Fibromyalgia is a condition of unexplained musculoskeletal pain. This problem has interested researchers since a long time. Pain occurring at various sites in the body and hardening of muscles occurs, without specific medical cause. It is induced by mental stress.

This is a condition seen in young adults affecting more women than men.

There is no known specific underlying cause for fibromyalgia. Despite extensive investigations no structural, inflammatory, metabolic or endocrine abnormality has been found in the muscles. Mental stress has been known to precipitate fibromyalgia. A hereditary predisposition is postulated though clear evidence for it is lacking. Sleep disturbances are always associated with fibromyalgia. The affected persons find it difficult to sleep well. Either they do not get sleep at all, or it is disturbed. There is also sense of fatigue. Some persons suffering from fibromyalgia have associated depression and irritable bowel syndrome.

The levels of serotonin are found to be reduced in the brain in cases of fibromyalgia. This causes reduced tolerance and perception to pain. At the slightest touch they feel pain on the affected site. There may be associated morning stiffness of affected part. Mental tension is a strong precipitating factor for causing fibromyalgia. Divorce, marital discord, work place tensions poverty, alcoholism e.t.c. are life events that are seen to be associated with this condition.

Pain can occur at one or multiple sites and is often associated with slight pain on touching the site. Common sites for pain are upper back, chest, elbow, e.t.c.

It is essential to diagnose fibromyalgia for its proper management. Diagnosis is made by excluding other causes of musculoskeletal pain. Since the clinical examination and tests are often normal, these patients are often labeled as hypochondriacs. This approach is not correct. This is a specific condition. As pain killers have no response they should be best avoided, especially if no response is seen in one or two weeks. Physiotherapy is known to aggravate the symptoms and therefore should be avoided.

Informing the patient regarding the nature of the problem and counseling her/him is very useful. Discussion about the personal life of the affected person, her problems and anxieties is also very helpful. Sometimes just unburdening one’s mind to a stranger is useful and helps in improvement of pain.

The patient should be taught, "self help” techniques. Relaxation techniques for the mind and body, keeping the mind cool at all times and trying to cope up with the personal problems would certainly help the person.

Programmed exercise is very beneficial for such individuals. Exercises like aerobics, yoga, e.t.c. provide physical exercise as well as mental relaxation. As such the person is reluctant to take up any exercise due to the pain and fatigue. But he should be encouraged to start doing any one exercise and increase it gradually. This will help overcome fatigue and also reduce pain.

Patient should be encouraged to build up a sleep schedule. That is trying to sleep and wake up at fixed times so that body clock gets habituated to it.

Sleeping pills to induce sleep may be used for few days but long term use should be avoided as there is risk of habituation and addiction. Low doses of antidepressants and tranquilizers help to overcome severe symptoms.

Though no anemia or malnutrition is present in these cases but improving nutritional status does improve the sense of well being and helps the individual to cope with the problems.

Fibromyalgia should be kept in mind whenever a person specially a woman has persistent ache at one or multiple sites in body, not explained by a definite cause and not responding to medical therapy. It is a problem caused by mental problems. Good counseling, mental relaxation and antidepressant medicines are helpful in the management.

Dr Rachna Pande,

Specialist, internal medicine

rachna212002@yahoo.co.uk