Fibro means (fibrous tissue) myo(muscle) and algos(pain) meaning muscle and connective tissue pain. It is a medical condition characterized by pain and allodynia(painful response to pressure). In other words it is a common syndrome in which a person has a long term, body pain and tenderness in joints, muscles and soft tissues. It is more common in females. Fibromyalgia has been considered either a musculoskeletal disease or neuropsychiatric condition.
Causes of fibromyalgia
According theory of fibromyalgia, patients have lower threshold of pain because of increased sensitivity in the brain to pain signals. main causes which are responsible are as under
1) genetic predisposition
3) dopamine dysfunction.
4) abnormal serotonin metabolism
5) sleep disturbances
6) infection with virus
7) physical or emotional trauma
Genetic factors play an important role in the development of fibromyalgia. For example there is a high aggregation of fibromyalgia in females.
Stress may be precipitating factor in the development of fibromyalgia. Sometime dopamine dysfunction may cause fibromyalgia, this is due to the disruption of normal dopamine-related neurotransmission.
Signs and symptoms of fibromyalgia
The universal symptom of fibromyalgia is pain, the pain in fibromyalgia is not caused by tissue inflammation instead seem to have increased sensitivity to different sensory stimuli and low pain threshold. Body pain of fibromyalgia can be aggravated by noise, weather change and emotional stress.
Pain involves both sides of the body. It usually affects neck, buttocks, shoulder, arms, upper back and chest. Tender points are the localized areas of body that are tender(cause pain) to light touch. Tender points are commonly found around elbows, shoulder, knees, hips, back of head and side of breast bone.
Fatigue occur in 90% of cases. Fatigue is mainly due to abnormal sleep. These patients lack deep restorative level of sleep. These patients awaken in morning without feeling fully rested, sometime awake with muscle aches or sensation of muscle fatigue as if they had been working out all night.
Mental disorders occur. It include poor concentration, forgetfullness (difficulty in remembering things), mood changes, irritability, depression and anxiety.
Other symptoms include migraine(condition characterized by moderate to severe headache and nausea), tension headache, numbness, tingling, abnormal pain, Painful and frequent urination.
Treatment of fibromyalgia
Pregabalin, duloxeline and milnacipran have been shown to reduce pain. Tricyclic antidepressants were most affective against pain, fatigue and sleep problems. Selective serotonin reuptake inhibitors had lower side effects. Tramadol, centrally acting analgesics moderately affective in treating pain. Tramadol combined with paracetamol is also effective to some extent.
Muscle relaxants such as cyclobenzaprine plays an important role as it helps to relieve skeletal muscle spasm and has been used for fibromyalgia treatment.
Tizanidine is used to treat spasm, cramping and tightness of muscles.
Physiotherapy treatment for fibromyalgia
Exercise improves fitness and sleep and may reduce pain and fatigue. It helps in
a) reducing pain
b) reducing muscle stiffness
c) reducing tender points
manual treatment is used to increase range of motion and decrease pain and swelling. Tissue massage along with stretching exercise are commonly used
physical treatment helps to increase muscle and joint flexibility while decreasing swelling and encouraging wounds to heal. It includes use of whirlpool/hydrotherapy or use of deep heating with hot packs/paraffin waxing.
Electrotherapy techniques help to encourage healing and decrease pain and muscle spasm.
Biofeedback and muscle stimulation is helpful to some extent.