FIBROMYALGIA 

What is Fibromyalgia ? 

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Fibronyalgia or sometimes called fibromyalgia syndrome (FMS) is a disorder with generalised body ache, weakness commonly affecting  wemen. It usually affects 2-4% of the population.

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What are the symptoms of Fibromyalgia ?

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Fibromyalgia is characterized by widespread muscle pain, presence of trigger/tender points at musculo-tendinous junctions, sleep disturbance, un-refreshed awakening, memory disturbance  with other symptoms exists like; fatigue, anxiety & depression, morning stiffness, leg cramps, paraesthesias, numbness, headaches etc. FMS may be associated with thyroid disorders,  rheumatoid arthritis (RA) and SLE. 
 

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How Fibromyalgia is diagnosed?

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Diagnosis of fibromyalgia is mostly clinical. There is no simple test to diagnosed Fibromyalgia. Some blood tests are recommended to rule out other disorders. Now a days a clinical tool is used to diagnose fibromyalgia. It has three parts. Part - 1 The body pain is mapped to 1- 19 areas of the body. Part 2 where main assessment is done on fatigability , un-refreshed awakening , memory disturbance and the somatic symptoms. Part 3 - there are some recommended blood tests to exclude the presence of other  diseases, they needs to be done. 

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What are the blood tests required for the screening of fibromyalgia ? 

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The recommended blood tests for fibromyalgia are complete blood count (CBC), erythrocyte sedimentation rate (ESR) ,C-Reactive Protein (CRP), Creatine phosphokinase (CPK) , Liver function tests (LFT) and Thyroid Function Tests. These tests sometimes may vary depending on patients condition. 

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Why Fibromyalgia occurs ? 

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The exact mechanism behind the fibromyalgia is not yet clear. But it is usually assumed the origin is multi-factorial. The mechanism that may lead to such condition are  trauma, raised substance P level in brain fluid (Substance P in CSF is 3 times higher in FMS), Low serotonin levels in platelets & CNS, low levels of ATP in RBC and trigger points, dysfunction of the The hypothalamic pituitary adrenal (HPA) axis, low growth hormone, increased levels of nerve growth factor (4 times higher) in CSF, Strong familial pattern, sex  (females more affected) and non-restorative deep sleep.  

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Is there any permanent cure of fibromyalgia ?

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Unfortunately there is no permanent cure of the disease. 

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What is the treatment for Fibromyalgia? 

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Though the disease cannot be cured permanently there are certain medications to control the disease.  The FDA approved medications for fibromyalgia are for Pregabalin , Duloxetine and Milnacipran. these drugs are usually used alone or with combinations, other drugs like amitriptyline, nortriptyline , gabapentin, simple analgesics like paracetamol, weak opioids like Tramadol and sometimes steroids for short duration may be given according to patients requirement. 

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How long the medications for Fibromyalgia needs to be continued? 

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Medications usually needs to be continued for years, follow up is usually recommended in every 3 months. 

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What is the treatment of fibromyalgia in adults who are not responsive to initial therapies ? 

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