Mediscene

Are you suffering from fibromyalgia syndrome?

By Smriti Daniel

It’s when all the tests – the MRIs and CT scans, the blood and urine tests – come back normal, that a patient first begins to worry that their pain is illusory. In a sense, this is true – we’re not sure what causes fibromyalgia syndrome itself, but new research indicates that abnormalities in the way our nervous systems process pain underlies this controversial disorder. But make no mistake, the pain itself is excruciatingly real and can be severely debilitating, says Consultant Rheumatologist Dr. Lalith Wijayaratne.

He explains the condition which is more likely to affect women between the ages of 20 and 55, has been associated with depression, fatigue, anxiety and insomnia. The toll it takes on those afflicted with it and their families can be very high – particularly when getting a correct diagnosis is the very first hurdle you have to cross.

“Pain is the most obvious symptom of fibromyalgia,” says Dr. Wijayaratne explaining that to be diagnosed with the disorder patients will have to have been in pain for three months or more. Unfortunately, for many patients much of this initial period is spent going from doctor to doctor in pursuit of a correct verdict. This can be quite hard to come by, so patients are normally relieved when they finally have an actual diagnosis to work with. For Dr. Wijayaratne, his first order of business is usually assuring people that it is not cancer or arthritis causing the pain since many patients are understandably anxious about the possibility of it being a fatal or disabling disease. While fibromyalgia is neither, it still isn’t exactly what one would consider a welcome diagnosis.

For starters, despite the possibility of effective management, there is no known cure. For patients with the disorder, the main complaint is of long-term, whole body pain and tenderness in the muscles, tendons, and other soft tissues. Still, there are particular points, such as the root of the neck or high up on your shoulder blades where the pain is particularly severe. The only abnormality doctors can detect are 11 to 18 such tender spots, including on the elbows, buttocks, chest, knees, lower back, neck, rib cage, shoulder and thighs.

The pain is not caused by tissue inflammation and the joints tend to be perfectly normal as well, says Dr. Wijayaratne. The standard drugs used for arthritis which control inflammation do not work very well in this condition. Typically, patients report an increased sensitivity combined with an unusually low pain threshold – things that would leave an ordinary person unmoved might disable someone with fibromyalgia. Noise, changes in the weather and emotional stress can all aggravate the pain.

Though this pain can be both severe and persistent, for a long time the seeming lack of tangible cause led the medical fraternity to treat fibromyalgia as if it were a psychiatric disorder. However, in recent years, the disorder has become the concern of rheumatologists like Dr. Wijayaratne. “It’s still an evolving topic,” he says, adding “if you had asked me about it even five years ago, I might have given different answers.” It is known that one’s genetic inheritance is very influential with symptoms of the disorder often appearing in members of the same family. As for the actual trigger, researchers have speculated that the cause of the disorder could be physical or emotional trauma or some unknown virus, but many of them are betting it will just come down to an abnormality in brain function.

Even with all the advances in medical science, the way our brains work is still not completely understood. For now, the prime suspects are those wonderful chemicals known as neurotransmitters. They transmit signals from one neuron to the next across the synapses, but when out of balance they have also been linked to the occurrence of clinical depression and anxiety. So it’s not entirely surprising that patients with fibromyalgia often exhibit symptoms of both. Still it’s also possible that it’s a vicious cycle – patients in a great deal of chronic pain might find themselves worn out by the struggle and depressed as a result.

Unfortunately, it’s a long term problem. Symptoms might sometimes improve but in other cases, the pain may get worse, lingering for months or even years. (It’s both saddening and revealing that there have been reports of patients with fibromyalgia succumbing to despair and committing suicide.)
Fibromyalgia is also commonly associated with headaches, disturbances in bowel movements and problems with concentration and memory. The latter have led to patients struggling to process or recollect details as they get lost in a ‘fibro fog’. Even more critically, fatigue and sleep disorders are very common in people with fibromyalgia. There’s nothing these two problems can’t make worse – and so doctors often begin their treatment by trying to restore a good night’s sleep to their patients. “Good sleep can actually relieve some of the symptoms,” says Dr. Wijayaratne, explaining that abroad the medical team typically includes a sleep specialist as well. Also included in a well rounded team would be a psychiatrist or psychologist, someone who can be on hand to help the patient cope with any depression they may be experiencing.

Post diagnosis, working on a patient’s outlook becomes a crucial step. “To keep the body fit, we must also focus on the mind,” says Dr. Wijayaratne explaining that he advocates both bio-relaxation techniques and meditation. Yoga too has its advantages, but he emphasizes that it’s always a good idea to make sure your tutor is genuinely qualified and aware of the possible complications the condition presents. He also recommends exercise, but cautions that one must do so with care and in moderation, beginning with perhaps just 10 minutes of a carefully chosen exercise before slowly building up. “The wrong exercise in the wrong frequency in the wrong intensity can make things worse,” he stresses. A good regimen can however help counteract another of the problems associated with fibromyalgia – namely poor circulation.

Drugs are necessarily the last resort, and here Dr. Wijayaratne says your consultant is likely to prescribe medications that are actually designed to manage depression and even epilepsy. For some patients the combination of lifestyle changes and medications will help relieve the pain, but one’s outlook can play a particularly critical role. “The way a patient understands the disease is very important,” says Dr. Wijayaratne, adding that he makes it a point to explain the situation to spouses and children as well, so that the patient is supported as much as possible. Of course, it can very hard for those around the patient – “the whole family suffers,” he says. However, a network of support can make a big difference to how a patient copes and in the long run could play a significant role in his or her recovery.

Top to the page  |  E-mail  |  views[1]
SocialTwist Tell-a-Friend
 
Other Mediscene Articles
‘Amma, my head hurts’
Are you suffering from fibromyalgia syndrome?
Diabetes What you should know
Trouble in your digestive engine
Living with another’s liver
Here it is, Cellulitis in a nutshell

 

 
Reproduction of articles permitted when used without any alterations to contents and a link to the source page.
© Copyright 1996 - 2011 | Wijeya Newspapers Ltd.Colombo. Sri Lanka | All Rights Reserved.