with an often-misunderstood condition also can result in depression and health-related anxiety.
While there is no cure for fibromyalgia, a variety of medications can help control symptoms. No one treatment works for all symptoms. Exercise, relaxation and stress-reduction measures also may help. The emphasis is on minimizing symptoms and improving general health.

Dr Nazma Akter is Resident Physician, Department of Medicine, MARKS Medical College & Hospital, Dhaka.
Email:[email protected]

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