Dr. Anu Daber

Dr Anu Daber Best Rheumatologist (Gold Medalist) EX- Rheumatologist (AIIMS, New Delhi) at Arthritis and Rheumatology Clinic in Gurgaon


What is Fibromyalgia? 

Fibromyalgia is a chronic health problem that causes pain all over the body and other symptoms. Fibromyalgia affects two to four percent of people, mostly women.

Other symptoms that patients most often have are:

  • Pain all over the body
  • Tenderness to touch or pressure affecting joints and muscles
  • Fatigue
  • Sleep problems (waking up unrefreshed)
  • Problems with memory or thinking clearly

Some patients also may have:

  • Depression or anxiety
  • Migraine or tension headaches
  • Digestive problems: irritable bowel syndrome (commonly called IBS) or gastro esophageal reflux disease (often referred to as GERD)
  • Irritable or overactive bladder
  • Pelvic pain
  • Temporomandibular disorder—often called TMJ (a set of symptoms including face or jaw pain, jaw clicking and ringing in the ears)

Symptoms of fibromyalgia and its related problems can vary in intensity, and will wax and wane over time. Stress often worsens the symptoms.

What causes FM?
The exact cause of FM is not known. It is likely to be multifactorial. Genetic predisposition with disease running in families is well recognized. Environmental insults including viral infections, stress (both emotional and physical) and depression in some cases can contribute to the onset of illness. FM can coexist with rheumatic diseases like rheumatoid arthritis, systemic lupus erythematosus and Sjogren’s syndrome.

How common is FM?
It is very common. Up to 3% of the population suffers from it. It is most common around the 4th decade. FM is more common in women but it can occur in men and children too.

How is FM diagnosed?
There is no single diagnostic test for fibromyalgia unlike blood sugar test for the diagnosis of diabetes. The diagnosis is based on the combinations of symptoms and physical examination. Widespread aches and pains affecting both sides of the body are the hallmarks of FM. Neck pain and back pain are the common symptoms. Extreme fatigue, early morning stiffness, non-refreshing and non-restorative sleep, subjective feeling of swelling of limbs and joints, numbness of peripherals are also common. Migraine-like headaches, abdominal symptoms like bloating, heartburn, tendency to visit the toilet frequently, particularly after food (irritable bowel syndrome) and urgency to pass urine frequently (irritable bladder) are other associated symptoms. FM patients also have multiple tender points over the body, which the doctor can identify on examination. So it is the combination of symptoms and the presence of tender points that lead to the diagnosis of FM.

What does current research say?
FM is shown now to be a syndrome of low pain threshold and altered pain perception. The volume setting for pain perception is found to be higher in FM patients compared with the normal population. Because of this FM patients would feel more pain compared with non-FM persons for the same amount of stimulus. This process is called central sensitization, high lighting that the origin of pain is from the nervous system rather than in the places where pain is felt. Alteration in pain related neurotransmitters, Serotonin and substance P have been demonstrated in cerebrospinal fluid. Abnormalities in the sympathetic nervous system, hypothalamo-pituitary adrenal axis, growth hormone secretion have been demonstrated in FM. This might indicate defective mechanisms to fight stress. Some association with depressive illness and other psychiatric diseases like chronic fatigue syndrome, non cardiac chest pain, non ulcer dyspepsia, chronic pelvic pain, depression, anxiety and fibromyalgia has been shown, indicating shared etiology.

How is FM treated?
Usually FM symptoms are mild and patients manage to lead a normal life in spite of the pain. Painkillers like paracetamol and NSAIDs like ibuprofen may be of some help. Unlike the pain of arthritis, the pain of FM doesn’t respond to the above drugs well. It is a different type of pain requiring a different type of medicine. Antidepressant drugs used in doses much lower than what is needed to treat depression are useful in correcting sleep disturbance and in improving pain threshold. Amitriptyline is one such drug. Dothiepin, nortriptyline, Duloxetine and Milnacipran are some of the antidepressant drugs found to be useful in managing the symptoms of FM. Anticonvulsant drugs (anti-fits drugs ) like Pregablin and Gabapentin also help the pain of fibromyalgia.
Cognitive behavioral therapy (CBT) will help patients to take control of his or her illness. This is usually done by trained pain psychologists. CBT changes the way the patient thinks about the illness and encourages patients to lead a more productive life.
Walking, swimming and cycling are some of the exercise strategies to improve one’s stamina and physical conditioning. Pain and fatigue make one deconditioned. Graded increase in the intensity and the duration is essential to overcome post exercise increase in pain. Relaxation techniques like yoga, Tai Chi and low impact dancing and aerobics may help many.
Fibromyalgia is generally treated by a team of pain specialists including rheumatologists, pain consultants, physiotherapists and pain psychologists. More importantly, the patient is an active member of the treatment team.

How to cope up with Fibromyalgia?

  • Knowing that FM, though a chronic painful disease, is not a life threatening or crippling should reassure you.
  • Learn to relax, pace your activities according to pain levels and energy levels.
  • Pain does not always mean tissue damage. So don’t stop your activities totally.
  • Ignore some discomfort, count on functional improvement.
  • Be prepared for some bad days and some good days.
  • A brief period of rest in between work (micro-rest) and an afternoon nap can be energizing.
  • Hot water showers and heat in any form will refresh you. A shower in the evening may help you to freshen up.
  • Regular sleep habits will help. Avoid caffeine and cola drinks after 6 PM. Avoid watching movies in bed. Condition your mind that bed is for sleeping.
  • By understanding the nature of the illness, you may be able to avoid unnecessary investigations and harmful therapy.
  • Be regular with your exercise and take the prescribed medication regularly.
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