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What is Fibromyalgia (FM or FMS)?
Fibromyalgia is a chronic corporeal disease of muscles , tendons , ligaments and joints.1Pain observed is far-flung and localized over muscle mass of the body , sleeve and legs . pain in the neck is described as allodynia and may not react to pain medications . Fibromyalgia is a common musculoskeletal botheration syndrome associated with few other symptoms such as fatigue , sleep mental disturbance , joint painand stress.2Cognitive symptoms may bedepressionor anxiousness . Tingling , indifference , and weakness in member are other associated symptoms . Joint stiffness , difficulty in swallowing , bowel and vesica abnormalities are occasional symptoms found in 1/3rd of patient role . activity are voluntarily bound since movements can increase the inclemency of pain in the neck . Co - morbid painful sensation condition with feeling of invalidation and isolation among char is one of thecommon symptom of fibromyalgia .
Fibromyalgia is a Holy Writ that comes from Latin and Greek oral communication expressing pain of muscles and fibrous tissue paper ( sinew and ligament ) . Fibromyalgia is press out as disease of fibro- , meaning “ fibrous tissues ” in Greek and Algos means “ pain ” in Grecian language . Fibromyalgia is an established diagnosing of morbid muscularity and central nervous organisation . National Institute of Health and American College of Rheumatology has identified the disease code . It is yet a very hard disease to diagnose and goody . Fibromyalgia is also a symptom normally adopted by drug essay patients .
Epidemiology of Fibromyalgia (FM or FMS)
Common in females between years 20 and 50 . Fibromyalgia is also witness among elderly and untried female patients . Chronic full spread pain is rarely observed in children . diagnosing of fibromyalgia in pediatric patient is often unmanageable to name because of difficulties to get a elaborated history of pain and tender points . In Sweden and Britain 1 % of the population is affected by fibromyalgia .
In the United States , approximately 4 % of the universe has fibromyalgia . Fibromyalgia syndrome ( FMS ) affects approximately 3 million to 8 million Americans .
Fibromyalgia is third most common musculoskeletal disease afterlow back painandosteoarthritis . Prevalence rates of 7.3 % to 12.9 % were watch over in general population across dissimilar state . Prevalence of general population was reported to be up to 15.7 % . Up to 65 % of patients withSystemic Lupus Erythematosusmeet the standard for fibromyalgia . FM is considered a member of the family of working somatic syndrome . A high prevalence of FM was show among relative of patients with FM and it may be attributed to genetic and environmental ingredient . The most late estimate from the United States propose that FM involve about 5 % of all women , In a more late study from Europe , the estimated overall prevalence of FM was 4.7 % for chronic widespread pain , and was 2.9 % when stronger pain and fatigue criteria were simultaneously used . Fibromyalgia is seen more often in females than male , with a ratio of 9:1 by ACR standard . It is most commonly diagnose in individuals between the eld of 20 and 50 , though oncoming can occur in childhood .
Pathophysiology of Fibromyalgia (FM or FMS)
forward-looking studies such as MRI , PET scan of the patients diagnosed of fibromyalgia have shown unnatural structural changes in brain . Research has not concluded if the change observed in wit is lower-ranking to fibromyalgia or fibromyalgia is a disease junior-grade to abnormal morphological change in central nervous system of rules . Some study have conclude puerility stress or prolong knockout strong-arm form may have have a variety in brain and neuroendocrine secretions in central flighty system lead to fibromyalgia .
modification of biological signals at neuro - receptors and within synapsis of spinal cord actuate multiple pain syndromes in trunk and limb muscles . Genetic inquiry has indicated similarities between depressive disorder and fibromyalgia signal chemical imbalance at neurotransmitter stratum . Changes in neurotransmitter and neuroreceptors are triggered by either psychological stress or strong-arm stress . Some study have suggested that people with fibromyalgia may perceive annoyance differently than healthy the great unwashed . Fibromyalgia may involve abnormal neuro - endocrinal activities in the central neural scheme that march pain ( the nociceptive system ) . Einstein scans of fibromyalgia affected role have plant abnormalities in painful sensation processing gist . Researchers have detected up to three times normal level of substance P ( a chemical substance messenger associated with increased pain in the ass percept ) in the cerebrospinal fluid of fibromyalgia patient .
