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What is Fibromyalgia?

1.What is Fibromyalgia? Fibromyalgia is a common condition that is characterized by widespread pain and extreme tenderness in many areas of the body. Many patients also experience fatigue, sleep disturbances, headaches, and mood disturbances such as depression and anxiety.

2.How common is the disease? It’s thought that as many as 1 person in every 25 may suffer from it. It is more common in women. it is the most common cause of generalized musculoskeletal pain in women between 20 and 55 years

3. What causes fibromyalgia? This is usually a tough question to answer cause usually we don’t have one test that will diagnose the disease and also the exact cause is still unknown as no specific physical cause has been found. This doesn’t mean the symptoms are unreal or ‘all in the mind’, but anxiety, physical or mental trauma, and sleep disturbance are thought to play a part. My answer usually is that
People with fibromyalgia, the muscles and tendons are excessively irritated by various painful stimuli. This is thought to be due to a heightened perception of pain, a phenomenon called “central sensitization”. Due to this central sensitization it also causes problems with sleep, digestive system, chronic fatigue, chronic bladder pain amongst others. There is no generally agreed-upon explanation for
how or why central sensitization develops in some people. A plausible cause may be genetics as those with a parent or sibling with fibromyalgia have a higher chance of developing it themselves. various stressors, including infection, diseases that involve joint inflammation (eg, rheumatoid arthritis or systemic lupus erythematosus), physical or emotional trauma, or sleep disturbances appear to trigger
the development of fibromyalgia.

Behcet’s has one of the highest numbers of people with concomitant fibromyalgia. One study reported up to almost 4 in 10 patients with Behcet’s have fibromyalgia. Locally in my practice I see a lot in young ladies between age of 20-50, amongst diseases I see a lot with lupus patients. Teenagers also see a lot especially those in pressure situations either psycho-social (family, parents) to form ones adjusting to
boarding school and Form 4 students.

4. What are the symptoms of Fibromyalgia?
The challenge with this disease is that there are no obvious outward signs. The symptoms may vary from person to person and also day to day. The most prominent symptoms are Widespread pain, fatigue and sleep disturbance. These symptoms I think are the most troubling to patients because it means their quality of life is affected from work, home and relationships with friends and family as they are unable
to function “normally” due to fatigue and joint pain. A lot of patients are often frustrated as their close friends and family don’t understand what is going on, also they have visited many doctors who also aren’t sure what is going on. Actually, some of my patients have had incidences where people (close friends, family and even medical personnel) thought they were either exaggerating their symptoms or
worse they are making up symptoms. This leads to subsequent depression, anxiety disorders that can complicate the treatment as many people are not open to accept the idea, they need help from the counsellors and psychiatrist. They also can’t seem to think clearly or remember things properly (sometimes this is called ‘fibrofog’ or ‘brainfog’).

Less frequent symptoms of fibromyalgia include symptoms of poor circulation – tingling, numbness or swelling of the hands and feet: irritability or feeling miserable, irritable or uncomfortable bowels (diarrhoea or constipation and abdominal pain) sometimes separately diagnosed as irritable bowel syndrome (IBS), headaches and feeling an urgent need to urinate especially at night

5. When should one think of fibromyalgia? Usually my index of suspicion is raised when a patient complains of widespread pain lasting three months or more associated with fatigue and/or waking up feeling unrefreshed and having problems with thought processes like memory and understanding (cognitive symptoms). Other give a way are the lack of positivity in the routine tests we do for a patient presenting with pain. We also suspect fibromyalgia in a patient who has a long-term medical condition that has mental and physical pain presenting with pain for example- Diabetes, rheumatoid arthritis, Behcet’s, lupus, low back pain that doesn’t seem to be improving despite the fact the disease is under control.

We also tend to see it in patients who are undergoing stressful situations. I have seen it in a number of teenagers for example those who have just joined form1 and are having difficulties adjusting to school. Usually they have some symptoms but the labs are normal. Have also managed form 4 students who are under pressure from KCSE and are always in and out of hospitals with different symptoms at a time. I
think these kids are under too much pressure to pass the exam either from parents or school. One case the student had been promised I think twas about 100,000 sh in rewards and the student cracked under the pressure. Her last year she was in and out of hospital barely in school. Stress can also come from family take for example some of the teenagers I have seen probably single parent to marital issues
within the family to even one sibling being favored. One case the parents kept asking the student why she cant be like her sister.

I have also seen it in particular ladies who are having marital issues from infidelity to un-supportive spouse or those in high pressure jobs who are trying to balance work and family. A lot of this information I would not have been able to fish out unless I didn’t have help from the counsellor and psychiatrists because unless we know the triggers, we are not able to fully treat the disease.

6. What are the treatment options for fibromyalgia?
Ideally, the treatment of fibromyalgia should involve you and your doctor, as well as (in many cases) a physical therapist, mental health expert, and other health care professionals. The first part is education on the disease and for the patient to see it as a real illness, and your pain is not “all in your head”. The discussion we have with our patients also is see fibromyalgia is not a degenerative or deforming condition, nor does it result in life-threatening complications. However, very importantly treatment of chronic pain and fatigue is challenging, and there are no “quick cures”

We have come a long way in our understanding the disease. The example I use is that many years ago if a doctor found a patient with pain, fatigue and normal investigations it was straight to mental hospital or doctor literally avoiding the patient. Now things are better we have treatments that may be helpful in relieving pain, improving your quality of sleep, and improving your mood. Examples of medicines include
pregabalin, selective serotonin inhibitors, gabapentin and usual pain killers. In cases of symptoms outside pain and fatigue we involve mental health team, gastroenterologists (digestive problems), neurologists (headaches, brain fog), physiotherapist and in the extreme cases pain specialists. Have had a few cases where we needed help from pain specialists.

