Fibromyalgia: The Invisible Disease

Fibromyalgia is a disorder of chronic, widespread pain and tenderness through out the body with no obvious cause. It is commonly seen in young or middle-aged women but can affect patients of either sex and any age.

Fibromyalgia: The Invisible Disease

Signs and symptoms

Fibromyalgia is actually a syndrome that consists of the following signs and symptoms –

 Persistent (≥3 month) widespread pain (pain/tenderness on both sides of the body, neck ,shoulder region,above and below the waist, including the axial spine.
 Stiffness typically patient complaints more often.
 Fatigue; low energy levels ,disrupted and unrefreshing sleep
 Cognitive difficulties;difficulty in remembering things
 Multiple other unexplained somatic symptoms, anxiety and/or depression, and functional impairment of activities of daily living (ADLs)

Diagnosis

Fibromyalgia is a diagnosis of exclusion as there is no organic cause for this,and patients must be thoroughly evaluated for the presence of other medical disorders that could be the cause of symptoms as fibromyalgia before a diagnosis of fibromyalgia is made.

The clinical assessment may reveal objective evidence for a discrete or comorbid illness, such as the following:
Hypothyroidism, connective tissue disorder, SLE,Serious cardiac conditions in those with chest pain, dyspnea, and palpitations.

Laboratory testing

Although patients with fibromyalgia do not have characteristic or consistent abnormalities on laboratory testing, routine laboratory and imaging studies can help to rule out diseases with similar manifestations and to assist in diagnosis of certain inflammatory diseases that frequently coexist with fibromyalgia. Routine lab test like hemogram,liver and renal functions test,thyroid profile,vitlevels. Several questionnaire to rule out anxiety, depression ,bipolar disorder,cognitive decline.

Management

As there is no definite treatment for fibromyalgia, so always combine pharmacologic and nonpharmacologic therapy in the treatment of fibromyalgia. Aggressively treat any comorbid conditions like depression, anxiety, insomnia.

Non pharmacotherapy: It includes Proper Diet (eg, promote good nutrition, vitamin supplementation, weight loss)
Stress management, dhyan, pranayama and yoga has tremendous results
Aerobic exercise (eg, low-impact aerobics, walking, stationary bicycle)
Sleep therapy (eg, education/instruction on sleep hygiene)
Psychologic/behavioral therapy (eg, cognitive-behavioral )

Pharmacotherapy: Medications used in the management of fibromyalgia include the following group of drugs: Analgesics (eg, tramadol)
Antianxiety/hypnotic agents (eg, alprazolam, clonazepam,)
Skeletal muscle relaxants (eg, cyclobenzaprine)
Antidepressants (eg, amitriptyline, duloxetine, venlafaxine, desvenlafaxine)
Anticonvulsants (eg, gabapentin, tiagabine)
Alpha 2 agonists (eg, clonidine)
Dopamine agonists (eg, pramipexole)erbs and supplements