enquiry and clinical study do indicate it is a disease due to abnormal office of neurotransmitter and receptor in central and peripheral nervous systems . Fibromyalgia is a disease , which involves corporal syndrome with a strong psychological and/or emotional component . Research has not conclude if the change observed in brain is subaltern to fibromyalgia or fibromyalgia is a disease secondary to unnatural geomorphological change in primal spooky system . Some study have concluded puerility stress or prolong severe forcible strain may have cause a change in mentality and neuroendocrine secretions in cardinal nervous organization go to fibromyalgia .
Causes and Risk Factors of Fibromyalgia (FM or FMS)
aetiology of fibromyalgia is not clearly described through clinical research or through lab cogitation . Causes of fibromyalgia may be related to biologic , genetic , and environmental factors .
Symptoms and Signs of Fibromyalgia (FM or FMS)
Fibromyalgia has symptoms that resemble symptoms ofautoimmune diseasessuch as creaky arthritis and lupus ( systemic lupus erythematosus ) . Autoimmune disease are diseases in which a defective immune system mistakenly round the body ’s own healthy tissues producing inflammation and legal injury . The pain in the ass in fibromyalgia ; however , does not appear to be due to autoimmune factors , and there is little evidence to hold up a role for an incendiary reception in fibromyalgia .
Symptoms of Fibromyalgia (FM or FMS)
Chronic Pain – Is mild to severe and characterized as allodynia and hyperalgesia . Pain is localized over several muscle and articulation . Joint disease is not find to be a reason of pain in the neck . Pain may be localized in areas such as shoulder , arms , neck , lower back , gluteal areas , second joint and legs . Pain is characterized as shooting , burning and deep ache . Body smart and stiffness are most commonly observed during sunup . For some patients , pain improves during the day and get speculative at dark . Others have pain all day long . bother may get worse with activity , cold or damp weather , anxiety and stress . Pain is felt as somatic and sympathetic pain with nociceptive and neuropathic characters . Neuropathic paintriggers abnormalities in moods such as depression and anxiousness .
Tender Points : Found in the soft tissues and muscular tissue on the back of the neck , shoulder , arms , elbows , forearms , breast , lower back , gluteal surface area , hips , shin and knees . The pain in the neck then spread out out from these area to adjacent anatomic field . Fibromyalgia may be rife in 20 to 30 % of affected role abide withrheumatoid arthritisand systemic lupus erythematosus .
Sleep Problems : Difficulty to fall asleep . Few patients who return benumbed during initial form complain of difficulty to fall deceased if they wake up in the middle of the night . Most of the clip these patients inflame up in two hour . Majority of patients complain that they can not fall asleep or stay asleep and they feel banal when they wake up .
Chronic Fatigue Syndrome ( CFS):Predominantly connect with fatigue and less of painfulness . Fibromyalgia is preponderantly affiliate with stark pain and less of a weariness . Fibromyalgia syndrome ( FMS ) has a pregnant electronegative wallop on day-to-day functioning and caliber of aliveness ( QOL ) . activeness are restricted- Difficulty with climbing stairs ( 62 % of patients ) , walking 2 block ( 55 % ) , and activities of day-to-day life ( 35 % ) .
Comorbid symptom : Irritable Bowel Syndrome ( IBS ) , usable intestine disturbance , genitourinary symptoms and interstitial cystitis .
Cognitive Dysfunction :
Neurological Symptoms – Numbness and tingling in hands and feet .
Cardiac Symptoms – Palpitation .
Headache – Tension or migraine headaches .
