Fibromyalgia: an enigma


What is fibromyalgia?

Fibromyalgia is a disorder that causes muscle aches and pain, tenderness, spasm, and stiffness, along with areas of the tendons and ligaments, and chronic fatigue. These tender points are common around the neck and shoulders, in the front of the knees, elbow, hip joints, chest, low back, thighs and calf (lower leg) muscles. There is an exaggerated nerve excitation and sensitivity all over the body.  All symptoms are magnified. There are 10 million people in the United States, and 3 to 6 percent of the global population, have fibromyalgia, 75 to 90 percent of them females.

When was this condition first diagnosed?

The signs and symptoms of what is today known as fibromyalgia was first described in the 1800s. It was thought then as mental illness. The first report of the tender spots all over the body was by a Scottish physician in 1820.  It was called fibrositis. The first recognition of fibromyalgia as a disease entity was in 1976, but it was only in 1981 when it was scientifically confirmed and the first diagnosis was made.

What is Primary Fibromyalgia Syndrome (PFS)?

PFS, the typical pattern of this condition is generalized, idiopathic (of unknown cause) fibromyalgia, accompanied by anxiety, fatigue, impaired sleep and irritable bowels, with no evidence of underlying diseases contributing to the symptom complex in among 5 percent of the population in the U.S.  PFS afflict healthy young or middle-aged women who are anxious, stressed, tense, and/or depressed. Children and adolescents (usually females) and older adults who have PFS may also have osteoarthritis of the spine. Men usually have localized fibromyalgia which is related to recreational or occupational strain.

I clearly remember when I was in pre-med, a teenager cousin of mine had pains all over her body and other signs which, today, would be obvious as fibromyalgia. Yet in the mid 1950s, it was an unknown entity, and therefore no medications for it except pain pills. Everyone thought she was malingering or had a psychosomatic ailment.

What causes fibromyalgia?

This is a challenging illness, not only for the patient, but also for the diagnostic prowess of the physician. In some cases, making a definite diagnosis is a dilemma, since the cause is unclear. There are various conditions that have been found to contribute to the causation of fibromyalgia, either alone or in combination, depending on the individual’s genetic make-up or predisposition. Among them are:  stress and trauma (as in a vehicle accident), rheumatoid arthritis, or autoimmune diseases, central nervous system problems, and genetics (MTHFR mutation). In some cases, no risk factors are found, the cause never confirmed, and only tentative diagnosis is made from clinical evidence, and the patient is treated empirically.

What are the symptoms?

The onset of the muscle pain, tender spots all over the body and stiffness is gradual and diffuse. The pain may be a deep ache or burning, is worsened by straining and overuse, and may be constant but varies in severity in response to weather changes, stress and activity.

The pain may move around the body. There may be spasms or muscle tightening.  Most sufferers feel tired or out of energy, have problem sleeping and a few may have diarrhea/constipation, difficulty swallowing, gas, heartburns and abdominal cramps. There may be tingling sensation or numbness in various parts of the body. Many patients have super sensitivity to odor, loud noise, bright lights, or even to medicines. Headache and pains in the jaws may also be present. Sometimes, they have dry eyes or problem focusing on objects that are near, imbalance or dizziness. Others may have palpitation or shortness of breath. Women with fibromyalgia may have urinary complaints, pelvic pains, painful menstrual periods, or even painful sexual intercourse.

Does any permanent damage result?

No permanent damage to any organ in the body results from fibromyalgia. The condition, while chronic and causing many bothersome symptoms, is not life threatening either. Today, with better understanding of the condition and the availability of the various therapies, including medications, patients are managed more effectively.

Does exercise aggravate fibromyalgia?

No. As a matter of fact, exercise is one of the best therapies for fibromyalgia. Starting with gentle, low-impact, stretching exercises, like walking, bicycling, and aerobics, this physical regimen should be performed daily and gradually increased. At first, there will be muscle soreness, as could be expected, but the exercise becomes more comfortable as days go.

What is the treatment for fibromyalgia?

The comprehensive management of fibromyalgia includes ruling out or treating diseases causing the symptoms, reassurance from the attending physician that the condition is benign and not hopeless, stretching and aerobic exercises (brisk walking, yoga, swimming, tae boxing), local application of heat and gentle massage, improvement in sleep, low-dose tricyclic antidepressant drugs. If drowsiness is encountered with one drug, an alternative drug may be used.

The three drugs the U.S.-FDA has approved to help treat fibromyalgia are:  Pregabalin (was first used to treat  seizures and nerve pain linked to diabetes;  Duloxetine hydrochloride ( Cymbalta) is an  antidepressant that’s also been used to treat diabetic nerve pain; and, Milnacipran (Savella), the first drug designed specifically for  fibromyalgia treatment. It affects  brain chemicals linked to pain.  Some of the drugs may also aggravate the insomnia. Aspirin and NSAIDS (non-steroidal anti-inflammatory drugs), even opioids, have generally not been found to be of any help. For severe persistent tenderness, local injection with 1 percent lidocaine (alone or in combination with hydrocortisone) has been effective.

Depression, serious emotional problem, as a result of fibromyalgia may require behavioral modification, group support therapy and/or professional guidance.

What is the prognosis?

Functional prognosis is usually very good with aggressive and comprehensive treatment. Fundamental in the success of therapy is patient-motivation, involvement and discipline. Armed with these three, the person with fibromyalgia is soon on her way to a more comfortable, happier, more productive and a fulfilling life.

***

Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: scalpelpen@gmail.com

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