Definition: a chronic pain condition involving the muscles and soft tissue. It is characterized by widespread allodynia, which is tenderness to touch and light pressure.
Signs and symptoms: The hallmark of fibromyalgia is widespread pain and tenderness lasting more than 3 months. It affects both sides of the body and areas above and below the waist (ie. all 4 quadrants of the body). People have “trigger points” which are localized areas in the muscle that can often be felt by treating practitioners as discrete “knots” or lumps in the muscles. In addition to pain people experience severe fatigue and sleep disturbance. They can also have joint pain, problems with their memory and concentration, muscle twitching or spasms. Conditions that are also frequently present in people with fibromyalgia include chronic fatigue syndrome, irritable bowel syndrome, restless leg syndrome, anxiety and depression.
Causes: At the present time the exact cause of fibromyalgia in unknown. There is no specific test, such as blood work or imaging procedures that can be used to make the diagnosis of fibromyalgia. There are a number of theories and associations that have been reported and require further investigation. One suggestion is that there is an alteration in the central nervous system due to prolonged or severe stress. Central sensitization suggests that the condition is due to a lower pain threshold because of increased sensitivity in the brain to pain signals from the body. Alterations in the brain’s neurotransmitter system (serotonin or dopamine) or endocrine system (growth hormone, cortisol) or in the autonomic nervous system have been identified in some studies. However the exact cause of the condition remains unknown.
Testing: The history and physical examination is the major test for fibromyalgia. It is often a diagnosis of exclusion which means that other serious conditions are ruled out by investigations. In people with fibromyalgia blood tests fail to show any serious abnormalities. CT and MRI scans looking for abnormalities affecting the brain, spinal cord or nerves are normal or inconsistent with the persons symptoms.
Treatment: There is no known cure for fibromyalgia. Treatment is aimed at improving a patient’s symptoms and function. The most effective treatment is a combination of prescription medication, education, aerobic exercise and cognitive-behavioral therapy.
There are a variety of medications that can improve the person’s pain but must be weighed against their side effects which often include fatigue and drowsiness. Anti-depressant medication, anti-seizure medication, muscle relaxants, neurotransmitter (dopamine) agonists and analgesic medication alone or in combination are often prescribed. Aerobic exercise and tai chi improves fitness and sleep and may reduce pain in people with fibromyalgia. Physiotherapy, massage therapy and the application of heat to affected areas can be helpful. Acupuncture, intramuscular stimulation (IMS) and trigger point injections can improve localized pain. Cognitive Behavioral Therapy (CBT) can help with the symptoms of anxiety,depression and pain.
Epidemiology: Fibromyalgia occurs in about 2 – 4 % of the general population. It is much more common in woman than men with a ratio of 9:1. It is usually diagnosed between the age of 20 and 50 but symptoms may have been present since childhood. There is usually a history of some form of stress that preceded the onset of the symptoms.
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