Fibromyalgia diagnosis & treatment in Bhubaneswar

• Usually there is a decreased pain threshold, and the patient will have a pain sensation to mild touch or pressure which is usually not painful in a normal person.
• This may be associated with decreased sleep, memory disturbance or depression.
• It is most common in females and usually starts in middle adulthood.
• Sometimes it may be associated with other rheumatic conditions like rheumatoid arthritis, lupus, ankylosing spondylitis etc.

• Pain all over the body
• Muscle or skin soreness
• Severe fatigue
• Decreased sleep, or waking up unrefreshed
• Memory disturbance or difficulty thinking clearly

Some associated symptoms may include

• Depression or anxiety
• Migraine or tension headaches
• Digestive problems
• Irritable or overactive bladder
• Pelvic pain
• Face or jaw pain, jaw clicking, and ringing in the ears

It is still considered a benign disease, as it does not cause any major physical illnesses like heart attacks, stroke, cancer, deformities, or loss of life.

• The exact cause of fibromyalgia is not known — it is multifactorial and varies from patient to patient.
• This is not an autoimmune disease or an inflammatory arthritis.
• Fibromyalgia may be seen in families because of certain genes, but genes alone cannot cause fibromyalgia.
• There are many factors that trigger fibromyalgia. It may be spine problems, long-term arthritis, injury, or other types of physical or emotional stress.
• This results in a change in the way the body “talks” with the spinal cord and brain, affecting the levels of brain chemicals and proteins that generate pain.
• More recently, this has been described as a Central Pain Amplification disorder — in other words, the pain threshold goes down.

A multimodal approach

Fibromyalgia cannot be treated by only giving drugs. It is treated by a multimodal approach where medicines have to be combined with non-medical therapy.

Non-drug therapies

• Cognitive behavioural therapy (CBT) or mindfulness exercise is a type of therapy focused on understanding how thoughts and behaviours affect pain and other symptoms. It is usually done by a clinical psychologist.
• Patients benefit most from regular aerobic exercises. Other body-based therapies, including Tai Chi and yoga, can ease fibromyalgia symptoms.
• Address risk factors like sleep disorders, such as sleep apnea, and mood problems such as stress, anxiety, panic disorder and depression.
• Other complementary and alternative therapies (CAM or integrative medicine) include acupuncture, chiropractic and massage therapy. Although they can be tried, their role is doubtful.

Medications

The USFDA has approved 3 drugs for the treatment of fibromyalgia, which include duloxetine, milnacipran and pregabalin. The first two drugs alter the brain chemicals (serotonin and norepinephrine) that help control pain levels. Pregabalin works by blocking the overactivity of nerve cells involved in pain transmission.

Regular painkillers like opioids and NSAIDs are usually not effective, and they can be avoided.

Consultations with the OARC rheumatology team run Monday to Saturday, 9:00 AM–2:00 PM and 4:30–9:00 PM. Call +91 93386 53086 or book online.

• Fibromyalgia is considered a benign disease — it does not cause major physical illnesses like heart attacks, stroke, cancer, deformities, or loss of life.
• Though there is no cure, medications can reduce symptoms in some patients.
• With proper multimodal treatment — combining medicines with therapy, exercise and sleep hygiene — a fibromyalgia patient can lead a normal life.

Questions to ask your doctor

• Is my pain fibromyalgia, or could another arthritis explain it?
• Would cognitive behavioural therapy with a clinical psychologist help me?
• What kind of exercise should I start with, and how often?
• Should duloxetine, milnacipran or pregabalin be part of my treatment?
• How do we address my sleep problems and mood symptoms?