Fibromyalgia is a disease that primarily involves the musculoskeletal system. The main symptoms include pain (generalised), sleep disorders and disturbances in mood and memory. The main problem has been identified to be an abnormally lowered pain threshold. Pain stimuli are greatly amplified by the brain. Precipitating factors include surgery, psychological stress, infections and physical trauma. Fibromyalgia treatment seeks to alleviate these symptoms.
The exact cause of the condition remains unknown. There are a number of risk factors, however, that have been identified through research. Genetic factors are believed to play a significant role. The disorder runs in families and a number of genetic mutations have been found in susceptible individuals. Some infections are also thought to trigger the development of the disorder as do physical and emotional traumatic episodes. Gender is also a risk factor as the disorder is more common in women than men.
If the patients are experiencing only mild symptoms, they may respond to NSAIDS. Ibuprofen, naproxen, paracetamol and diclofenac are all effective in relieving pain. If the symptoms fail to respond to treatment with these drugs, stronger analgesic agents may be used. Opioids such as morphine and meperidine are good choices as are codeine and tramadol. Tramadol should be used cautiously as it may cause side effects such as diarrhoea, fatigue and withdrawal symptoms.
A number of antidepressants are also effective. These antidepressants help in increasing the amount of neurotransmitters in the brain. They include, among others, dopamine, noradrenaline and serotonin. Research shows that low levels of neurotransmitters may play a role in the lowering of the threshold for pain. Increasing their amount, therefore, helps reduce the pain. The commonly used antidepressants include amitriptyline, duloxetine and fluoxetine.
Another group of drugs that acts on the brain to relive symptoms includes the anticonvulsants. These drugs lower the amount of neurotransmitters but have a similar clinical effect to that of antidepressants in spite of opposing mechanisms of action. Pregabalin is one of such drugs. It decreases the amount of glutamate and therefore effectively reduces pain perception. Some of its side effects are weight gain, nausea, vomiting, weight gain, dizziness, blurred vision and constipation.
Apart from pharmacological drugs, there is a role for psychological intervention. Since most of the affected individuals have also been found to suffer from depression, cognitive-behavioural therapy may be used to relive a number of the associated symptoms. Patients are able to diver their attention from negative thoughts that may precipitate the condition and to remain positive. It is also common for drugs to be administered alongside these treatments.
While pain is the main condition, there are many other associated symptoms that have to be treated. Commonly associated symptoms include endometriosis, depression, fatigue, sleep disturbances, anxiety and irritable bowel syndrome among others. Each of these symptoms may require the consult of a specialist who will recommend the most effective form of management.
Patients with fibromyalgia require psychological counselling as they have to live with this condition for a long time. They need to remain positive so that responsive to treatment is improved and their quality of life is also improved. They need to know that while there is no definitive treatment, symptoms may subside with time. An encouraging development in fibromyalgia treatment is the fact that there is hope for better and more effective therapies in future.By Janelle Burnett