At one moment, a life of activity consumed with enjoyable activities like biking, golfing, going to the movies, out to dinner. Then one day, it’s gone. Replaced with constant pain and fatigue. Here’s the lowdown on fibromyalgia.
Fibromyalgia is one of the most common forms of arthritis seen in a rheumatology practice. It is actually a soft tissue form of rheumatism. Typically, a patient will complain of feeling achy all over, being chronically tired, and feeling like they’re walking around in a constant fog. Often a patient will complain of short term memory problems.
The American College of Rheumatology has set criteria by which fibromyalgia symptoms can be classified. These consist of a history of widespread pain for three or more months and pain in 11 of 18 tender point sites when 4 kilograms (about 9 pounds) of pressure is applied. When accompanied by a history of chronic fatigue and non-restorative sleep (waking up and feeling as if you haven’t slept), there is a strong suspicion that fibromyalgia is to blame.
People affected by fibromyalgia experience two unique responses to stimuli. They perceive normal stimuli as being painful and they perceive painful stimuli as being more painful than it should be.
These abnormal responses are thought to be due to an abnormality involving pain-processing pathways within the central nervous system.
History and physical examination is the first step in evaluation. Unfortunately, there are no specific laboratory tests that confirm the diagnosis. However, the tests can be helpful in excluding other conditions that can mimic fibromyalgia such as hypothyroidism, lupus, and rheumatoid arthritis.
Treatment consists of a combination of four approaches. The first is patient education. Talking with the patient about the diagnosis and presenting what he options are. The second is institute medications. These may include one or more of the following:
• Analgesics which help to control pain. An example would be a drug such as Tramadol
• Antidepressants which are used for their ability to elevate serotonin and nor-epiephrine levels in the brain. Examples include amitryptiline, fluoxitene, and duloxitene.
• Muscle relaxants like cyclobenzaprine
• Anti-seizure medicines like gabapentin
• Anti-fatigue medicines (modafinil)
The third therapy is non-impact aerobic exercise which helps to increase endorphin production in the brain and helps to recondition muscles.
Finally, the fourth is cognitive behavioral therapy which helps with goal-setting, coping and other measures which reduce the sense of victimization that people with fibromyalgia often have.
Fibromyalgia can be treated effectively. It is important that a patient seek out a qualified and empathetic rheumatologist to help them.
Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians.
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