Fibromyalgia
by Nnamdi Nwaogwugwu M.D.
Are you a dedicated, hardworking, detailed oriented career minded women between the ages of 20-60 that has begun to develop multiple pain complaints with associated fatigue, and daily tension headaches.
This pain has caused you to present to multiple medical doctors searching for pain relief, but your search never yields a diagnosis or an effective treatment plan. This unrelenting pain has begun to erode your previous stellar work performance, because you are forced to miss work from sheer exhaustive fatigue and pain. Your co-workers, friends, and family members have begun to worry about your chronic and constant pain complaints and are offering unsolicited treatment suggestions to assist you in achieving pain relief and wellness. You have begun to second-guessing yourself, wondering whether all your pain symptoms are in your head, as all of your previous medical evaluations, diagnostic testing, blood work, have all been normal.
Don’t be discouraged, you may have Fibromyalgia (FMS). You may be asking yourself what is Fibromyalgia?
Fibromyalgia is a common medical condition that affects 2%-4% of the general population and is seen mostly by family practice (5.7%) and rheumatologist (21%). The Syndrome affects highly successful, Type A personalities and predominately affects women (75%) of the time. The condition is characterized by diffuse muscle pain for at least three months duration in 11/18 specific tender point locations on the body. The locations are:
Occiput-Bilateral base of the neck
Low cervical-Bilateral anterior aspects of the intertransverse spaces C5-C7
Trapezius – Bilateral midpoint of upper border
Supraspinatus- Bilateral above scapular spine near medial border
Second rib-Bilateral at the second costochondral junctions
Lateral Epicondyle-Bilateral, 2cm distal to epicondyle
Gluteal –Bilateral in the upper outer quadrant of the buttocks
Greater trochanter-Bilateral, posterior to the trochanteric prominence
Knee-bilateral at the medial fat pad proximal to the joint line
In addition to the pain, the individual must also complain of moderate-severe fatigue (75% of the time), stiffness (75%) neck and low back pain, tension headaches (45%). The symptoms may vary from day to day and is made worse by vigorous exercise, inactivity, poor sleep, stress, work. A significant amount of people have to file for disability due to the fatigue, diffuse pain complaints emotional turmoil that ensues. Many primary care doctors form the opinion that due to the multiple pain complaints, and the association with IBS and stress that the individuals must have a psychiatric problem. In truth most individuals with FMS don’t carry a diagnosis of depression, but may develop a reactive depression due to the lack of a clear diagnosis, emotional support and lack of understanding about the nature and treatment of their pain.
The treatment for FMS rests in educating and reassuring the patient that the condition is not life threatening and considerable pain relief can be obtained with the combination of medications to restore sleep and incorporation of other treatment options. The treatment choices may consist of trigger point injections, ultrasound therapy, acupuncture, massage, and aerobic exercise and organized stretching program.
