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What is fibromyalgia?

It is safe to state that pain falls into two broad categories: the kind you can articulate, and pain that is beyond words. All these years, you might have felt like a swan, elegantly gliding above the water, but paddling frantically beneath the surface to avoid sinking. You have, for some time, suffered with persistent widespread muscle pain and other symptoms, such as depression and anxiety. In addition, you might have encountered headaches, memory problems and dizziness. As Winston Churchill once complained, the future would have seemed like one damn thing after another. You can still swim and put on a good show, so that your friends and family do not notice how much is wrong. Have you ever felt that the struggle is getting to the point where you feel too exhausted to keep going? Well, you are not alone. Millions of Indians suffer from fibromyalgia. In fact, many have lived with pain for years before we have found fibromyalgia as the cause for their symptoms. It affects 1-2% of adults, with women accounting for 80-90 percent of sufferers.

What causes fibromyalgia?

You have probably wondered why this has happened to you. There are likely to be many factors involved. Recent research suggests that fibromyalgia is triggered by an injury to the central nervous system. The problem lies not in the peripheral muscles and joints where the pain is felt but in the spinal cord and the brain, where the message of pain is modulated, received and interpreted.

Researchers think it may be due, in part, to injury, emotional distress, infections or illnesses that change the way the brain perceives pain. Whether the damage arises from a single episode or cumulative events is unclear. This results in increased sensitivity of your nervous system to non-painful signals. For example, what could be touch for a person without fibromyalgia might be perceived as pain by the fibromyalgia sufferer. Other factors that may play a role include:

• A family history of fibromyalgia.
• Abnormal production of pain-related chemicals in the nervous system.
• Prolonged stress or sleep deprivation.
• Childhood stressors – physical, emotional & sexual abuse.

How is fibromyalgia diagnosed at Atlas Pain Care, Coimbatore?

Though you might suffer from significant pain and disability, the blood tests and X-rays and scans are usually normal. The pain of fibromyalgia is, however, real. The suffering is real, and recent research has suggested that there are very real changes in the brains of people with fibromyalgia.

To diagnose, we first rule out other possible causes for the symptoms – for example, rheumatoid arthritis, bursitis or tendonitis – by performing a complete medical history and physical examination. The diagnosis is made by eliciting pain on deep pressure in at least 11 out of the 18 paired distinct painful points described by the American College of Rheumatology. Diagnosis therefore is based on the presence of ongoing musculoskeletal pain for at least 3 months and the clinical determination of what we call “tender points”.

Why is early diagnosis important?

India, for that matter any society, affirms people for ‘doing’, for outcomes, for achievements. There is little affirmation for those who ‘cannot do’. The pain of fibromyalgia can make it hard to work, keep up with relationships and participate in hobbies and social activities. The earlier it is diagnosed and treated, the earlier you can reclaim your life. Any lengthy delay can be detrimental to recovery because living with fibromyalgia, without addressing it, only leads to increased levels of stress, pain, and frustration.

More doctors are now aware of this condition, which means that it could be addressed sooner. Fortunately, there is also a growing list of treatment options that may be of help. The trick is to articulate your symptoms clearly. Tell it like it really is. Talk openly with your doctor about other health problems you may have, as well as how the pain interferes with your daily life. This will help you work together to find the best treatment plan.

What can people living with fibromyalgia do to feel better?

Fibromyalgia is managed by a multi-disciplinary team of experts at Atlas Pain Care, Coimbatore, using a variety of drug and non-drug treatments including physiotherapy, occupational therapy, coping techniques, improved sleep hygiene, work place modification, acupuncture and meditation. With this approach, you stand to gain considerable relief and can look forward to a near normal lifestyle.

Medication:

There are now approved treatments for fibromyalgia. You should talk with your doctor to determine the best way to manage your fibromyalgia. Medications are just one of a number of therapeutic tools available.

Exercise:

Your best may not be enough to cure all ills, solve all problems or heal all hurts, but your best is the most that you have to offer. Although pain and fatigue may make exercise and daily activities difficult, it is important to stay as physically active as possible. Research shows that gentle exercise and flexibility can help reduce pain. Take small steps at first and gradually build up to an exercise program that you can do.

Sleep & Nutrition:

A good night’s sleep can help ease pain and fatigue. Many people with fibromyalgia struggle with sleep disorders that interfere with restful sleep. A pain programme such as Axon’s could recommend helpful sleep habits. Eating well is central to good health. Having a balanced diet means eating plenty of fruits, vegetables and healthy proteins; avoiding snacks with lots of sugar; and drinking plenty of fluids.

Cognitive-Behavioural treatments:

Each episode of crisis brings one back to square one; it is not possible to plan ahead, or sometimes it is not possible to know how one is going to get through the day. While you wait for a cure, you can build on your strengths. A good pain management programme helps to focus on what you could do rather than what you could not.

Humans are meaning makers; part of the spiritual dimension is the search for meaning. To an extent, in an Indian context, this search is influenced by the ability of the person to find symbols and ritual that connect them with their source of meaning, for example, through worship. This religious coping strategy helps, and so does pursuing your hobby.

Relaxation techniques, coping strategies, mindfulness meditation are all strategies offered by better pain management programmes in the country.

Work environment:

When your desire is to work, certain changes have to be made for you to function effectively. The unpredictable nature of pain and the stress it can evoke are constant challenges, but there are steps employers can take to make it easier. These may include:

Modifying the workspace (for example, ergonomic keyboard, chair)Planning periodic breaks during the day. Incorporating pain management strategies to corporate wellness programmes. Moving employees to different, less physical or repetitive jobs within company, and flexible work schedules.

A good occupational therapist, specializing in pain management, could help you with these.

Complementary medicine:

Meditation is a known stress-reliever and can help. Massage may help as well. Tai Chi, acupuncture and chiropractic treatment also may help relieve symptoms. The trick is finding what works for you in a meaningful way and for longer periods.

Where can I find support?

Talking with trusted friends and family members and asking for help when you need it is important. Those who are closely acquainted with the person in pain can make the most-subtle judgments with certainty. Even when you feel overwhelmed or isolated, try to stay connected with loved ones, you’ll be less likely to experience depression or feel alone in your journey. Talking to other fibromyalgia sufferers, and accessing information from Internet forums on fibromyalgia, may help you to learn to cope.