THE INVISABLE DISEASE

Marion Pellicano Ambrose

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

The pain and fatigue associated with this disease can be crippling. Constant pain and lack of sleep,along with this fatigue often leads to depression. The fact that this is an invisible disease also causes much distress. Family members, coworkers, and sometimes even medical personnel tend to ignore or downplay the effects of this disease. Unless one has experienced the horrific effects of Fibromyalgia, they should not judge. This goes for scoffing at people using handicapped parking or devices that “look perfectly healthy”.

Women are much more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.

The pain associated with fibromyalgia often is described as a constant dull ache, typically arising from muscles. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

Fibromyalgia is characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points. Tender point locations include:

·                                 Back of the head

·                                 Between shoulder blades

·                                 Top of shoulders

·                                 Front sides of neck

·                                 Upper chest

·                                 Outer elbows

·                                 Upper hips

·                                 Sides of hips

·                                 Inner knees

Fatigue and sleep disturbances
People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is frequently disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea, that further worsen symptoms.

Coexisting conditions
Many people who have fibromyalgia also may have:

·                                 Fatigue

·                                 Anxiety

·                                 Depression

·                                 Endometriosis

·                                 Headaches

·                                 Irritable bowel syndrome

Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include:

·                                 Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.

·                                 Infections. Some illnesses appear to trigger or aggravate fibromyalgia.

·                                 Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.

Why does it hurt?
Current thinking centers around a theory called central sensitization. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals.

Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.

Risk factors for fibromyalgia include:

·                                 Your sex. Fibromyalgia is diagnosed more often in women than in men. Female reproductive hormones may play a part in how women experience pain.

·                                 Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.

·                                 Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.

Fibromyalgia generally doesn't lead to other conditions or diseases. But the pain and lack of sleep associated with fibromyalgia can interfere with your ability to function at home or on the job. The frustration of dealing with an often-misunderstood condition also can result in depression and health-related anxiety.

Because many of the signs and symptoms of fibromyalgia are similar to various other disorders, you may see several doctors before receiving a diagnosis. Your family physician may refer you to a rheumatologist, a doctor who specializes in the treatment of arthritis and other inflammatory conditions.

What you can do
Before your appointment, you may want to write a list that includes:

·                                 Detailed descriptions of your symptoms

·                                 Information about medical problems you've had in the past

·                                 Information about the medical problems of your parents or siblings

·                                 All the medications and dietary supplements you take

·                                 Questions you want to ask the doctor

What to expect from your doctor
In addition to a physical exam, your doctor will probably ask you if you have problems sleeping, and if you've been feeling depressed or anxious

In 1990, the American College of Rheumatology (ACR) established two criteria for the diagnosis of fibromyalgia:

·                                 Widespread pain lasting at least three months

·                                 At least 11 positive tender points — out of a total possible of 18

But fibromyalgia symptoms can come and go. And many doctors were uncertain about how much pressure to apply during a tender point exam. While the 1990 guidelines may still be used by researchers studying fibromyalgia, less stringent guidelines have been developed for doctors to use in general practice. These newer diagnostic criteria include:

·                                 Widespread pain lasting at least three months

·                                 No other underlying condition that might be causing the pain

Blood tests
While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include:

·                                 Complete blood count

·                                 Erythrocyte sedimentation rate

·                                 Thyroid function tests

In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health.

Medications
Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

·                                 Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve, others) — in conjunction with other medications.

·                                 Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or fluoxetine (Prozac) to help promote sleep.

·                                 Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Therapy
Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.                                                             Many have found acupuncture and massage therapy helpful in controlling the pain and fatigue of Fibromyalgia.

Besides dealing with the pain and fatigue of fibromyalgia, you may also have to deal with the frustration of having a condition that's often misunderstood. In addition to educating yourself about fibromyalgia, you may find it helpful to provide your family, friends and co-workers with information.

 Living with fibromyalgia

Even with the many treatment options, patient self-care is vital to improving symptoms and daily function. In concert with medical treatment, healthy lifestyle behaviors can reduce pain, increase sleep quality, lessen fatigue and help you cope better with fibromyalgia.

Here are some self-care tips.

·         Make time to relax each day. Deep-breathing exercises and meditation will help reduce the stress that can bring on symptoms.

·         Set a regular sleep pattern. Go to bed and wake up at the same time each day. Getting enough sleep lets your body repair itself, physically and mentally. Also, avoid daytime napping and limit caffeine intake, which can disrupt sleep. Nicotine is a stimulant, so those with sleep problems should stop smoking.

·         Exercise often. This is a very important part of fibromyalgia treatment. While difficult at first, regular exercise often reduces pain symptoms and fatigue. Patients should follow the saying, "Start low, go slow." Slowly add daily fitness into your routine. For instance, take the stairs instead of the elevator, or park further away from the store. After awhile, do more physical activity. Add in some walking, swimming, water aerobics and/or stretching exercises. It takes time to create a comfortable routine. Just get moving, stay active and don't give up!

·         Educate yourself. Nationally recognized organizations like the Arthritis Foundation and the National Fibromyalgia Association are great resources for information. Share this information with family, friends and co-workers.

Points to remember

·         Look forward, not backward. Focus on what you need to do to get better, not what caused your illness.

·         As your symptoms decrease with drug treatments, start increasing your activity. Begin to do things that you stopped doing because of your pain and other symptoms.

·         With proper treatment and self-care, you can get better and live a normal life.

It's also helpful to know that you're not alone. Organizations such as the National Fibromyalgia Association and the American Chronic Pain Association can help put you in touch with others who have had similar experiences and can understand what you're going through.

http://www.mayoclinic.com/health/fibromyalgia/DS00079

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001463/