~ Dr.P.S Ajrawat
Definition: What is fibromyalgia?
You hurt all over, and you frequently feel exhausted. Even after numerous tests, your doctor can’t find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia.
Fibromyalgia Pain is a chronic condition characterized by widespread pain and stiffness in your muscles, ligaments, tendons, and joints, as well as fatigue and multiple tender points—places on your body where slight pressure causes pain.
Women are much more likely to develop the disorder than are men, and the risk of fibromyalgia increases with age. Fibromyalgia symptoms often begin after a physical or emotional trauma, but in many cases there appears to be no triggering event.
Symptoms, Causes, and Risk factors
Signs and symptoms of fibromyalgia pain can vary, depending on the weather, stress, physical activity, or even the time of day.
• Widespread pain and tender points
The pain associated with fibromyalgia is described as a constant dull ache, typically arising from muscles. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.
Fibromyalgia pain is characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points. Tender point locations include the back of the head, between the shoulder blades, top of the shoulders, front sides of neck, upper chest, outer elbows, upper hips, sides of hips, and inner knees.
• Fatigue and sleep disturbances
People with fibromyalgia often awaken tired, even though they seem to get plenty of sleep. Experts believe that these people rarely reach the deep restorative stage of sleep. Sleep disorders that have been linked to fibromyalgia include restless legs syndrome and sleep apnea.
Fibromyalgia is also characterized by anxiety, depression, and disturbances in bowel function. Mental and/or emotional disturbances occur in over half of people with fibromyalgia.
These symptoms include poor concentration, forgetfulness, mood changes, irritability, depression, and anxiety. Since a firm diagnosis of fibromyalgia is difficult, and no confirmatory laboratory tests are available, patients with Fibromyalgia Pain are often misdiagnosed as having depression as their primary underlying problem.
Other symptoms of fibromyalgia include tension headaches, numbness or tingling in different parts of the body, abdominal pain related to irritable bowel syndrome (“spastic colon”), and irritable bladder, which causes painful and frequent urination. Like fibromyalgia, irritable bowel syndrome can cause chronic abdominal pain and other bowel disturbances without detectable inflammation of the stomach or the intestines.
Each patient with fibromyalgia is unique. Any of the above symptoms can occur intermittently and in different combinations.
Doctors don’t know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include:
Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.
One theory, called central sensitization, states that people with fibromyalgia pain have a lower threshold for pain because of increased sensitivity in the brain to pain signals.
Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain, or an increase in neurotransmitters, as we discussed in the previous chapter. In addition, the brain’s pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.
The body pain of fibromyalgia can be aggravated by noise, weather changes, and emotional stress.
Risk factors for fibromyalgia include:
Your sex. Fibromyalgia occurs more often in women than in men.
Age. Fibromyalgia tends to develop during early and middle adulthood. But it can also occur in children and older adults.
Disturbed sleep patterns. It’s unclear whether sleeping difficulties are a cause or a result of fibromyalgia. But people with sleep disorders, such as nighttime muscle spasms in the legs, restless legs syndrome, or sleep apnea, often have fibromyalgia.
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 pain.
Evaluation, Diagnosis, and Treatment
Patrice was diagnosed with fibromyalgia in 2003. Her first pain management physician prescribed Oxycontin (10mg.), Oxycodone (20mg.), and a regimen of physical therapy at a local rehabilitation hospital. Although the medication and physical therapy helped somewhat, it did not markedly improve her fibromyalgia. Moreover, Patrice did not want to become dependent upon the medication.
Her physician then chose to prescribe Lyrica in addition to the medication she was already taking. The side effects caused her ankles and feet to swell, and she gained 40 pounds. Despite being medicated, her chronic pain did not dissipate. When Patrice’s fibromyalgia was particularly severe, she went to the emergency room for treatment, which resulted in more pain medicine and muscle relaxant prescriptions.
Then Patrice contacted me.
“During my initial evaluation,” she says, “I learned that one leg was shorter than the other and Dr. Ajrawat was kind enough to present me with shoe inserts in order to equal out my balance. I was started on multimodality treatments, which included trigger point injections, nerve blocks, physical rehabilitation, meditation therapy, medications, and psychotherapy with Dr. S. K. Ajrawat. I learned I had previously thought that exercise would exacerbate my pain and not help treat it, but Dr. Ajrawat taught me how exercise plays an important role in chronic pain management. I also learned how to meditate, and through this technique I have broken a 28-year smoking habit.”