Monday, 11 March 2013

What Is Fibromyalgia Syndrome (FMS) and is it treatable?

Fibromyalgia is a disorder that causes muscle pain and fatigue (feeling tired). People with fibromyalgia have “tender points” on the body. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs. These points hurt when pressure is put on them.

Fibromyalgia is the most common musculoskeletal condition after osteoarthritis. Still, it is often misdiagnosed and misunderstood. Its characteristics include widespread muscle and joint pain and fatigue as well as other symptoms. Fibromyalgia can lead to depression and social isolation.

This overview of fibromyalgia syndrome (FMS) covers symptoms, diagnosis and treatment, and the impact fibromyalgia has on lives. The impact comes from the tremendous physical and psychological strains that come with FMS. Those strains can lead to loss of work hours, reduced income, and even job loss.

A syndrome is a set of symptoms. When they exist together, they imply the presence of a specific disease or a greater chance of developing the disease.

Fibromyalgia was previously called "fibrositis," but this name was changed when it became evident that inflammation was not a part of this condition. In 1990 the American College of Rheumatology (ACR) established criteria for the classification of fibromyalgia as a product of a well-designed, multi-center study of the condition (Wolfe F et al, 1990).

As defined by ACR, fibromyalgia must include:
  1. A history of widespread pain for at least three months. Widespread pain must have all of the following: pain in the left side of the body, pain in the right side of the body, pain above the waist and pain below the waist. In addition, axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back) must be present.
  2. The patient must report feeling pain in 11 of 18 tender sites on digital palpation (with 4 kg of force) which are located bilaterally on the body.
  3. Lastly, the presence of a second clinical disorder does not exclude the diagnosis of fibromyalgia.
With fibromyalgia syndrome, the following symptoms commonly occur together:
  • Anxiety or depression
  • Decreased pain threshold or tender points
  • Incapacitating fatigue
  • Widespread pain
People with fibromyalgia may also have other symptoms, such as:
  • Morning stiffness
  • Headaches
  • Painful menstrual periods
  • Inability to concentrate, problems with thinking and memory (sometimes called “fibro fog”)
  • Abdominal pain
  • Chronic headaches
  • Difficulty maintaining sleep or light sleep
  • Dryness in mouth, nose, and eyes
  • Fatigue upon arising
  • Hypersensitivity to cold and/or heat
  • Incontinence
  • Irritable bowel syndrome
  • Numbness or tingling in the fingers and feet
Fibromyalgia Symptom Chart

A person may have two or more coexisting chronic pain conditions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia. It is not known whether these disorders share a common cause.

Incapacitating fatigue together widespread pain (muscular pain in particular), are the primary signs indicative of possible fibromyalgia.

Your muscles may feel like they have been overworked or pulled. They'll feel that way even without exercise or another cause. Sometimes, your muscles twitch, burn, or have deep stabbing pain.

Fibromyalgia can cause signs and feelings similar to osteoarthritis, bursitis, and tendinitis. Some experts include it in this group of arthritis and related disorders. However, while the pain of bursitis or tendinitis is localized to a specific area,  pain and stiffness with fibromyalgia are widespread.

Who are more likely to get Fibromyalgia?
More than 12 million Americans have fibromyalgia. Most of them are women ranging in age from 25 to 60. Women are 10 times more likely to get this disease than men.

People with certain other diseases may be more likely to have fibromyalgia. These diseases include:

Rheumatoid arthritis
Systemic lupus erythematosus (commonly called lupus)
Ankylosing spondylitis (spinal arthritis).

How is Fibromyalgia Diagnosed?
There are no specific laboratory tests to diagnose fibromyalgia. Fibromyalgia is mostly diagnosed by way of exclusion. That means the doctor will rule out other conditions that could cause similar symptoms. To make an accurate diagnosis, the doctor will rely on a comprehensive history, a physical exam and possibly some specific blood tests to rule out other conditions.

Conventional treatment of Fibromyaligia
Recommendations for the conventional medical management of fibromyalgia typically are based on a program that emphasized education, use of antidepressants and/or muscle relaxants, exercise and cognitive therapy best accomplished when the patient and healthcare providers work as a team (Goldenberg, et al, 2004).

According to the American College of Rheumatology, conventional drug therapy for fibromyalgia is primarily aimed at treating the symptoms. Because of the wide range of symptoms and signs related to fibromyalgia one often finds that such patients are prescribed a very wide range of medicines, ranging from pain medicines, muscle relaxants to anti-depressants and more.

The nonsteroidal anti-inflammatory drugs (NSAIDs), including Cox-2 inhibitors, have not been found to be effective for treating fibromyalgia syndrome pain. It's usually best to avoid opioid pain medications because they tend not to work well in the long-run and can lead to problems with dependency.

In 2004, Goldenberg et al published results from an extensive literature search of fibromyalgia treatment trials and found no evidence for efficacy of opioids, corticosteroids, NSAIDs, benzodiazepines and nonbenzodiazepine hypnotics, melatonin, calcitonin, thyroid hormone, guaifenesin, dehydroepiandrosterone or magnesium. Since this article's publication, duloxetine (Cymbalta), milnacipran (Savella) and pregabalin (Lyrica) have attained FDA approval for treatment of fibromyalgia, although as is typical, each of these drugs is known to cause a variety of side effects, including significant fatigue, dizziness, nausea, headache, insomnia, sexual problems (that can even last for years after stopping drug treatment), weight gain, excessive sweating and constipation. The most serious adverse effects cases, admittedly rare, are uncontrolled hypertension, hepatotoxicity (liver toxicity) or suicide. Even more problematic is the fact that each of these drugs is known to create a wide variety of minor and serious symptoms if or when the patient tries to stop taking the drug.

In 2010, a systematic review of the most recently used conventional drugs for fibromyalgia was published in a leading scientific journal (Clauw, 2010). Although some drugs had beneficial effects, the author acknowledged the significant limitations of these benefits and the need to utilize other treatment options. He wrote, "Because of the modest overall analgesic efficacy seen with any class of analgesic drug in any chronic pain state, we should be particularly aggressive about using more non-pharmacological therapies in treating patients with chronic pain."

Homeopathic Treatment of Fibromyalgia Syndrome (FMS)
The body of scientific evidence showing efficacy of individualized homeopathic treatment in the care of patients with fibromyalgia suggests significant benefits. If you or someone near and dear to you has fibromyalgia, consider getting professional homeopathic care for both safe and effective treatment.

Ultimately, the homeopathic treatment of patients with fibromyalgia requires individualised care by registered homeopathic practitioners who are adequately trained in homeopathy. This condition is too complex for 'self-care treatment' or for treatment by clinicians who have not received professional training.


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