Sandra woke up feeling groggy and in pain. Her entire body ached, and her joints and muscles seemed stiff. This was nothing new for Sandra, who had had similar symptoms for the past two years following a traumatic experience at work that she was still struggling to deal with. Besides the pain, an overwhelming fatigue was present most days of the week.
Understandably, Sandra also felt down most days. It was difficult for her to get motivated to do the simplest tasks at home, and her physical pain kept her from doing much in the community. Despite feeling fatigued during the day, it was often difficult to fall asleep at night.
Sandra had a friend that was becoming increasingly concerned about the decline she was witnessing. Over coffee one day, she suggested Sandra should see a doctor; Sandra reluctantly agreed.
The doctor took a detailed history from, to include past medical problems and current medications. The physical exam revealed multiple tender points with light pressure. Sandra was diagnosed with Fibromyalgia and a course of physical activity, counseling, and prescription medication was recommended.
Fibromyalgia is a very common condition that predominately affects women between the ages of 20 and 50. Fibromyalgia is not a disease, per se. Rather, it is considered a syndrome, consisting of a group of common symptoms.
The Pain that Doesn't End
Fibromyalgia usually has some component of pain as one of the primary symptoms. At times, the pain may be barely noticeable. Other patients may experience severe, debilitating pain that interferes with their daily activities.
Unlike the pain of arthritis, fibromyalgia is often a dull ache that affects muscles near a variety of joints, and may be constant. Fibromyalgia patients often note the pain is worse following physical activity, changes in the weather, or times when emotional stress is increased. At times “good days” can occur, where there is little discomfort present.
Some patients have a sudden onset of their symptoms following a traumatic event, injury, or surgery. Other times, the condition builds slowly in intensity over a several years.
But I’m Too Tired.....
Intense fatigue is the cornerstone of fibromyalgia. This is an interesting finding, since many patients sleep a least 8 hours in a day. Sufferers from fibromyalgia often complain they have difficulty falling or staying asleep, and usually do not feel refreshed when they awaken. The condition is worsened if other conditions that may affect sleep are also present, such as Restless Legs Syndrome, Obstructive Sleep Apnea, or depression.
Making the Diagnosis
There is no blood test or imaging study that can diagnose fibromyalgia. Since it a syndrome and not a disease, fibromyalgia is never life threatening. However, the presence of the symptoms can certainly affect a patient's life.
To make the diagnosis, symptoms of pain must be present for at least three months, and be located on both sides of the body. Tender points are small areas that hurt more with application of moderate pressure. On physical examination, at least 11 of the following 18 tender points in should be present:
- Back of the head
- Front sides of the neck
- Upper chest
- Top of shoulders
- Between shoulder blades
- Outside of elbows
- Upper hips
- Sides of hips
- Inner knees
How does one treat a medical condition that is not a disease, and may have elusive symptoms? Since fibromyalgia is such a common condition, trial and error has shown effective treatments that help most people.
Exercise - As happens with most medical conditions, regular light or moderate intensity exercises generally helps make things better. Exercise will help build stamina and energy levels, and will likely reduce fatigue and pain over the long run. The biggest problem with an exercise program is persuading a person to start, and then continue despite a temporary increase in pain and fatigue which may occur in the beginning.
Medication - A variety of medications can be prescribed to help reduce the symptoms of fibromyalgia. Among the more common medicines used are anti-depressants. These have been shown effective even if depression is not present also. Anti-seizure medications are used at times, which may reduce the symptoms based on their action on brain chemistry and nerve conduction.
Muscle relaxants can also help relieve muscle pain, and the associated sleepiness they induce may also increase rest. Pain medication of one kind or another is also commonly used. Care should be taken to avoid long term use of habit forming pain medications, such as narcotics.
Counseling - Since fibromyalgia is often associated with a single stressful event, or ongoing stress in a person’s life, having emotional support is often helpful. By identifying factors in life that make the symptoms worse, coping strategies can help keep things under control.
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