Fibromyalgia can interfere with a person's ability to function
Sunday, January 05, 2014 9:00 PM
One of our readers asked that I write about fibromyalgia. This is a chronic neurosensory disorder that can cause debility and severely interfere with a person's ability to function.
It usually presents in young or middle-aged women, affecting about nine times as many women as men. It is a frustrating condition for patients as well as physicians as it is poorly understood and current treatments are often minimally effective.
Fibromyalgia has traditionally been described as a rheumatologic condition resulting in various combinations of a number of musculoskeletal and neurologic symptoms. The most common are widespread muscle pain and stiffness, fatigue, and sleep problems. Problems with clouded thinking (known as fibrofog) can also be present. Psychological problems including depression and anxiety are also frequently described.
Fibromyalgia has been classified as a "central sensitivity syndrome" (CSS). This term describes what appears to be a problem with how the central nervous system (brain and spinal cord) processes pain. Narrowing down the cause of the illness will allow researchers to focus on specific therapies to treat it.
There are also other vague "syndromes" that are classified as CSS conditions. Syndromes are ill-defined conditions that present with multiple signs and symptoms. Some of these other CSS syndromes include chronic fatigue syndrome, chronic pelvic pain syndrome, irritable bowel syndrome, tension headache, restless leg syndrome and posttraumatic stress disorder.
Medical knowledge is still in its infancy in regard to understanding the complexity of our nervous system, particularly in how it interacts with our environment and our experiences. We know how pain is biochemically processed in the nervous system, but have a poor understanding of why people experience pain in different ways.
The most widely held hypothesis for the development of fibromyalgia and other CSS disorders involves this complex relationship between the nervous system and the environment. It appears in most cases that certain ingredients must first exist. These include female sex, genetics, abuse or another adverse experience during brain development in childhood, and persistent stress.
The degree to which fibromyalgia affects a certain patient's ability to function is usually dependent on other psychological factors. These factors have been shown to have a bearing on how pain is perceived and whether or not people will move on to have problems with chronic pain.
High levels of ongoing anxiety and stress, a history of trauma, mood and anxiety disorders, personality traits and disorders, and problems with coping all play a roll in the possibility of moving on to the possibility of developing a chronic pain syndrome.
The diagnosis of fibromyalgia is clinical, which means it's based on the medical history and physical findings. Unfortunately, the signs and symptoms of fibromyalgia are often vague and are also found in many other conditions that are difficult to diagnose, such as the other central sensitivity syndromes mentioned above.
Fibromyalgia is often a diagnosis of exclusion, meaning other, easier to diagnose diseases need to be ruled out first. These can include conditions such as hypothyroidism, lupus, rheumatoid arthritis and polymyalgia rheumatica, among others.
There are some physical findings on examination that can help suggest the diagnosis, but there is no specific blood, radiologic or other test to nail it down.
Treatment of fibromyalgia is often difficult. Since pain is so subjective, doctors have a very tough time understanding what a patient is experiencing as well as being able to objectively monitor response to treatment.
The key to treatment is employing a multifaceted approach utilizing medication, aerobic exercise and psychological and behavioral therapy. It is also essential to treat underlying sleep disorders. There is no quick fix and it can take months or years for some people to find the right combination of medications and therapies to find adequate relief.
There is hope that with ongoing research into the underlying multi-factorial causes of fibromyalgia, that more specific therapies and medications can be developed to help the hundreds of thousands of people who suffer daily from this condition.
Dr. John Roberts practices medicine in Crawfordsville. He also writes a daily medical tip that is published on page A1 of The Paper of Montgomery County.>