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Fibromyagia

Fibromyalgia is a complex multi faceted disorder. It is poorly understood not only by the common people but sadly a vast majority of the medical fraternity are also are pretty oblivious to it’s course, diagnosis and management. Fibromyalgia ,if left untreated for a long time can have a considerably debilitating effect on the quality of one’s life. It was only in 1990 that the American College of Rheumatology defined Fibromyalgia and published their research which has now become the cornerstone in diagnosing Fibromyalgia.
The quartet of Unexplained pain, easy fatigability, frequent mood disturbances and loss of function are the major components in Cornerstone in diagnosing Fibromylagia (FM). There are four main components in FM: Pain, fatigue, mood, and function.

The incidence of FM is seven times more in women than men. Incidence has been seen to be more in women of the childbearing age. More often than not fibromyalgia presents in association with other somatic disturbances like chronic fatigue syndrome, temper mandibular joint dysfunction, Irritable Bowel Syndrome. As of today, a patient centric multidisciplinary approach to tackle fibromyalgia has been the most widely accepted methodology by clinicians all over.

Etiopathogenesis

Clinical Presentation

FM is characterised by widespread pain present all throughout. Bilateral involvement of body parts is seen. Pain also occurs in the axial structures like the cervical spine, thoracic spine, lumbar spine or the chest wall. The following 18 musculoskeletal structures have been identifies as the commonest trigger or tender points in FM. A patient exhibiting tenderness palpation in 11 out these 18 points may strongly favour the diagnosis of fibromyalgia.

Other than tender points the other features of Fibromyalgia are as follows

Diagnosis

The Fibromyalgia Impact Questionnaire is a questionnaire for the patient comprising of 20 questions. This helps to quantify the impact of Fibromyalgia on the patient. Scoring ranges from 0-100 with majority of the FM patients scoring over 50

Treatment

Non Pharmacological Treatment- Living with Fibromyalgia is a big challenge
When compared to some of the other chronic conditions.

Clinicians need to excercise a lot of patience with these patients. One of the key elements to non pharmacological approach is to encourage the patients to become SELF MANAGERS through counselling and training. Patient education is focussed on improving pain, sleep, fatigue and function. Out of the non- pharmacological approaches excercise and psychoeducational approaches have shown be highly beneficial in curbing the symptoms of FM. High intensity aerobic excercises And Aquatherapy are very helpful in some patients.[11,12]] Other tools which might have a positive impact on the quality of life are meditation, stress management and relaxation techniques.

Pharmacological Intervention : TAntidepressants:Tricyclic Antidepressants in low doses of 25-50mg/d have been found to be effective for bringing about improvement of fatigue, sleep, pain and depressive symptoms of fibromyalgia.
Amitryptyline has found itself as the first line drug in the management of fibromyalgia in many practices. It has to be carefully monitored as patients on it will have a tendency towards weight gain and developing tolerance.
Serotonin Noradrenaline Reuptake Inhibitors are also used in treating FM as levels of serotonin and noradrenaline has been found to be lower in certain subgroups.
Duloxetine at 60mg dosage has been tried but with only marginal effects on patients with FM.
Milnacipran which inhibits the reuptake of serotonin and noradrenaline (norepinephrine), has found itself approved in Australia for the treatment of FM. It is generally administered with a dosage of 100 mg which is given daily in divided doses.

Antiepileptic drugs : The neurotransmitters Substance P and glutamate are found in increased levels in patients suffering with Fibromyalgia. These constitute the targets of pregabalin and gabapentin, which help in promoting sleep, alleviating anxiety and modulate pain. Other drugs that are commonly used in the management of fibromyalgia areTramadol, Pramipexole and Memantine. There is weak supporting evidence for use of anti inflammatory medications and hardly any so for paracetamol. Opioid induced hyperalgesia and poor clinical response have put drugs like codeine, fentanyl and oxycodone as contraindications

Intravenous Infusions : Myer’s Cocktail, named after John Myers MD is a well known form of infusion treatment in the medical circles attending to FM. It’s constituents are as follows

Think a cocktail might help you better manage your fibromyalgia symptoms? We’re not talking about a fruity drink with a cherry and an umbrella. Many people who are living with fibromyalgia swear by the Myers cocktail, an intensive vitamin and mineral dose delivered once a week intravenously. Both patients and practitioners report that this infusion – named for John Myers, MD, the Baltimore doctor who first experimented with a vitamin and mineral mix of magnesium, calcium, B vitamins, and vitamin C – helps ease fibromyalgia pain and other symptoms, such as profound fatigue.
According to fibromyalgia researcher David Katz, MD, founding director of the Prevention Research Center at Yale University in Derby, Conn, about 12,000 people across the United States are treated with the Myers cocktail, and about four out of five say the treatment helps ease fibromyalgia symptoms. The treatment is considered to be a form of complementary and alternative medicine (CAM), not traditional treatment, which includes prescribed medications. However, people often are willing to try novel approaches because living with fibromyalgia is often challenging and fibromyalgia symptoms can be so persistent. Myers Cocktail 101

The Myers cocktail contains a variety of nutrients:

Proposed Mechanism of action : Proposed Mechanism of action- Though the exact mechanism of action remains unclear, groups of patients receiving Myer’s Cocktails have experienced reduction in pain and fatigue.B Vitamins are essential for maintaining the health of nerve cells and hence probably stabilisation of the nerve cells by the influx of B Vitamins maybe helpful in reducing the pain. The fatigue of FM has been compared to the fatigue experienced after rigorous excercise, which can build up lactic acid in the oxygen deprived muscles. The Magnesium and Calcium help in dilating the blood vessels so that they can carry more oxygen and help muscles relax.

