Fibromyalgia — pain all over the body

TRY to imagine having a health complication that causes chronic, widespread body fatigue, along with a host of other physical and psychological pain that is so crippling that it interferes with your ability to function.

Well, not only do some people not have to imagine, but according to medical internist Dr Samantha Nicholson, fibromyalgia patients face the awful reality of some doctors questioning their ‘claim’ of being so ill because a variety of tests often return negative results.

Fibromyalgia is a condition that causes people to feel pain in the muscles all over the body. The disorder, formerly referred to as fibrositis and which commonly affects the muscles and ligaments, is seen in a greater number of women than men, most commonly among people in their 20s and those in middle age.

Internist Dr Jomo James says people with fibromyalgia also have “tender points” — places on their body that hurt when they are touched.

Of note, there is no known cause of the disease, and in relation to a cure, Dr James said some people seem to get over the disease, but for most it can’t be cured. As a result, he said people diagnosed learn to deal with the condition and lead fairly normal lives, as symptoms don’t get worse over time and the condition is not life-threatening.

Other symptoms of the disease besides pain, according to Dr James, include trouble thinking clearly; flu-like symptoms; headaches; depression and anxiety; stomach pain; too many or too few bowel movements (diarrhoea or constipation); pain in the bladder or the need to urinate in a hurry or often; and problems with the jaw.

Dr James said diagnosing fibromyalgia is based on symptoms such as muscle pain all over the body and severe tenderness in at least 11 of the 18 known “tender points” of fibromyalgia.

“Sometimes doctors diagnose fibromyalgia without checking for the number of tender points a person has. This might happen if the person has many areas that feel painful, and is bothered a lot by symptoms that are often caused by fibromyalgia. Some of these symptoms include feeling tired when getting up in the morning and during the day, and having trouble thinking clearly,” he stated.

Added Dr Nicholson: “There are some patients who come in every day complaining about a zillion things, and every day it is something new — today it’s an arm, tomorrow it’s leg pain and the next day it is a headache, and this makes them rather difficult patients to treat. This becomes even more difficult when the patient becomes frustrated in their quest for an explainable and treatable diagnosis. The fact is they have probably been to many doctors trying to get information on their condition, or they have probably been seeing the doctor over and over, and it puts a strain in the doctor-patient relationship because sometimes the patients feel like they are not being believed.”

One challenge faced with fibromyalgia is the fact that it may co-exist with other unexplained medical conditions as well as conditions with associated chronic pains including rheumatoid arthritis, systemic lupus and erythematosus. It also often coexists with unexplained conditions such as irritable bowel syndrome or interstitial cystitis.

Some theorise that fibromyalgia may be just another mental illness — a theory which ties closely to the ability of medications used in the treatment of mental illnesses in offering relief.

“My belief is that the neurotransmitters which transmit the sensation of pain are misfiring; so they are firing when they don’t need to fire, and so what someone else may feel as just a little pinch, [fibromyalgia patients] find to be intense pain and it is exaggerated because of the hyperactivity of the neurotransmitters; but whatever it is, it seems to be neurotransmitter-based because it responds to drugs that alter neurotransmitters, for example psychiatric drugs,” Dr Nicholson reasoned.

In general, Dr James said treatment can include:

1. Medicines to relieve pain, improve sleep, or improve mood.

2. Physical therapy to learn exercises and stretches.

3. Relaxation therapy.

4. Working with a counsellor.

To get the best treatment, the internist said many people need a team that includes:

1. A doctor.

2. A physical therapist.

3. Someone trained in mental health (such as a social worker or counsellor).

Dr Nicholson said patients who self-medicate can put themselves in harm’s way.

“They will take Advil, Aleve and other things that they can get over the counter like Ibuprofen, and sometimes they take too much and run into problems with overdose, which is commonly seen with the use of acetaminophen. With Ibuprofen or Naproxen it may not necessarily be overdose, but it can cause irritation of the stomach, ulceration and bleeding from the stomach.”

Therefore, if you are concerned that you might have fibromyalgia, Dr Nicholson said that it is best that you get evaluated because over-the-counter medications have no effect on the neurotransmitters.

Dr James said if diagnosed, the individual must take medication prescribed, maintain an active lifestyle to help with the muscle pain, and maintain a positive attitude.

Participating in stress-reduction programmes, learning relaxation techniques, or participating in hypnotherapy (hypnosis), biofeedback, acupuncture, tai chi, yoga or cognitive behavioural therapy may help to alleviate certain symptoms.

“Fibromyalgia is not life-threatening, although it can affect the quality of day-to-day life. The severity of this impact depends upon a number of factors, including the patient’s medical, family, and social supports; their financial status; and their past experiences. One of the most important factors in a person’s long-term prognosis is the person’s ability to take charge, to avoid “catastrophising,” and to learn to cope well with symptoms while remaining as active as possible,” he said.