Learning about Fibromyalgia

Fibromyalgia is a long term condition characterised by widespread muscle pain and fatigue. It is thought to affect 3-5% of the population. It can affect anyone at any age but is more common in women.

Fibromyalgia is a chronic condition characterised by widespread muscle pain and fatigue. The term 'fibromyalgia' literally means pain in muscles and fibrous tissues (ie: tendons and ligaments).

For many years it was thought that fibromyalgia was psychologically based but is now recognised as a medical condition in its own right and research into the condition has increased.

Approximately 80% of fibromyalgia sufferers are women and the condition is most commonly diagnosed in the 30 to 45 year age group.

The cause of fibromyalgia is unknown. There are indications that an injury, infection or illness may trigger the condition. There are also indications that hereditary factors are involved in the development of fibromyalgia as sometimes it occurs in several members of one family.

It is thought that fibromyalgia may be due to a malfunction in the way the central nervous system processes pain signals. This leads to people with fibromyalgia experiencing as pain, sensations that other people might perceive as uncomfortable.

Two brain chemicals, Serotonin and Substance P, are thought to play a role in the condition.

Serotonin is a neurotransmitter (a chemical that enables the transmission of nerve impulses) that influences mood, appetite, pain perception, sexual function, anxiety, temperature control and sleep. Studies have indicated that levels of this chemical are lower than usual in people with fibromyalgia.

Substance P, another neurotransmitter, is involved in transmitting pain sensations to the brain and also regulates the way we perceive pain. Some studies have found substantially elevated levels of this substance in people with fibromyalgia.

A person with fibromyalgia can experience a wide range of symptoms but the main ones are muscle and joint pain, stiffness and fatigue.

The one symptom experienced by everyone with fibromyalgia is pain. This pain can be described in various ways, such as an ache, a sharp pain, a throbbing or a burning feeling. The pain is felt throughout the body and on both sides of the body. The pain can move from one part of the body to another. The amount of pain experienced can vary throughout the day and can also worsen with a change in weather, increase in stress, noise, activity and lack of sleep.

Stiffness of muscles and joints is most noticeable in the morning and after a period of rest. This can interfere with work and daily activities such as driving. Keeping moving is the best way to prevent stiffness. If a person has to sit for long periods, he or she can reduce stiffness by regularly getting up to move around and stretch.

Fatigue is experienced by up to 90% of people with the condition. The level of fatigue can vary from person to person, from being barely noticeable to severe. As with the amount of pain experienced, the degree of fatigue can vary throughout the day, from day to day, and may even be absent on occasion.

Many people with fibromyalgia experience sleep problems. There are a number of stages of normal sleep ranging from light to deep sleep. It seems that people with fibromyalgia often lack the deep restorative stages of sleep and often wake feeling unrefreshed.

Over half of people with fibromyalgia experience symptoms such as irritability, forgetfulness, lack of concentration, mood changes, anxiety and depression.

Other symptoms that can be experienced by people with fibromyalgia include:

• Migraine and tension headaches
• Recurrent abdominal pain
• Diarrhoea
• Difficulty swallowing
• Irritable bladder leading to frequent or painful urination
• Numbness and tingling of the extremities
• Dry eyes and mouth.

Diagnosis

Fibromyalgia can be a difficult condition to diagnose as the symptoms of fibromyalgia are often similar to those of other conditions, such as rheumatoid arthritis or chronic fatigue syndrome. Blood tests and x-rays usually return normal results in someone with fibromyalgia but they are often performed in order to rule out other conditions.

In order to make a diagnosis of fibromyalgia the doctor will look for the following indicators of the condition:

• A history of widespread pain
• At least 11 of 18 specific tender point sites (as shown below)
• Normal blood tests
• Chronic fatigue
• Sleep disturbances
• Skeletal pain (mainly in the neck and back).

Graphic courtesy of A. Bonsall and MedicineNet.com

Treatment

While there is no cure for fibromyalgia, the condition can be managed using a variety of measures. Optimal management requires cooperation between the patient and various treatment providers.

Exercise is highly recommended even though people with fibromyalgia may be reluctant to exercise because of their pain. Exercise is important to prevent the muscles from losing strength due to lack of use. Other benefits of regular exercise include sleep promotion, aiding digestion, increasing blood flow and improving muscle tone. It is best to start with small amounts of low impact exercise (such as walking) on a daily basis, and gradually increase this as tolerated.

Rest is also important in managing fibromyalgia. People with fibromyalgia often feel exhausted after only small amounts of activity. It is often helpful therefore, to rest regularly during the day and even during activity if it is needed. Even brief periods of rest (such as 5 to 10 minutes) can be helpful.

Stress reduction is important as increased stress can magnify fibromyalgia symptoms. Finding methods of relaxation (such as reading or listening to music) that suit the individual with fibromyalgia can be helpful in stress reduction. Talking about the condition with friends and family can also be helpful. Some people may find it helpful to work with a professional counsellor or psychologist to develop relaxation techniques and strategies to cope with the pain

Sleep is often inadequate in quality for people with fibromyalgia. It is not advisable to use sleeping tablets unless they are absolutely necessary, and then only for brief periods of time. Some methods that may help to gain more restful sleep include avoiding alcohol and coffee in the evening, using the bedroom only for sleep (ie: not for working or eating), ensuring the room is dark when trying to sleep and having a regular time for going to bed.

Alternative therapies such as acupuncture/acupressure, homeopathy, hot and cold packs, massage therapy, nutritional supplements and dietary modifications, herbal preparations, osteopathy or chiropractic treatment, have proved effective for some people in managing the symptoms of fibromyalgia.

Studies have shown that low doses of two different antidepressant medications can be helpful in relieving the pain of fibromyalgia in some people. Amitriptyline (a tricyclic antidepressant) taken at night can help with promoting a restful sleep and reducing muscle pain and spasms. Prozac (fluoxetine) taken in the morning may add to the effects of the Amitriptyline by further controlling the pain during the day. While these medications help some people with fibromyalgia, they are not effective in all cases.

So from learning about this it is important that when initially meeting a person I ask about what symptoms they are experiencing e.g. where the pain is, how they are coping with it, what helps, what doesnt help, how their sleep is, how they manage fatigue, and how they feel within themselves so I can understand their experience of living with this condition.

My intervention could be aimed at education around fatigue management, coping with pain, sleep management, stress management, aids to cope with difficult ADL's when pain/fatigue is a distrubrance,

Jess