by Jenny L. F. Andrus, M.D.
I commonly see patients in my busy Interventional Pain Management Practice who present with widespread pain and other troublesome symptomology. They may have been given an incorrect diagnosis or maybe the physician(s) they have seen have told them that they can find nothing wrong. By the time I see most of these patients, they are often quite frustrated, as they know that the pain they feel is real, but often the other symptoms that accompany their condition are dismissed or not considered to be part of the same pain syndrome. It is my job to act as a detective, to uncover what is really going on and to give patients a definitive diagnosis. In this article, I will attempt to clarify what Fibromyalgia is and isn’t, how it is diagnosed and the most effective treatments for this disorder.
Imagine waking up one morning and finding that your body generally hurts all over. You find that you are stiff and sore when rising from your bed, like you worked out rigorously a couple of days before. The pain might seem to be emanating from joints, muscles, tendons or soft-tissue all over your body. Your muscles might also be in spasms, but strangely, the origin of the pain is vague. There could be certain spots on your body that are tender to the touch, feeling almost like a bruise, where one does not exist. You might feel deeply fatigued from sleeping restlessly and you may have mood swings or difficulty remembering things. Along with the overall pain and soreness you feel, you may also suffer from tension headaches, bladder irritation and Irritable Bowel Syndrome, anxiety, depression or TMJ. This is the complex symptomology of the patient who suffers with Fibromyalgia.
Fibromyalgia affects women much more often than men and is most commonly seen between the ages of 20-50. We are not sure why it develops, but current medical thinking is that it starts after one of the following:
- A traumatic emotional event
- A traumatic physical event
- Injury or illness from a virus
Somehow, this triggering event changes the way that the nerves of the body speak to the brain, amplifying nerve signals that otherwise you would simply ignore. We are not sure if this “miscommunication” happens at the nerve level or if it happens in the brain, where the nerve signal is interpreted. It is this “over-amplification” of everyday nerve signals that causes the widespread musculoskeletal (and often urinary and digestive) discomfort and difficulty getting a restful sleep commonly seen in Fibromyalgia patients. Unfortunately, we have not discovered the switch that will make the nerves of the body or the brain’s receptor cells behave normally again, so we have to treat the symptoms to make the condition more manageable until a cure is discovered.
When a patient presents in my office with the symptoms outlined above, I usually start by ruling out other diseases or conditions that could cause the same symptoms, such as arthritis or other neuropathic disorders. I may order blood work or a urine analysis to rule out other potential causes, although Fibromyalgia cannot be diagnosed by a blood or urine screen. I ask a lot of questions about sleep quality, the presence of headaches, depression or anxiety. I also ask about constipation or diarrhea, or both, which can indicate Irritable Bowel Syndrome, which often goes hand-in-hand with FM. There are definitive signs that I look for, such as tender “trigger” points, which are located through-out the body. If I find that a patient has at least 11 of 18 of these tender points, along with the other symptoms discussed earlier, that is a good indicator that Fibromyalgia may be the cause of the problem.
Once we have decided that Fibromyalgia is diagnosis, there are many things that the patient can do to help manage their symptoms. I recommend that my FM patients keep a pain journal to track their symptoms to see if any patterns emerge. Patients should note when they feel well and when they feel badly, and try to correlate those times with any triggering events. Stress is proven to cause FM flares, so patients should be aware of and try to avoid stressful situations whenever possible. Meditation, massage and the use of relaxation techniques are helpful when treating in the symptoms of FM. Everyone has limits, especially when they do not feel well. I encourage my patients to stick to activities they enjoy and to feel okay saying “No” sometimes.
Although it may seem counterintuitive when treating painful musculoskeletal conditions, a regular, gentle exercise program can work wonders for FM patients. Exercise not only improves muscle tone and cardiovascular health, but it also improves mood, releases stress and relieves the depression that may accompany this disorder. I may recommend a patient visit the OSC Physical Therapy Department, so that they can be taught the correct way to exercise, so that it does not exacerbate their symptoms. Yoga, biking, water aerobics and walking are all excellent exercises for those who suffer with FM and can be done easily, without expensive gym memberships.
Treating Fibromyalgia with medication(s) can be difficult, as many of the remedies that we use for other types of painful conditions may not be helpful. For example, steroids given orally or by injection do very little to relieve the pain of Fibromyalgia, because the pain is not caused by inflammation. OTC anti-inflammatories tend not to work to relieve pain, because the pain is nerve-related. I usually will try to treat the pain with a drug which has been approved for neuropathic pain, such as Lyrica or Savella. I may also use a drug called Cymbalta, which helps to treat depression and works well, in combination with the other medications for neuropathic conditions. I will also work to address sleep issues with the patient and may recommend a non-narcotic sleep aid to induce a more restorative, deeper sleep. For more recalcitrant cases, I might also prescribe muscle relaxants and anti-seizure drugs.
Because every patient is different, there is no “one-size-fits-all” treatment for FM. Through trial and error, most patients find a treatment regimen within which they can live and thrive. Fibromyalgia patients tend to see their symptoms wax and wane over time, meaning that sometimes they will feel pretty good for a while and then they will experience a “flare” where many of their symptoms will be quite pronounced and painful. Although there is no cure for FM, with careful physician oversight and in partnership with the patient, the symptoms of FM can be managed successfully so that patient can lead a full and active life.
To access tools that can help you track your pain or communicate more effectively with your physician, go to the website of the American Chronic Pain Association at www.theacpa.org
Jenny L. F. Andrus, MD is a Fellowship-trained Interventional Pain Management Specialist who practices at Orthopaedic & Spine Center. For more information on Dr. Andrus and the conditions that she treats, call 757-596-1900 for an appointment.