By Robert J. Ycaza, MD –
Once considered a pure psychological derangement resulting only from a patient’s imagination; the validity of fibromyalgia syndrome (FMS) as a disease entity has increasingly gained acceptance among clinicians.
The fundamental problem seems to be how/why the pain is being processed in the brain rather than tissue damage or inflammation at the sites where the pain is experienced.
There is growing evidence that other conditions like irritable bowel syndrome (IBS), temporomandibular joint disorder (TMJD), seem to share the same mechanism of abnormal pain processing at the brain level.
FMS is solely a clinical diagnosis, since there is no blood test or radiological study that can confirm its presence. Oftentimes diagnosis is reached by first ruling out other entities as a cause of the widespread pain before labeling a patient of having FMS.
This syndrome is defined as pain lasting more than three months that affects areas on both the left and right sides of the body as well as being present above and below the waist level. The American College of Rheumatology, adds to the definition the presence of specific tender points as being positive at least 11 out of 18.
Practically speaking most of the patients experience a widespread pain, having tenderness not only in the specific points described by the ACR but throughout the entire body. It is estimated that 4-11% of the population is affected with fibromyalgia.
Development of pain in multiple areas (more than 7), sleep difficulties, high stress working environment, health seeking behavior, pre-existing bronchitis in Gulf War veterans, will predispose patients for the development of FMS.
More studies are currently being conducted with preliminary results that indicate there is a familial and a genetic inheritance is becoming of greater relevance. A key observation regarding these genetic studies is that the genes that are involved are relevant to the central and sympathetic nervous system rather than musculoskeletal tissues.
Generally patients with FMS are between 35-65 years old, and the majority are females. In addition to the pain, patients complain about other symptoms as well, including: sleep disturbances, fatigue, morning stiffness, forgetfulness and difficulty concentrating. These symptoms could be aggravated by emotional stress and weather changes. It is not uncommon that FMS patients have a history of back pain, headaches, IBS, depression anxiety, restless leg syndrome, sinus problems and ringing in the ears. Moreover, only 50% of patients with FMS are able to maintain gainful employment
Since there is no clear etiology causing FMS, proper diagnosis can be challenging for the physician and combatting this syndrome can become frustrating for the patient. The current general consensus is to treat the patient within the multimodal and multidisciplinary approach.
It is very important that the patient can achieve mechanisms to cope with fibromyalgia and by doing so improve their own and interpersonal relationships, since like with any type of chronic condition, all spheres of life are affected.
Non-Pharmacological Approach: patient education, exercise (start slow, a few times a week, increase as tolerance is built and avoid high impact movements) and aquatic therapy. Sleep hygiene, determine if sleep apnea is present and resolve if it is. Psychology counseling, important to address that the problem is not simply a figment of the patient’s imagination, but that FMS, although atypical, is real.
Pharmacological Approach: various antidepressants and antiepileptic drugs successfully treat the symptoms of fibromyalgia. Every case is different and often a combination of medications are used in order to alleviate FMS symptoms.
If you or any of your family members suspect having this debilitating syndrome, feel free to contact Dr. Ycaza’s office for a thorough consultation, your pain alleviation can be underway.
Robert J. Ycaza, M.D.