Fibromyalgia is a disorder in which many joints and muscles feel painful, in addition to sleep problems, fatigue, mood disorders and impaired memory. It is thought that this is due to the intensification of pain signals during their processing by the brain, leading to the increased perception of pain.
Symptoms of fibromyalgia typically occur following a physical injury or surgery, an infectious episode or severe mental trauma, but in many cases, it has set in insidiously with no obvious etiological agent to account for it.
Women are at higher risk than men. The manifestations may vary, including temporomandibular joint issues, tension headaches, depression, irritable bowel syndrome, and severe anxiety.
One common symptom is pain on exerting pressure over one or more of the trigger points, of which there are 18 in the body (in the form of nine pairs).
This has not been universally recognized as a medical condition because many health professionals suspect it is a fallback diagnosis when no other condition has been identified, simply as a way to make the patient feel better because the symptoms now have a name and presumably a cause. This is partly because many of these individuals are found to suffer from preexisting mental disorders or to have psychosomatic illnesses or have a history of psychological trauma. In any case this diagnosis should be accompanied by a thorough evaluation of mental status and psychological traumas in childhood.
Fibromyalgia – the anatomy
The muscles of the body are covered and surrounded by a layer of tough connective tissue called the fascia, which not only decides the extent of muscle contraction and expansion but is penetrated by and sheathes the blood vessels and nerves that pass through it to the muscle underneath. Fibromyalgia is associated with an abnormal and persistent increase in muscle tone which results in chronic fascial tension, which in turn presses upon the muscle, the blood vessels and the nerves and strains the tendons as well.
This is thought to be the reason for the start of fibromyositis or chronic muscle inflammation. This is followed, in due course, by calcium deposition inside the muscle and tendon tissue. The eventual outcome is secondary inflammation of the skeletal system. Together, these induce neurotransmitter alterations and fluctuations in their levels, often observed to follow the onset of persistent pain.
Treatment of fibromyalgia
Acetaminophen is used to reduce the pain and stiffness of fibromyalgia, but the results vary from person to person. Other narcotic analgesics with or without over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may be added to the combination as needed.
This, and includes the use of selective serotonin and norepinephrine reuptake inhibitors (SNRIs) for the treatment of the pain and tiredness often associated with fibromyalgia, selective serotonin reuptake inhibitor (SSRIs) to help achieve better sleep, and tricyclic antidepressants.
Some drugs which act on GABA-ergic neurons may help to reduce pain in various conditions by interfering with pain signaling gateways in the neuronal circuits and thus decrease the intensity of symptoms in fibromyalgia.
It is commonly believed that counseling, cognitive behavioral therapy, and other psychotherapies are useful to varying extents in controlling fibromyalgia. Their effect may be mediated via psychological improvement because many individuals have a history of mental distress. Learning how to cope with such past experiences and memories, as well as reduced sensitivity to pain, are some of the significant benefits of such therapy, which has succeeded in ‘curing’ the symptoms in a few cases.
The fascial tension is key to the symptoms of the condition and therefore physical therapy may help significantly to relax the muscles and joints and improve the mobility, which reduces the pain. Some modalities include acupuncture, sports massage and chiropractic joint mobilization. The therapists may be very effective in motivating patients to manage their condition better and to continue physical exercises at home to maintain and increase the degree of symptomatic improvement.
Fibromyalgia is more common in individuals who already have an affected family member.
Rheumatism is a known risk factor for fibromyalgia.
Women have a higher risk than men to develop this disorder, perhaps because of the effect of the female reproductive hormones on pain sensitivity.
Fibromyalgia may follow, or be exacerbated by, some disease conditions.
It has been manifested along with post-traumatic stress disorder in many cases.
Management of mental issues is crucial to achieving symptom relief in fibromyalgia.
Patients with anxiety-related disorders or neurotic symptoms are more likely to develop this condition.
Since vitamin D deficiency is often found to be a common factor in these individuals, low sunlight exposure should be asked for and the vitamin D levels evaluated in such cases.
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