Signs of Fibromyalgia (FM or FMS)
Diagnosis of Fibromyalgia (FM or FMS)
Prognosis of Fibromyalgia (FM or FMS)
Treatment of Fibromyalgia (FM or FMS)
Medications for Fibromyalgia (FM or FMS)
1 . Antidepressants - Antidepressants were “ associated with melioration in pain , low , fatigue , sleep disturbances , and health - touch quality of life in affected role with fibromyalgia syndrome ( FMS ) .
” drug that at the same time increase the amount of two brain nerve transmitter , 5-hydroxytryptamine and norepinephrine , have been approved to handle fibromyalgia in adults .
These drug include Elavil , duloxetine ( Cymbalta ) , Prozac , Desyrel ( trazodone ) and milnacipran ( Savella ) .
2 . Antianxiety – Enhances effect of neurotransmitter GABA ( gama - aminobutyric acid ) . GABA receptors are creditworthy for gate dominance of chloride channel . Several GABA receptors and subtype of GABA receptor are name . Benzodiazepam play specific to these GABA receptors . Benzodiazepam is therapeutically effective in regale anxiousness , insomnia , excitement , seizure , muscle spasms andalcohol withdrawal method .
3 . Antiepileptic – Antiepileptics are GABA agonists . chemical mechanism of action as an anodyne is not cognize . Several pharmacological action mechanism were observed such as GABA protagonist , interaction with electromotive force gated calcium TV channel and it stop the formation of new synapses . Gabapentine ( Neurontin ) and pregabalin ( Lyrica ) are very effective in 1/3rd of fibromyalgia and chronic neuropathic pain . Neuropathic pain sensation caused bycancer , HIV , radiation treatment andcomplex regional pain syndromeis treated with Neurontin .
4 . Tramadol – Also known as Ultram , Ultracet , Ryzolt and ConZip in USA , Ralivia in Cananda , is used commonly to regale mild to moderate pain sensation of fibromyalgia , restless leg syndrome and rheumatoid arthritis .
5 . Nonsteroidal Anti - inflammatory drug ( NSAIDs ) – NSAIDSare anti - inflammatory medicine foreshorten as nonsteroidal anti-inflammatory drug . NSAIDs are not in effect in severe pain sensation and non - rabble-rousing origin pain . Fibromyalgia only has a limited value . Most coarse NSAIDs used in fibromyalgia treatment are Celebrex , isobutylphenyl propionic acid ( Motrin , Advil ) and naproxen ( Aleve ) .
6 . Muscle Relaxant – chemical mechanism of natural action of most of the muscle relaxants is debated and unreadable . Muscle relaxants excite locale ceruleus in brainstem that go to increased vent of norepinephrine in spinal corduroy . Norepinephrine inhibit alpha motor neuron leads to relief of muscle spasm in skeletal muscles . Muscle relaxant blocks re-uptake of norepinephrine . It is structurally related to to tricyclic antidepressant drug such as an amitriptyline . Muscle relaxants used to treat fibromyalgia are Flexeril , Soma and Skelaxin .
7 . Dopamine Antagonist – Dopamine resister like pramipexole ( Mirapex ) , ropinirole ( Requip ) are effective in care for selected case of fibromyalgia .
8 . Opioids – Opioids are considered only after all other medicative and unmedicinal therapies have been play out . There is no evidence thatopioids are of any benefit in fibromyalgia . Opioids are not advocate as they can exasperate and heighten mood disorder . Opioid may have serious side effects like abuse and dependence .
9 . Naltrexone – Naltrexone at very low dose has been found to be good in reducing fibromyalgia symptoms by more than 30 pct in a belittled controlled run .
10 . Quercetin – Quercetin is a flavanoid pharmacological participating anti - inflammatory born compound . It is in effect in fibromyalgia since it inhibits ignition and mast cells . It is not approved by DEA ( Drug enforcement agency ) . There is nonscientific paper published of therapeutic use of quercetin and evidence pain relief in fibromyalgia patients .
