» How Can My Doctor Help Me With Fibromyalgia?
How Can My Doctor Help Me With Fibromyalgia?

Are you having constant muscle aches and joint pain? Perhaps headaches on top of that or trouble sleeping? Not sure why you can't sleep at night? You may have a condition called fibromyalgia or fibromyalgia syndrome (FMS). How can you find out?

The October 2010 supplemental issue of The Journal of Musculoskeletal Medicine is all about Fibromyalgia. The authors of the first article tell us that your primary care physician is the best place to start. Physicians understand the basic science behind fibromyalgia and know how to create a plan of care that's just right for you.

Fibromyalgia isn't really a disease. It's a group of symptoms that tend to occur together either at the same time or in close proximity to one another. You may experience tension headaches that seem to come and go even when you aren't stressed. Sometimes there's joint pain that travels from one joint to the next. Or you feel like a truck ran over you every morning when you wake up.

Scientists haven't been able to unlock all of the secrets behind fibromyalgia syndrome (FMS). Right now, the main theory is that FMS occurs when something goes hay wire in the nervous system. That something may be what's called central sensitization syndrome. It means your nervous system is ramped up to react too soon, too often, and for too long. Pain signals are sent when ordinary sensations of light (or other pleasurable) touch occurs.

Your doctor can sort out all the symptoms, select the best tests, and rule out other reasons for your physical distress. Physicians are trained to take a good patient history and interview patients about psychosocial stressors. It turns out that psychologic, emotional, and social stresses are linked with a higher rate of FMS in the general population.

The information gleaned from the medical intake examination will help your physician identify any risk factors you may have for fibromyalgia syndrome. Some of the more common risk factors include traumatic injury, heavy lifting or pulling, and mood disorders. Anxiety, depression, and post-traumatic stress disorder also seem to be linked with FMS. Having a bipolar illness increases the risk of developing fibromyalgia syndrome (FMS) dramatically.

What causes this condition to develop? Sometimes FMS occurs as a result of some other medical condition. For example, patients with rheumatoid arthritis (an inflammatory disease), metabolic dysfunction (e.g., thyroid problems), or cancer often develop a type of FMS referred to as reactive fibromyalgia. It's important to identify whether or not the FMS is primary (the main problem) or secondary (caused by other problems).

Folks who have fibromyalgia syndrome (FMS) often have certain triggers that seem to bring on (or increase) symptoms. The triggers vary from person to person but may include degenerative (spinal) disc disease, headaches (all kinds), irritable bowel syndrome, reflux (heart burn), trigger points of the muscles, and poor posture.

What can the physician do to treat your fibromyalgia? Getting a good and accurate diagnosis is half the battle. A good physician who is thorough and knowledgeable in his or her interview and examination skills is worth their weight in gold.

Early recognition, diagnosis, and treatment can provide a faster resolution of symptoms and much improved prognosis. In fact, half of all adults diagnosed with fibromyalgia early in the development of their disease (and who are adequately treated) no longer have this problem two years later.
There are different modalities (tools) that can be used to gain control of the main symptoms. Physical Therapy, exercise, nutrition, trigger point injection, and medications form the core program used for this condition. Exercise is getting a lot of support right now because of the wide range of evidence showing that any form of exercise but especially isometrics can be helpful.

The Physical Therapist will prescribe the optimal mode (type), frequency, intensity, and duration of exercise for each patient on an individual basis. There isn't a one-size-fits-all type of program because of the wide range of physical abilities and disabilities among adults with this condition.

Pilates-based stretching, yoga, and low-impact aerobic exercise have the greatest benefit. Anyone with fibromyalgia syndrome (FMS) must be very careful when trying weight-lifting, rowing, or jogging. In fact, these are not really recommended during painful flare-ups. Many people with FMS don't have any real trouble during exercise. It's the painful joint and muscle "after shock" that is the worst. Some can barely get out of bed the next day after what seems like a mildly strenuous work out.
Sometimes several medications are combined to get the most relief of symptoms with the fewest adverse effects. Some medications address the pain or sleep issues, while others deal with the anxiety, depression or other psychologic disorders.

It is expected that treatment will continue to improve as scientists make new discoveries about fibromyalgia syndrome (FMS), its causes, triggers, and responses to different therapies. This article highlights five key areas of understanding right now including fibromyalgia as a primary vs. secondary problem, the role of psychosocial stressors, pain patterns associated with FMS, type of exercise best suited to this problem, and type of medications to prescribe.

Reference: David S. Hallegua, MD, and Daniel J. Wallace, MD. Fighting Fibromyalgia: Five Key Issues. In The Journal of Musculoskeletal Medicine. October 2010. Supplement. Pp. S3-S9.