Fibromyalgia

From time to time, everyone suffers from aches and pains. These pains may be caused by a flu, exercising, poor posture or fatigue. However, when the pain, stiffness and aching becomes persistent there is probably a medical reason for the discomfort.

Many arthritis disorders can cause aches, pains and stiffness. If the diagnosis of a specific form of arthritis is ruled out with appropriate blood tests and x-rays, fibromyalgia may be the reason for the pain. Although the condition is quite common, particularly in females, it is very difficult to diagnose due to lack of diagnostic blood tests.

Fibromyalgia causes stiffness and aching in ligaments, tendons, and muscles. The patient may present with multiple trigger point tenderness as the only physical finding. Many patients with fibromyalgia will complain of chronic fatigue and, most significantly, non-restorative sleep, that is they never feel fresh after a night’s sleep when waking up in the morning.

In addition to the complaint of muscle pain, the patient may complain of swelling of the joints which, in fact, when examined, does not exist. Most common areas of soft tissue pain are between the shoulder blades of the back, inside the elbows, outside the hips, inside the knees and on both sides of the neck. If the physician presses on any of these trigger points an exquisite reproduction of the patient’s symptoms is reproduced.

Fibromyalgia does not cripple, however, the chronic pain can be incapacitating. Many individuals become anxious and depressed because of the pain. This further compounds the weakness and poor sleep patterns. At least one-third of patients with fibromyalgia may complain of pain in the temporomandibular joints and have a history of grinding their teeth, in particular, while sleeping at night. This is a significant associated finding of fibromyalgia. Additionally, fibromyalgia has been associated with irritable bowel syndrome, tension headaches, mitral valve prolapse and chronic fatigue syndrome. Recent research has shown that fibromyalgia may be a result of lack of oxygen to the muscles.

Treating fibromyalgia is very difficult and takes dedication and persistence from the patient and physician alike. Both patient and physician need to trust that while the first treatments may not work, if they both stay the whole course of treatment and utilize all forms of therapy, some relief of symptoms may occur.

The first form of treatment is to correct the sleep pattern. For this, tranquilizers and anti-depressants may be necessary to induce a form of REM sleep. REM sleep is the level of sleep where dreams of a positive nature occur.

Next, in forty percent of patients, the addition of the nutrient known as malic acid helps reduce the muscle pain significantly. In theory, this is because malic acid is important for the production of energy in the body and oxygenation of the muscles. Malic acid also helps improve the energy of many fibromyalgia sufferers.

Additionally, but only occasionally, local injections of a local anesthetic and corticosteroid preparation are sometime beneficial in helping break muscle spasm and ,therefore, the pain cycle. The alternative use of ice and heat applied to the trigger points has been helpful to some individuals and deep massage has also been used to help in breaking the muscle spasm.

Finally, it is essential that the patient understand the diagnosis and reasons for their symptoms. If feasible, the patient’s family needs to be involved to help overcome the problems the patient experiences. The vast majority of patients with fibromyalgia should be able to continue normal activities with some modification. If the patient is motivated and follows the prescribed therapeutic regime, a good response can be expected. The ultimate aim is to allow the patient to control the disease instead of letting the disease control the patient.

Author: Norman B. Gaylis, MD, FACP, FACR

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