Fibromyalgia

George Morris Physio Wigan


Fibromyalgia

What is Fibromyalgia?

Fibromyalgia, or FM for short, is a chronic condition of widespread pain and profound fatigue.

The pain tends to be felt as diffuse aching or burning, often described as head to toe. It may be worse at some times than at others. It may also change location, usually becoming more severe in parts of the body that are used the most.

The fatigue ranges from feeling tired to the exhaustion of a flu-like illness. It may come and go and people can suddenly feel drained of all energy - as if someone just "pulled the plug".



How Common is FM?

Fibromyalgia is a common illness; in fact, it is as common as rheumatoid arthritis and can even be more painful. People with mild to moderate cases of FM are usually able to live a normal life, given the appropriate treatment. If symptoms are severe, however, people may not be able to hold a paying job or enjoy much of a social life. The name Fibromyalgia is made up from "fibro" for fibrous tissues such as tendons and ligaments; "my" indicating muscles; and "algia", meaning pain.



A Collection of Symptoms

Fibromyalgia is known as a syndrome because it is a collection of symptoms rather than a specific disease process that is well understood. Besides pain and fatigue, FM symptoms often include -

Unrefreshing sleep - waking up tired and stiff

Headaches - ranging from "ordinary" types of headache to Migraine

Irritable Bowel Syndrome - frequent diarrhoea or constipation, sometimes accompanied by gas in the abdomen, or nausea.



Diagnosis

FM is not new, but for most of this century it was difficult to diagnose. Part of the problem has been that the condition could not be identified in standard laboratory tests or X-rays. Moreover, many of its signs and symptoms are found in other conditions as well, especially in M.E.

Two Canadian doctors developed a way of diagnosing FM in the 1970s, and in 1990 an international committee published requirements for diagnosis that are now widely accepted. Once other medical conditions have been ruled out through tests and the patient's history, diagnosis depends on two main symptoms:

widespread pain for more than three months, together with

pain in at least 11 of 18 specified tender point sites when they are pressed.

"Widespread pain", means pain above and below the waist, and on both sides of the body. The "tender points", or spots of extreme tenderness, are rarely noticed by the patient until they are pressed.



What Causes FM?

Fibromyalgia often develops after some sort of trauma that seems to act as a trigger, such as a fall or a car accident, a viral infection, childbirth or an operation. Sometimes the condition begins without any obvious trigger. The actual cause of FM has not yet been found. Over the past several years, however, research has produced some insights into this puzzling condition. For instance, it has been known that most people with FM are deprived of deep, restorative sleep. Current studies may find out how to improve the quality of sleep. Latest research has identified a deficiency in Serotonin in the central nervous system and a resulting imbalance of Substance P. The effect is Disordered Sensory Processing (the brain registers pain when others might experience a slight ache or stiffness). With these advances comes the added hope that a cause may now be found and hence a cure or more effective treatment.



Current Treatment

At the present time treatment for Fibromyalgia aims at reducing pain and improving sleep. In other words, the symptoms are being treated, rather than the condition itself.

Medications most often prescribed for FM are tricyclic drugs used to treat depression, although doses for FM are much lower than for depression. In some cases, these drugs will help with both sleep and pain. Over-the-counter medications may help to relieve the pain of FM but severe pain may require the expertise of a pain clinic. It is best to discuss any form of pain relief with your specialist or general practitioner. It is most important to note that medications work for some people but not for others.

Support from family, friends and other people who have FM is extremely valuable to those who have Fibromyalgia. Professional counselling may help some people to cope with this illness and to take an active part in their own treatment.

Learning to manage the condition seems, so far, to be the most successful way of dealing with Fibromyalgia. A combination of heat, rest, exercise and reducing stress can enable a person with FM to maintain a productive life.



Managing Fibromyalgia

The best way to cope with Fibromyalgia is to use a number of techniques that ease the symptoms as much as possible.

Relaxation is one technique that works really well for almost everybody with FM. It reduces tension in the mind and the body right away. The results are calming for all the symptoms, especially for the pain. Relaxation can be learned from books, tapes, videos or special courses.

Heat is important. A hot water bottle and hot baths or showers will help reduce pain and banish morning stiffness. Soaking hands and feet in hot water for a few minutes can ease their aching. Exercise is the most common prescription for Fibromyalgia. Two kinds of exercise are of benefit: stretching and aerobic. Both should be done gently at first, for a few minutes at a time. As the pain permits, exercise time can gradually be increased. Good stretching exercises for FM can be recommended by a physiotherapist, found in a yoga class or book or on video.

Aerobic exercises should be the low impact type: walking and moving around in warm water are excellent, swimming is good for some people, but must be done in a heated pool. Cold water is likely to make symptoms worse.

Recent research shows that people with FM have to find their own exercise limits. Their fitness goals cannot be set by someone else.

Although no particular diet has been shown to help FM, a healthy diet is important to provide protein, vitamins and minerals. It is best to avoid or at least cut down on coffee, tea and alcohol. Some sufferers have a tendency to gain weight, this can be distressing in itself. If you follow a healthy diet this should in turn help with your weight control. Sufferers of FM can have good days and bad days. On a good day it is important to pace yourself; overdoing it may simply make matters worse.

Rest is also vitally important. Listen to your body when it tells you to slow down.

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