Fibromyalgia

Patient often complains about their musculoskeletal pain accompanied by fatigue, sleep disturbance, memory loss and also mood issues, this is called fibromyalgia. The etiology of fibromyalgia remains unknown, but recently many researchers believe that fibromyalgia amplifies painful sensations by affecting the way of brain and spinal cord process.

Fibromyalgia is not a progressive disease. It also does not cause damage to joints, muscle or organs.

Symptoms:

1. Sleep disturbance.
2. Morning stiffness.
3. Pain and tender points.
4. Swelling.
5. Numbness and tingling sensation in the hands, arms, feet and legs.
6. Daytime fatigue.
7. Restless leg syndrome.
8. Cognitive problems (Fibro fog).
9. Depression and anxiety.
10. Headache.
11. Jaw and facial pain.
12. Digestive issues.
13. Painful menstrual cramps.
14. Irritable bowel syndrome.
15. Problems with urination.
16. Sensitivity to touch.
17. Pelvic floor dysfunction.
18. Widespread pain (Feels like it affects muscles rather than joints).

Cause:

Factors that lead to these changes are given below-

• Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
• Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
• Physical or emotional events. Fibromyalgia can sometimes be triggered by a physical event, such as a car accident. Prolonged psychological stress may also trigger the condition.

Risk factors:

• Your sex: Fibromyalgia is diagnosed more often in women than in men.
• Family history: You may be more likely to develop fibromyalgia if a parent or sibling also has the condition.
• Other disorders: If you have osteoarthritis, rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.

Investigation:

• Complete blood count
• Erythrocyte sedimentation rate
• Cyclic citrullinated peptide test
• Rheumatoid factor
• Thyroid function tests
• Anti-nuclear antibody
• Celiac serology
• Vitamin D

Treatment

In general, treatments for fibromyalgia include both medication and self-care strategies. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms, but trying a variety of treatment strategies can have a cumulative effect.

Medications

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

• Pain relievers: Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Opioid medications are not recommended, because they can lead to significant side effects and dependence and will worsen the pain over time.
• Antidepressants: Duloxetine (Cymbalta) and may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep.
• Anti-seizure drugs: Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms.

Physiotherapy treatment:

A variety of different treatment can help to reduce the effect of fibromyalgia. Such as:

• Physical therapy: Basically in this condition a physiotherapist should do symptomatic treatment for the patient. Also a physical therapist can teach the patient some exercises that will improve his/her strength, flexibility and stamina.
• Hydrotherapy: Hydrotherapy might be particularly helpful for this kind of patients.
• Occupational therapy: An occupational therapist can help the patient to make adjustments to work area or the way to perform certain tasks that will cause less stress on patient’s body.
• Counseling: Talking with a counselor can help to strengthen belief in patient’s abilities and teach him strategies for dealing with stressful situations.

Electrical therapies:

1. UST– It is a sound wave which passes through in deep tissues and also makes a resonance that increase blood circulation and release pain.
2. TENS– Electromagnetic wave that helps to reduce pain.
3. HIL– Helps in deep penetration and reduce pain.
4. ESWT– In case of chronic condition ESWT helps to create micro trauma and also helps in automatic healing.

Complications:

The pain, fatigue and poor sleep quality associated with fibromyalgia can interfere with your ability to function at home or on the job. The frustration of dealing with an often-misunderstood condition also can result in depression and health-related anxiety.

Physiotherapy Treatments

Patient must concern with a physiotherapist for better solution. A physiotherapist will apply two types of treatments. They are:

Manual: 

1: Activity modification: A physiotherapist will find out the improper techniques for which he/she suffers from the disease. Also the physiotherapist will correct his/her functional techniques.

2: Postural education: Bad posture is one of main cause for cervical pain. A physiotherapist will help the patient to maintain good posture and control pain.

3: Soft tissue mobilization: Soft tissue mobilization is important for releasing trigger points from cervical muscles.

4: Range of motion improving exercises: After checking ROM of the affected region physiotherapist will improve the condition of restricted motion.

5: Cervical mobilization: Mobilization and manipulation in combination with exercises are effective for pain reduction and improvement in daily functioning in sub-acute or chronic mechanical neck pain with or without headache.

6: Stretching exercises: Patient should keep his/her body straight. Push chin forward in a way that stretches the throat. Softly tense the neck muscles. Hold this for 5 seconds and back to the neutral position. Repeat it for 5 times.

7: Forearm traction: For cervical forearm traction patient should be in supine lying and the physiotherapist should stand by the side of patient’s head. The position of patient and physiotherapist also make 90 degree angle. Than physiotherapist place his/her forearm below patient’s neck and make exercise from supination to pronation.

8: Home advice: A physiotherapist also advice the patient to do some home exercises- such as: cervical extension, side to side rotation, deep cervical flexor strengthening, scapular stretching and strengthening etc.

Electrical: 

1. UST– It is a sound wave which passes through in deep tissues and also makes a resonance that increase blood circulation and release pain.
2. TENS– Electromagnetic wave that helps to reduce pain.
3. HIL– Helps in deep penetration and reduce pain.
4. ESWT– In case of chronic condition ESWT helps to create micro trauma and also helps in automatic healing.