A job loss condition

Fibromyalgia is a condition characterized by pain, fatigue, disruptive or poor sleep, anxiety and depression.

It often causes functional impairment of daily activities.

It is more common in young or middle age females, with a predominance female: male ratio of 5:1. It is a chronic relapsing condition and a main cause of loss job or productivity.

There are no diagnostic tests that confirm fibromyalgia. The diagnosis is clinical and usually requires that pain is present for over three months.

The pain is usually along the spine and in all four quadrants of the body, predominantly muscles and musculoskeletal junctions, and elicited by pressure digitally on 11 of 18 points known as “trigger points”.

Recently Fibromyalgia patients have been found to present some brain abnormalities in the SPECT scans and display quantitative abnormalities in pain perception and perceive pain even with non painful stimulus, such as light touch.

They also present hyperalgesia, or augmentation of the pain processing in which a painful stimulus is magnified and perceived at a higher intensity than it would be by a normal volunteer.

These data are suggestive of a sensitized pain perception in the Fibromyalgia syndrome.

Today it is believed that there is an altered central pain processing in the brain which is responsible for the Fibromyalgia syndrome, and is called a “Central Sensitivity Syndrome”.

This central sensitization probably contributes to the other symptoms like fatigue, sleep disturbances, anxiety and depression.

Fibromyalgia was included in unexplained clinical conditions or functional somatic syndromes, that were characterized by more symptoms, suffering and disability than by consistent physical findings.

That is why Fibromyalgia was once often dismissed by physicians and the public as a psychological disorder or “waste basket” diagnosis.

Examples of other central sensitivity syndromes are:

Chronic fatigue syndrome, irritable bowel syndrome, chronic pelvic pain syndrome, tension type headache/ migraine, and posttraumatic stress disorder.

The treatment of this condition has to be multidisciplinary.

The first step is to recognize that the patient has pain or other symptoms, validating his illness.

If there are psychological or sociocultural components, they should be addressed.

If there are specific sources of pain like bursitis or spondylosis they should be treated.

A multifaceted plan that incorporates various adjuvant medications, aerobic exercises, physical therapy, and psychological and behavioral approaches to reduce distress and promote self-efficacy is the recommended approach.

Medicines that have demonstrated positive effects in patients with fibromyalgia are Dextromethorphan, Alprazolam, Clonazepam, Buspirone, Cyclobenzaprine, Amytriptyline, and Pregabalina (Lyrica) among others.

Once again, I want to emphasize the importance of exercise.

Exercise is vital in the treatment, both reducing the anxiety and promoting endorphins, nitrous oxide and other “natural drugs” that help us feel better.