Fibromyalgia

Fibromyalgia is a chronic long-term disorder characterised by widespread musculoskeletal pain, sleep fatigue, and some issues with memory and mood. The researchers believe that fibromyalgia amplifies the sensations of the pain by altering the way the mind distinguishes between the pain and non-pain signals. Anyone can develop fibromyalgia, including children also. Women are twice as affected as compared to men. Approximately 20% of the population who have suffered from any other chronic disease like rheumatoid arthritis or lupus can also develop fibromyalgia.

The defining and primary symptoms of the fibromyalgia are;-

1. Pain in muscles
2. Pain in joints
3. Fatigue
4. Cognitive difficulties (Problems with thinking, memory, and concentration)
5. Anxiety
6. Depression
7. Problems related to the gastrointestinal tract like diarrhoea or constipation
8. Pain in face and jaw
9. Constant headache
10. Sleep problems
11. Presence of numbness in hands or feet

In this condition, the brain cannot differentiate between pain and non-pain signals. It is caused when there is a glitch in how the brain and spinal cord interpret the pain signals. In fibromyalgia, there are more cells present for conveying the signals for pain than are present in a normal state. That means the pain sensation is always amplified before reaching the brain. In addition, the pain receptors in the brain seem to have developed some memory and become sensitised. It means that they can overreact to pain signals. Some other factors like chronic diseases like arthritis or any other inflammatory diseases and posttraumatic stress disorder.

Some of the risk factors can increase the chances of developing fibromyalgia.

1. Sex: Although the reason behind the development of fibromyalgia is not well known, it has been diagnosed mostly in women. 
2. Family history: If there is a family history of fibromyalgia, you are at a higher risk of developing fibromyalgia.
3. Age: There are more chances of being diagnosed with fibromyalgia at a younger age. And the risk of fibromyalgia increases the older age. However, fibromyalgia can be seen in children also.
4. Altering parameters: Changes in the treatment, temperature or weather, and sleep pattern alterations also increase the risk of fibromyalgia.
5. Other conditions: You are more likely to get affected by fibromyalgia if you are already suffering from osteoporosis or rheumatoid arthritis. Hormone fluctuations, lack of sleep and the presence of illness, work-related, and emotional stress increase the risk of fibromyalgia.

1. The family doctor may diagnose fibromyalgia if they are familiar with the condition. But, it is always preferred to see a rheumatologist. A rheumatologist is a doctor who is an expert in diagnosing the problems associated with the joints, muscles and bones. 
2. The patient is asked about the family history of the condition. It is asked because you are more likely to have fibromyalgia if there is a family history.
3. The doctor may also perform a physical examination and may check the tendons.
4. Fibromyalgia is diagnosed if you have pain in at least four spots out of these five regions. 
   1. Left upper region
   2. Left lower region
   3. Right upper region
   4. Right lower region
   5. Axial region
5. Some blood tests are also recommended like:
   1. Complete blood count
   2. Rheumatoid factor
   3. Erythrocyte sedimentation rate
   4. Thyroid function test
   5. Celiac serology
   6. Vitamin D
   7. Anti-nuclear antibody
6. The patient is diagnosed with fibromyalgia if the following three conditions are satisfied. 
   1. A symptom severity scale (SS) score of five or higher and a widespread pain index (WPI) score of seven or higher
   2. Persistent symptoms with similar severity for at least 3 months
   3. Absence of any other condition that indicates the presence of symptoms.

The treatment of fibromyalgia may include both medicines and self-care. 

Medicines

1. Pain killers: Painkillers that are available as over-the-counter medicines such as paracetamol, ibuprofen, and naproxen are also effective in reducing the pain caused by fibromyalgia. Opioid medicines are not recommended to decrease pain because of their side effects. Opioid medicines also cause dependence if used for a long time.  
2. Anti-seizure drugs: An anti-seizure drug known as pregabalin was the first medicine approved by the Food and Development Administration (FDA) to be used in case of fibromyalgia. Another medicine, gabapentin, was developed for treating epilepsy. But now, it has been used to reduce the symptoms and pain in the case of fibromyalgia. However, this medicine is not approved by Food and Development Administration (FDA). 

Alternative Therapies

1. Exercise: A physical therapist can teach you some exercises that will help you to improve your strength and stamina. Water-based exercises are particularly helpful. 
2. Psychotherapy: Psychotherapy may help in reducing pain. Behaviour modification therapy is the form of therapy that aims at reducing the pain sensations and stress levels of the patients.  
3. Acupuncture: Acupuncture therapy may also help increase the quality of life in patients with fibromyalgia. The number of sessions of therapy required for healing depends upon the severity of the condition. 

Following types of complications can appear if the condition is not treated in time.

1. Having signs and symptoms like depression and anxiety.
2. Women who are suffering from fibromyalgia may experience a lower quality of life.
3. Patients with fibromyalgia have a higher chance of developing depression of a higher degree.
4. Death due to suicide and injury are higher among patients with fibromyalgia.

Disease progression

There are four stages of fibromyalgia that have been identified to date. They are:-

1. Regional fibromyalgia with normally identified symptoms. In this stage, the symptoms of fibromyalgia are non-complicated, like the feeling of pain and tenderness in the joints.
2. Generalised fibromyalgia with increasing pain in the joints of the body. It may also include some additional symptoms like depression and anxiety in the patients.
3. Fibromyalgia with advanced and associated conditions. In this stage, the sleep disturbance increases, and the sensation of pain also increases in the body.
4. Secondary fibromyalgia is reactive to the presence of other diseases. It means that the condition is affected by other chronic diseases in the body.

You should take advice from a doctor when you have started experiencing any of the following signs and symptoms.

1. The pain and fatigue had started to interfere with your sleep.
2. Activities at home and work are affected by fibromyalgia.
3. Anxiety and depression start interfering with routine activities.
4. The tenderness in the joints has increased to the extent that it has become difficult and very painful to move the joints.