11 . Guaifenesin – Also eff as Robitussin , Fenesin , Organidin and Humibid is usually used as coughing appetite suppressant . remove unreasonable phosphate from the body and thus is effectual in the treatment of fibromyalgia .
FDA does not approve Guaifensin for fibromyalgia treatment .
Massage Therapy For Fibromyalgia (FM or FMS)
Massage helps to improve blood provision to brawn as well as relieves musculus spasms . Target tissue may include muscularity , tendons , ligaments , fascia , skin , stick , and connective tissues . Massage can be applied with the hands , fingers , elbows , knees , forearm , and base .
Interventional Pain Treatment for Fibromyalgia (FM or FMS)
Trigger Point Cortisone Injection : Cortisone injectant is beneficial in treating fibromyalgia only when pain is extremely life-threatening and is associate with terrible muscleman cramp which is localized over 2 or 4 cutter spots . Wide spread muscle infliction over 5 to 6 tender detail or more of adequate intensity may not reply to trigger point injections .
Cortone Acetate injection has limited economic value in treating fibromyalgia except to relieve terrible pain , which may want hospitalization and I.V. opioid therapy .
Alternative Treatment for Fibromyalgia (FM or FMS)
Biofeedback - Biofeedback is the method acting of discussion used by physical therapist and psychologist . Biofeedback involve instruction of physiologic method to command certain involuntary bodily outgrowth such as heart pace , bloodline insistency , muscle tautness and skin temperature . Information ’s are varan and feedback to patients . Patients are instruct to cook the recital of these instruments by using involuntary physiological nous to body control .
It is a modified stylostixis . Electrical current is passed between acupuncture needles . It is unlike than percutaneous electrical stimulation since the acupuncture needle is put over stylostixis points . There is no scientific grounds hint it is useful in treating fibromyalgia .
stretch is a group utilization or item-by-item exercising . Group of muscleman are deliberately stretched out by lengthiness or flexion of juncture . After initial stretch use for few weeks , hyperextension , flexion , abduction and adduction of these muscle are accomplish by joint motion . Goal is to increase flexibleness . Yoga is an good example of healing stretching . swim and aquatic physical exertion are also good if water temperature is not too stale or warm . Patients with symptom of fibromyalgia do not tolerate cold water . quick water system can cause tiredness sooner . Tai chi was canvass in a small single blinded randomized curb run , lead in a relative benefit ratio of 2.0 on the Fibromyalgia Impact Questionnaire .
Principle of treatment is to practice static charismatic field created by placement of attractor over sure part of body inducing pain to treat inveterate pain . Magnet improves rake flowing in underlying tissue . magnetized field is limited in feast and thus does not cause any long - condition harm to haemoglobin or any other blood mental object .
Fibromyalgia pain may not respond to conventional treatment . Non - responding disease to formal medication may reply by changing day-after-day habits of feeding , ease , and stress .
Combination Therapy for Fibromyalgia (FM or FMS)
Fibromyalgia is a wide spread pain syndrome . There are no magic pill available to break pain . Treatment options are multiple as discussed earlier . compounding of some of these intervention modalities may assist to decrease bother and sufferings . Treatment software would include medicinal drug and non - pharmacologic adjuvant treatment . Most of the institution and expert in treating fibromyalgia advise multi - discourse combination . There is no research supporting multimodal treatment being helpful in control or belittle symptom of fibromyalgia . Most common combination of discourse is medications , physical therapy and cognitive behavior discussion . Each patient may have combination of pain and muscle spasm with unlike cognitive symptom . Thus , combining of treatment can not be “ one for all ” ; each affected role is evaluate and considered for dissimilar combination of treatment .
Tests to Diagnose Fibromyalgia (FM or FMS)
Investigations for Fibromyalgia (FM or FMS)
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