Lidocaine Infusions : Lidocaine infusions are becoming pretty popular amongst some patients and practitioners alike. Some patients have reported a significant reduction of the symptoms of FM.

Ketamine Infusions : Ketamine works by blocking the NMDA receptors. In doing so, it can reboot the pain receptors which have been altered in patients of FM. In the long term ketamine may also help in decreasing Neuro inflammation which might play a role in neuropathic pain.

At Alleviate

We go for MULTIDISCIPLINARY APPROACH involving pain physicians, physical therapists, clinical nutritionists, clinical psychologists, and pharmacological as well as non-pharmacological interventions for the cornerstone in the management of this complex yet highly debilitating entity.

FAQs - Fibromyagia

Is fibromyalgia a common disease?

Fibromyalgia is the second most common disease that affects bones and muscles.

What are the possible causes of fibromyalgia?

Research and studies show that there is aren’t a particular cause of fibromyalgia. Several reasons cause body pains. But, it is often triggered due to stressful event that includes physical stress or psychological stress.

  • Another possible reason is arthritis or an infection that indicates higher chances of getting fibromyalgia.
  • Trauma, infection, or surgery may also be linked to fibromyalgia in some people.
  • Impairment of the hypothalamic-pituitary axis has also led to fibromyalgia.
Are there any risk factors associated with fibromyalgia?

Fibromyalgia is a chronic disease and is often seems to be a lifelong condition. But the disease will get worsen over time.

What are the fibromyalgia pain points?

Fibromyalgia pain is generally widespread, involving the bilateral movement of body parts involving the neck, shoulders, arms, buttocks, hip bone, knee, and chest wall. Pain can also occur in axial structures such as the cervical spine, thoracic spine, lumbar spine, or chest wall. There are around 18 musculoskeletal structures that have been identified as the tender points in fibromyalgia. A person is diagnosed with fibromyalgia exhibiting 11 out of 18 tender or trigger points.

What are the fibromyalgia symptoms?

Other than tender points, the symptoms associated with fibromyalgia may involve:

  • Fatigue
  • Headaches
  • Joint Pain
  • Headaches
  • Insomnia
  • Restless legs
  • Depression
  • Associated tingling or numbness
  • Nervousness
  • Impaired Memory
  • Jaw Pain
  • Anxiety
  • Fibromyalgia
When can I consult a doctor for diagnosis?

If you are having any of the above symptoms, you need to immediately consult for diagnosis. Your doctor will first ask the questions related to commonly known fibromyalgia symptoms. Treatment will begin once the symptoms of fibromyalgia are determined.

What is the treatment for tender points of fibromyalgia?

Treatments involving fibromyalgia condition may have one or more several options. The non-pharmacological approach is also a part of the treatment procedure to encourage patients that help in reducing pain, have a balanced sleep, reduce insomnia, eliminate fatigue, and improve functional movements.

What is Pharmacological Intervention used for in fibromyalgia?

Pharmacological intervention is the prescribed medication used by doctors to improve fatigue, sleep, pain and assist in withdrawing depressive symptoms of fibromyalgia.

  • Antidepressants - Tricyclic Antidepressants with low doses are prescribed by doctors.
  • Amitryptyline is the first-line drug that helps in many practices of fibromyalgia.
  • Serotonin Noradrenaline Reuptake Inhibitors are also used in treating fibromyalgia.

Dosage of these medications is prescribed after a detailed examination of the patient.

What treatment options do the pain management doctors recommend?

Pain management specialist doctors and physicians recommend the following treatments for fibromyalgia symptoms:

  • Pharmacological Intervention
  • Antiepileptic drugs
  • Intravenous Infusions
  • Proposed Mechanism of action
  • Lidocaine Infusions
  • Ketamine Infusions
What are Antiepileptic medications used for in fibromyalgia?

Antiepileptic medications help in different ways of the patients suffering from fibromyalgia. It aids in promoting sleeping, alleviating anxiety, and modulating pain.

Is Intravenous Infusion helping in fibromyalgia?

Intravenous Infusions or IV therapy constitutes B vitamins, magnesium, vitamin C, hydroxocobalamin, pyridoxine hydrochloride, dexpanthenol, and calcium gluconate, all of these are important for nerves cells and muscles to function. And the treatment is considered to be a form of complementary and alternative medicine.

What is the proposed mechanism of action?

It is the pharmacological term. A Proposed Mechanism of action helps in reducing pain and fatigue. It helps in stabilizing the nerve cells through B Vitamins. Magnesium and Calcium are essentials in dilating the blood vessels that help in muscle relaxation.

What are Lidocaine Infusions used for fibromyalgia?

Many practitioners use Lidocaine infusions for fibromyalgia as it significantly provides relief from pain and reduces other common symptoms of fibromyalgia.

How does Ketamine works for fibromyalgia?

Ketamine is a mechanism that helps in blocking the NMDA receptors and reboots the pain receptor, which is altered in fibromyalgia patients. It also helps in decreasing Neuro inflammation in the longer run.

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