Where did these muscles come from?â€ moaned the elderly woman. â€œI never noticed them earlier. Now they hurt all the time. And I canâ€™t even sleep at night.â€ She pointed to various parts of her body, back, shoulders and hips. Any spot she indicated, when pressed, apparently precipitated agonising bolts of shooting pain, causing her to shudder.
Twenty years ago, such a patient would have been labelled a depressed hypochondriac (one who worries or talks excessively about his or her health). But many medical changes have occurred in the last decade and the condition described is now recognised as a specific entity. It occurs in 3.5 per cent of women and 0.5 per cent of men over the age of 50 years. It was initially called fibrositis, chronic muscle pain syndrome, psychogenic rheumatism or tension myalgia. Now it is termed fibromyalgia and recognised as a chronic condition characterised by fatigue and widespread pain in the muscles, ligaments and tendons. Typically there are multiple tender points â€” usually 11-18 â€” distributed all over the body, where even slight pressure causes pain. It is associated with other symptoms like fatigue, sleep disturbances, night-time muscle spasms, restless legs, headache and joint pains. The pain may be severe in the jaws or shoulders. The bowels may not function properly. There may be constipation alternating with diarrhoea, abdominal pain and bloating. This leads to a misdiagnosis of idiopathic bowel syndrome (IBS). There may be abnormal responses and heightened sensitivity to odour, noise, bright light and touch. There may also be difficulty in concentration, moodiness, lack of restful sleep, depression and anxiety. All these inexplicable vague symptoms interfere with the quality of life. The symptoms are non-progressive and uncomfortable but not serious.
The exact cause of fibromyalgia is not known. It may be precipitated by a viral infection. The chemical neurotransmitters responsible for pain increase in the brain. This causes a heightened and prolonged response to any painful stimulus received by the nerves.
The diagnosis of fibromyalgia is clinical (based on medical history and physical examination). It is suspected if a person with a family history of restless legs (an uncomfortable feeling in the legs when sitting or lying down, causing a powerful urge to move them) or rheumatic disease develops the characteristic symptoms for a minimum of three months. Other conditions like hypothyroidism, polymyalgia rheumatica, neuropathies, lupus (chronic inflammatory disease that can affect various parts of the body such as the skin, joints, kidneys, etc.), multiple sclerosis and rheumatoid arthritis can mimic fibromyalgia. These can be ruled out with appropriate tests.
Medication can be used for treating fibromyalgia. Pain can be tackled with paracetamol, non-steroidal anti-inflammatory drugs or tramadol. The lowest effective dose needed may have to be prolonged. Anti-depressants belonging to the selective serotonin re-uptake inhibitor (SSRI) group regulate brain chemicals that transmit pain signals and can be effective in reducing the heightened sensitivity to pain. These are a fairly new group of drugs. The older anti-depressants such as amitriptyline, doxepin, fluoxetine and paroxetine â€” alone or in combination â€” can tackle the depression and help to promote sleep. As treatment is long term, habit forming addictive valium and other benzodiazepines are best avoided.
Self-care and discipline are more important than visits to the physician, drugs and medications in the management of fibromyalgia.
Reduce stress. One of the reasons for stress is an inability to say â€œnoâ€. Recognise your limits and set realistic goals. Allow time for relaxation. Pace yourself so that the goals are achieved. Stopping work or quitting a job is not the answer. Those who become non-productive do poorly compared with people who stay active. Deep breathing, prayer and meditation may be helpful.
Get enough sleep. Fatigue is a symptom and an aggravating factor. The amount of sleep each individual needs varies between six and eight hours. Sleep and get up in a dark room at the same time each day to get adequate rest. Avoid daytime napping.
Exercise. It may increase the pain initially but as the muscles become toned and responsive, the fibromyalgia pains gradually disappear. Also, the fitness level increases and the mood automatically elevates. Aerobic exercises such as walking, jogging or swimming must be done for 40 minutes a day.
Massage. Pain and triggering decrease if the tender points are massaged with a capsaicin (the active component of chilli peppers) containing ointment four times a day. This can be alternated with the application of ice packs to the area. This helps to reduce the medication required.
Accupuncture and acupressure are beneficial. The stimulation involved in these procedures cause changes in the levels of neurotransmitters, produces tolerance and decreases pain. Only disposable needles should be used to prevent the transmission of hepatitis and other infectious diseases.
Fibromyalgia has been known and described for hundreds of years. It was tackled and managed adequately with diet, exercise, rest, massage and acupuncture long before the advent of modern day medication.
Source: The Telegraph (Kolkata, India)