Other common symptoms are impaired sleep, morning stiffness, headaches, irritable bowel syndrome, restless legs syndrome, dizziness, painful menstrual periods, numbness or tingling of the extremities, memory problems, and heightened sensitivity to cold, noises, odors, and bright lights. Anxiety and depression are common among patients with fibromyalgia. The sleep disturbances common with fibromyalgia cause individuals to wake up tired and unrefreshed despite having 8 to 10 hours of sleep. Some studies suggest that brain-wave irregularities occur that disrupt the deep restorative stage of sleep. Restless legs syndrome may also contribute to poor sleep patterns. With restless leg syndrome, the leg muscles involuntarily contract every 20 to 40 seconds during sleep, arousing the individual from deep sleep even though he or she is usually unaware of the interruption. Some experts think that fibromyalgia does not actually cause sleep disturbances, but that poor sleeping patterns come first, and in fact it is sleep deprivation that causes many cases of fibromyalgia. The rationale for this theory is that disturbed sleep appears to trigger factors in the immune system that cause inflammation, pain, fatigue, and a decreased pain threshold, all if which are common symptoms of fibromyalgia. because the symptoms of fibromyalgia fluctuate, suggesting that the problems experienced are not systemic but result from environmental factors. For a clinician who is familiar with fibromyalgia, though, a diagnosis can be made on the basis of two criteria established by the American College of Rheumatology in 1990: 9 ● Widespread pain lasting more than three months. To be considered “widespread,” pain must occur on both the right and left sides of the body, above and below the waist, and near the spine. ● Pain upon digital palpation with a force of about 4 kg in at least 11 of the 18 tender points (see figure 3). Some physicians consider these criteria too rigid and believe a diagnosis of fibromyalgia can be made even when individuals do not have the required minimum number of 11 tender points. to the side effects of these drugs (nausea, constipation, itching, and mental blurring), and often decide not to use them for the long term. Several classes of antidepressants have been found to be the most useful medication for treating fibromyalgia. Although they don’t work for all fibromyalgia patients, they have been shown to help relieve pain, fatigue, and insomnia in about 25 percent of patients. 11 Tricyclic antidepressants taken at bedtime can help promote restorative sleep, help relax painful muscles, and increase the effects of endorphins, the body’s natural pain-killing substances. The newer class of antidepressants, selective serotonin reuptake inhibitors (SSRIs), seems to be more effective for many people with fibromyalgia, but SSRIs don’t help everyone. Results of a study using a dual-action antidepressant, duloxetine, demonstrated that it was effective in improving symptoms and relieving pain of fibromyalgia. 12 Duloxetin works by increasing the availability in the brain of both serotonin and norepinephrine, as do some other antidepressants such as Effexor. Compared with the control group, the patients given duloxetine had significant reduction in both generalized and tender-point pain, as well as significant improvement in general activity, mood, walking ability, normal work, sleep, and enjoyment of life, as measured by standardized tests.Corticosteroids, such as prednisone, have not been shown to be effective in treating fibromyalgia.
Figure 3: The Location of the Nine Paired Tender Points that Comprise The 1990 American College of Rheumatology Criteria for Fibromyalgia
Illustration Source : National Institute of Arthritis and Musculoskeletal and Skin Diseases
Diagnosis There are no standard laboratory tests or other diagnostic tests that can be used to diagnose fibromyalgia, so the diagnosis must be determined on the basis of patient symptoms and physical examination. It is common for individuals to consult a variety of physicians and therapists before receiving a diagnosis. Unfortunately, in this process, some doctors conclude that a patient’s pain is psychosomatic, or tell the patient there is nothing they can do. In addition, an incorrect diagnosis is often made, because the symptoms of fibromyalgia overlap with those of other conditions. For example, in one study, about 70 percent of patients who have the diagnostic symptoms of chronic fatigue syndrome also meet the criteria for diagnosis of fibromyalgia. 8 Other complex conditions with similar clusters of symptoms that may be misdiagnosed are chronic myofascial pain syndrome and posttraumatic stress disorder. Clinicians may also pursue potential allergies as a diagnosis, especially Treatment Managing the pain and dysfunction related to fibromyalgia is challenging and frustrating for patients and clinicians alike. In 2004 a group of experts reviewed all published scientific research on fibromyalgia and concluded that, on the basis of the evidence, a treatment program for fibromyalgia should emphasize education, certain medications, exercise, cognitive therapy, or all four approaches. 10 Education and coping skills Recognizing the need for lifestyle adaptation is one of the most important factors in improving the symptoms of fibromyalgia. In addition to educating themselves about fibromyalgia, patients should provide information to their family, friends, and coworkers. Educational classes and support groups available through organizations such as the Arthritis Foundation and the American Chronic Pain Association can provide information and put individuals in touch with others who have had similar experiences and understand what they are going through. Essential education to help patients in appropriate self care for fibromyalgia should include sleep habits, stress reduction, exercise, and a healthy diet. Medications Medications typically used to treat musculoskeletal pain, such as nonsteroidal anti-inflammatory drugs and aspirin, are not usually effective in relieving the pain of fibromyalgia. Narcotic-based drugs, including codeine, morphine, and methadone, sometimes provide pain relief for a small subgroup of severely afflicted patients, but individuals with fibromyalgia are especially sensitive
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