Feb 15, 2009

HEALTH: A tissue, a tissue, we all fall down

There is no cure for fibromyalgia, a condition generally mistaken for arthritis, but there are things you can do to manage it, writes Shamama Shabbir
Fibromyalgia is a condition characterised by widespread pain in the muscles, ligaments and tendons, generally mistaken for arthritis. Ligaments and tendons are the tissues that connect muscles to bones; in fibromyalgia the tendons and ligaments, or fibrous tissues (fibro-), and the muscles (-my-) become painful (-algia) and tender and this condition affects the whole body Although fibromyalgia is a relatively recent term, this syndrome has been known by several other names over the past years, including soft tissue rheumatism, fibrositis and non-articular rheumatism.Fibromyalgia is a common disease, affecting between two to six per cent of the entire population and women are five times more likely to develop fibromyalgia than men. The incidence of it increases with age, and it is most common in women 50 years of age or older. It is generally diagnosed after an accident or injury.As it is a “syndrome”, and that very term is defined as a “grouping of symptoms”; the warning signs of this disease are as follows:• Stiffness, especially in the morning, and pain in muscles and joints all through the body• Trouble sleeping at night and a feeling of being very tired all the time• Numbness in muscles and joints• Poor memory and concentration• Depression• Tension• Migraine headaches• Pain in the jaw• Chronic fatigue syndrome• Irritable bowel and bladderThe amount of pain varies from person to person and from day to day. The pain may be quite mild on many days but it is sometimes so severe that it affects your work and your personal and social life. Some people find that the pain feels worse in cold or damp weather. The intensity of the pain often causes a decrease in activity which then causes the muscles to weaken, making future activity even more difficult. As such, a patient of fibromyalgia often gets trapped in a vicious cycle.The pain not only interferes with their day-time activities, it also interferes with their sleep, resulting in fatigue during the day. However, the condition rarely has any visible symptoms so people with fibromyalgia look “fine” to others and it is often hard for them to get understanding and support from family, friends and employersResearch shows that patients with fibromyalgia suffer increased sensitivity (known as sensitisation) to pressure or relatively minor knocks which would not normally be painful. To some extent this may be related to chemical changes in the nervous system, but the exact cause is not fully understood.A number of factors might be involved in causing fibromyalgia but, again, the exact cause has not been discovered. For many people the condition develops gradually without any single, specific reason; however with others there may be some obvious causes that triggered the problem. Pre-existing trouble in the joints, especially those of the neck and lower back, motor vehicle accidents, work-related injuries, viral illnesses, surgery, infections, emotional trauma, or physical or emotional stress can all be factors in the onset of fibromyalgia.If your doctor thinks you have fibromyalgia or arthritis you must consult a rheumatologist; a doctor who has received special training in the diagnosis and treatment of problems with muscles, joints and bones.To be diagnosed with fibromyalgia, you must have experienced widespread pain for a period of three months or longer. The pain must be above and below the waist, and on both the left and right sides of the body. Another characteristic feature of fibromyalgia is the existence of at least 11 (of a possible 18) distinct sites of deep muscle tenderness that hurt when touched firmly; these include the side of the neck, the top of the shoulder blade, the outside of the upper buttock and hip joint, and the inside of the knee. Your doctor will test this by pressing on these spots with his or her thumb.In addition to widespread pain and specific tenderness in 11 of the 18 points, many people with fibromyalgia experience a wide variety of other symptoms. Because some of these symptoms are also common in other types of arthritis, your doctor may order blood tests, X-rays and other laboratory tests. These tests are done to find out if other diseases are present; they do not specifically diagnose fibromyalgia.There is no cure for fibromyalgia but there are things you can do to manage the disease. The goal of treatment is to help in the management of pain and other symptoms and correct diagnosis is the first step towards this goal. Despite all the pain you don’t have a condition that will cause permanent disability; many different treatments are available to help you manage your pain and other symptoms. Your doctor can prescribe a variety of medications which may help with the pain. These include painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)Self-help is one of the key factor which helps in reducing the symptoms. The best thing to do is not to overexert yourself at any cost. Exercise, sound sleep and dealing with physical or mental stress are the key to reducing the pain and fatigue of fibromyalgia. Following these guidelines may also help:• Exercise. This will not only help in reducing pain but will also keep muscles from becoming weak. Of course, due to the pain and the fatigue, it will be hard to make a start so the key is to choose a time when you feel you have the energy. Start with short time spans and gentle exercises like stretching and bending gently and walking, but be careful not to overdo it as you will strain you muscles. Once you build up your stamina you can graduate to low impact aerobic programs designed for people with arthritis, water exercise programmes and use of exercise equipment such as a stationary bike, treadmill or Stairmaster. Swimming is one of the best forms of exercise for fibromyalgia.• Heat therapy in any form, be it a hot shower, use of a heating pad or soaking in a warm bath, helps relax aching muscles and reduces pain and soreness by increasing circulation.• Lifestyle management plays a key role in not only reducing the pain but also in improving your quality of life. A few changes may be needed in how you approach day-to-day chores and you may need to switch to labour saving devices like bringing food to the table on a trolley instead of carrying each dish by hand or doing the ironing sitting at a table instead of standing. Listen to what your body is telling you, once you know the things that make your pain and fatigue worse you can make changes to them.Fibromyalgia affects everyone in a different way. Some people manage to remain at work and to lead satisfying, fulfilling lives. Others have trouble sustaining their previous level of work and recreational activity. One of the main factors that seems to affect the outcome is how quickly the diagnosis is made and treatment started.

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