Exercise, stretching programs, and other activities are also important in helping to manage symptoms. An approach that involves combining multiple different types of intervention into an organized treatment program is usually best. Being physically active will not cause harm or long-term muscle damage, and it can help improve pain and function. We encourage our patients to do exercise as research has shown that this improves sleep, fatigue and overall, well-being of the patient. Managing expectations of the patient is another discussion I have with the patients. The symptoms may often increase or decrease over time but there maybe some degree of muscle pain and fatigue may persist. Nevertheless, most people with fibromyalgia improve, and most people lead full, active lives.

7. I have fibromyalgia, any tips you could give that may help relieve my symptoms?
 Try to Learn as much as possible and understand your condition.
 Stress plays a major contribution to the disease try to use psychological and physical techniques to reduce tension in the body and self-directed anger or frustration. Sometimes visiting a counsellor or psychiatrist will help teach you coping techniques. Tackle any stress or
unhappiness at home or at work. My advice usually if it causes you stress either fix it or get rid of it.
 Fatigue is a major symptom which is frustrating to the patient so learn Pace your daily activities. For example if it takes 1 hour to get out of bed , sleep earlier and wake up earlier. Another example is when doing physical activities do what you can then rest don’t try to compare
yourself with others
 Research has shown exercise improves fatigue and sleep. Follow a graded programme of physical activity (for example swimming, walking or cycling), starting gently and gradually building up.
 Share your experiences with other people. Talk to your family, close friends, colleagues. This way they get to understand what your going through. It also helps them to accommodate you.
 Avoid tea, coffee (and any other forms of caffeine) and alcohol close to bedtime. These interfere with sleep. Sleep has a big role in the science of the disease.
 Try not to sleep during the day.
 Avoid watching TV and using computers, tablets or smartphones in your bedroom.
 Eat a balanced diet and keep to a healthy weight. Research has shown that junk food has lots of oxidants that potentially can worsen the disease. My advice is because I know they will never stop junk food I encourage them to reduce the quantity and get substitutes like fruits whenever they want to junk.
 Stop smoking. Smoking has been shown to worsen the disease.

Fibro Fatigue: Why It Happens and How to Manage It
The fatigue caused by fibromyalgia is different from regular tiredness. The fatigue may be described as:
 physical exhaustion
 unrefreshed sleep
 lack of energy or motivation
 depressed mood
 difficulty thinking or concentrating

What causes Fatigue in fibromyalgia?
One theory for why fibromyalgia also causes fatigue is that the fatigue is the result of your body trying to deal with the pain. This constant reaction to pain signals in your nerves can make you lethargic and exhausted.

Most people with fibromyalgia also have trouble sleeping (insomnia). You may have problems falling or staying asleep, or you may still feel exhausted after waking up.

How to manage fibro fatigue
It’s possible to manage fibro fatigue with medications and lifestyle changes, though it may be difficult to make the tiredness completely go away.

Here are some strategies that may help you reduce your fatigue:
1. identify the triggers- common examples include- diet, environment, mood, stress levels and sleeping patterns. Start keeping a written or electronic record of your fatigue level each day. Record what you ate, when you woke up, and when you went to bed, along with any activities
you did that day. You can then use that information to avoid doing the things that tend to make you more tired

2. Exercise regularly- exercise has been shown to significantly reduced symptoms of pain, sleep, fatigue, tender points, and depression. If you’re unsure of where to begin, try starting with just 30 minutes of walking per day and then slowly increase the pace and duration over time

3. Change your diet- try to follow a balanced diet, avoid processed, fried, salty, and sugary foods,
and try to maintain a healthy weight.

4. Create a relaxing bedtime routine- Here are a few tips for a healthy sleep routine:
 go to bed and get up at the same time everyday
 avoid alcohol, nicotine, and caffeine
 invest in a good quality mattress
 keep your bedroom cool and dark
 turn off screens (computer, cell phone, and TV) at least an hour before bedtime
 keep electronics out of the bedroom
 avoid having a large meal before bedtime
 take a warm bath before bed

5. Reduce stress- Living in constant pain can cause stress. Stress, in turn, can make your fatigue worse. Yoga, qigong, tai chi, meditation, and other mind-body activities are excellent ways to reduce stress. There’s evidence that these types of movement therapies may significantly
reduce sleep disturbances, fatigue, and depression in people with fibromyalgia. These activities may also lead to an increase in quality of life.
6. Schedule in your rest time-A good way to manage fatigue caused by fibromyalgia is to schedule rest into your day. A quick nap or just lying down at some point could be what you need. Try to plan your most rigorous tasks for times when you think you’ll have the most energy.
Source: healthline.com/health/fibromyalgia/fibromyalgia-fatigue