Fibromyalgia Syndrome

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Fibromyalgia syndrome is characterized by presence of pain and trigger points in different parts of the body at the same time. The other clinical symptoms that accompanies are disturbance in sleep pattern, memory loss, headaches, irritable bowel, diffuse pain throughout body, and morning stiffness. As compared to other myofascial pain, the fibromyalgia is far more widespread and covers different parts of the body especially the neck region and low back.

Why the pain is widespread?

There is a huge significance of involvement of neck and low back areas simultaneously. The pain in neck can leads to secondary development of pain in the arms and hands, chest and upper back; the pain in the low back can leads to pain in the hips, thighs’, calf’s as well as feet. Moreover due to the presence of pain in these two regions the mid back may also be stiff and painful as it is also the part of same chain i.e. spine. Thus by involvement of these two region virtually whole body may experience pain, mild or severe.

Diagnosis of fibromyalgia syndrome

Importance of diagnosis

The term fibromyalgia is used interchangeably with other muscular conditions like myofascial pain syndrome, creating confusion over exact diagnosis. Moreover, for many patients, the diagnosis of fibromyalgia syndrome comes as end o the road in terms of treatment. So, it is important to diagnose fibromyalgia syndrome correctly and at the same time eliminating any other local pathology that will escape once the patient will be diagnosed as a case of fibromyalgia.

The diagnostic criteria

The diagnostic criteria for fibromyalgia syndrome are clearly specified here. The diagnosis should be made when

  1. There is generalized pain involving three or more anatomical sites for 3 months or longer. These anatomical sites are:
  • OcciputTender sites fibromyalgia
  • Cervical
  • Trapezius
  • Supraspinous muscle
  • Second rib
  • Lateral epicondyle
  • Gluteal muscles
  • Greater trochanter
  • Knee
  1. Exclusion of other diseases or conditions that may cause similar symptoms
  2. Reproducible tenderness in 11 out of 18 prescribed sites.

Note: here we are mentioning 9 sites of one side; same applies to the other side of the body.

  • Suboccipital muscle insertion
  • Anterior aspect C5– C7
  • Midpoint upper border
  • Medial border of scapula
  • Upper surface of costochondral junction
  • 2 cm distal to the epicondyle
  • Upper outer quadrant of buttocks
  • Trochanteric prominence
  • Medial fat pad of knee joint

Along with the above mentioned criteria, there will be the presence of some other clinical symptoms like

  • Early fatigue
  • Pain intolerance (due to central sensitization)
  • Morning stiffness: difficult to get up from the bed
  • Sleep disturbance – due to which some people starts substance abuse like taking alcohol, sleeping pills etc.
  • Irritable bowel syndrome
  • Headaches

Is it curable?

Before reaching to any conclusion to this question, we must first understand the pathogenesis of this problem.

Pathogenesis

Pain Cycle In fibromyalgia
Pain Cycle In fibromyalgia

Although the underlying pathophysiology of this problem is still not clearly understood but here are some of the possible causes:

  • Emotional trauma- either for a longer duration or short but un- withstandable
  • Abnormal blood flow to the muscles
  • Genetic and familial factors
  • Perceptual amplification of pain or central sensitization of pain.
  • Serotonin deficiency

Along with this, there are some other factors which can give rise to trigger points. These are:

  • Chronic overexertion or involvement in one activity for a very long time without taking sufficient rest.
  • Poor posture at work
  • Lack of exercises
  • Sleep disturbance

The big question

A multi- disciplinary long term treatment approach will lead to a state where the pain will not bother the client while doing his functional activities.

The treatment of fibromyalgia requires a client- centered multi- disciplinary approach. This will only happen for the clients diagnosed with fibromyalgia syndrome, if they have realistic expectations from their treatment outcomes. This is also a responsibility of the concerned medicos to explain the possible outcomes of the treatment- both short term and long term goals. Patient should expect from the doctor to tell them the treatment outcomes.

Treatment Philosophy

Here are the treatment philosophy (not just the principles) followed at our clinic for the treatment and management of fibromyalgia.

Giving sufficient time to the patient is the key

  • Both physiological and psychological stresses contribute to the development of fibromyalgia syndrome. So, both must be taken into the account while treating a case.
  • It’s not only the pain that needed to be dealt but the co- morbidities also. These includes sleep disturbance, irritable bowel, headaches.
  • Patient must be prepared for the long term management at home.
  • Always start with the most non- invasive techniques and progress slowly.

Management of Fibromyalgia treatment

Documentation

Keeping the records of the client’s present condition and the past medical record along with the documentation of pain and disability will help in keeping the track on the outcomes of different treatment modalities.

Treatment modalities

Here is the list of treatments available for the client’s having fibromyalgia treatment.

Note: Only the physiotherapy treatment approach is followed at our clinic. For all other approached, we refer the patient to the concerned specialist, as and when required.

Physiotherapy in fibromyalgia

  • Pain counseling
  • Therapeutic ultrasonic therapy
  • TENS
  • Myofascial release
  • Spine and joint mobilization
  • Soft tissue elongation
  • Dry Needing for trigger points
  • Ergonomic and postural advice

Injection therapy

This is an invasive technique for the inactivation of the trigger points. Injections include local anesthetics, steroids, Botox etc.

Pharmacologic Management

  • Antidepressants
  • Anti- anxiety agents
  • Anti- inflammatory agents

Behavioral Management

Although we had never used this technique but it is in wide use internationally. Use f cognitive behavior therapy seems logical in the management of chronic pain management.

Whatever treatment approaches are used but there must be a proper documentation of the treatment outcomes.

Conclusion

The most depressing and anxious situation for the patient is the non- diagnosis, unclear diagnosis, misunderstanding of the patient’s condition. The foremost thing is to make sure that the patient must know that what causes this condition, how and how much the condition is treatable. Starting the treatment early and focusing on short term and long term treatment goals should be the treatment strategy. At the same time, active patient participation in the treatment should be facilitated.

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