Fibromyalgia commonly occurs in adult women aged between 20 and 60 years old. There are broad areas of the body that are painful and there is chronic pain in the musculoskeletal pain. Patients often complain of fatigue, sleep disturbance and sub-chronic spasticity, irritable bowel syndrome, edema, poor circulation in the fingers or extremities, anxiety and depression and loss of function. An important characteristic of the pain is pressure pain, which occurs when a certain part of the body is pressed. Fibromyalgia may temporarily alleviate but it is a chronic condition. Treatment may improve the symptoms but the condition often lasts for several years.
Cause
The cause of fibromyalgia is not yet known. It is thought that trauma, or several emotional stressors such as divorce or loss of spouse, contributes to the condition. It is also believed to be associated with sleep disturbances. Recent studies have suggested the association with imbalances in neurotransmitters, abnormal amino acids in the blood, abnormal oxygen use of tissues and viral infection. The cause of fibromyalgia has not yet been found from investigations and tests, so patients are often told that there are no known problems with their condition.
Symptoms patients feel:
●Painful areas on the body and a feeling of fatigue even without doing hard work.
●Areas on the body which show pressure pain
●Stiffness and a lack of feeling refreshed in the morning
●Light sleeping
●Tingling or changes in sensation
●Headache and dizziness
●Anxiety or depression
●Abdominal pain and frequent diarrhea or constipation
●Decreased concentration or memory problems
●Skin rashes or itchiness
Diagnosis
*American College of Rheumatology Diagnostic Criteria (1999)
●The diagnosis is made by exclusion of other conditions
●At least 11 out of the 18 pressure points are painful to pressure and this pain should continue for at least 3 months. There should be pain in the right and left side, the lower and upper body, neck and the lower back musculoskeletal system.
●Decreased movement due to musculoskeletal pain.
●Disturbances and sleep and not feeling refreshed after sleep.
●Temporary joint spasticity in the morning
●Decreased tolerance to cold or high humidity
Treatment
Treatment requires the patient to engage in regards and emotional modification, so the most important aspect of treatment is patient education.
Drugs such as amitriptyline, cyclobenzaprin, NSAIDs can be used, as well as cognitive behavioral therapy.
Local anesthetic injections at pressure pain spots and heat therapy can be effective, depending on the patient.
Medications are also used to help people sleep deeper. The patient should not feel dizziness or stagger when waking up in the morning. The symptoms start to improve after treatment for 4 to 6 weeks.
Sleep disturbance or lack of sleep can make the symptoms worse so it is important to develop regular sleeping habits. Patients should go to bed at a set time and avoid taking naps during the day.
Light cardiovascular exercises are helpful but strenuous exercises can worsen the symptoms.
Support and education
The patient needs to understand about the characteristics of the condition and will need support and understanding from their families.
Patients should be aware that physical, emotional and environmental stressors could contribute to their pain and fatigue. Therefore, it is important that they make appropriate lifestyle adjustments. Patients should avoid worrying too much about their symptoms and should try to relax the mind and the body.
By Cha Hoon-suk
The author is a doctor at the Division of Rheumatology at Samsung Medical Center and a professor of Sungkyunkwan University school of Medicine. ― Ed.
