![]() ![]() The word fibromyalgia means pain ('algia') coming from the muscles ('my') and fibrous tissues ('fibro') such as tendons and ligaments. Most people with fibromyalgia also have other symptoms in addition to the pains - see below. Therefore, fibromyalgia is sometimes called fibromyalgia syndrome, or FMS. It is a chronic (persistent) condition. What causes fibromyalgia?The cause of fibromyalgia is not known. However, research has shown that people with fibromyalgia have certain subtle changes in some chemicals in the brain and nervous system. For example, there seems to be a minor change in the level of certain brain chemicals called neurotransmitters. These are the chemicals responsible for transmitting messages between nerves and between brain cells. Research studies have also shown that people with fibromyalgia tend to have an increased amount of a chemical called substance P in the fluid that bathes the brain and spinal cord (the cerebrospinal fluid - CSF). This substance may be involved in the way pain messages are transmitted. This is called 'central sensitisation'. This may be due to various minor changes in brain chemicals. What triggers or causes these changes is not known. However, because the cause is now thought to be due to the processes described above in the brain and spinal cord, the term 'fibromyalgia' does not accurately describe the condition. That is, there is little evidence that the disease is due to a problem with peripheral tissues such as muscles, tendons and ligaments (although the pain is often felt in these tissues). Who gets fibromyalgia?About 1 in 50 people develop fibromyalgia at some stage. It is seven times more common in women than men. In most cases it first develops between the ages of 25 and 55. It is less common in younger adults, and is uncommon in children. What are the symptoms of fibromyalgia?The main symptoms are pains felt in many areas of the body, and tiredness. Some people also develop other symptoms. The severity of symptoms varies from person to person. PainPain can occur in any area of the body. Typically, many areas of the body are affected, and some people feel the pain 'all over'. The neck and back are the sites that are often the most painful. The severity of the pain can vary from day to day. The pains may be made worse by stress, cold or activity. After a night's sleep, you may also feel quite 'stiff' for a few hours. Many areas of the body may also be quite tender. TirednessTiredness (fatigue) is common, and is sometimes severe. In some cases it is more distressing than the pain. It is also common to have a poor sleep pattern. You may wake feeling exhausted. Many people feel worst first thing in the morning, but improve by the afternoon. Even a small amount of activity may make you tired. The tiredness may cause you to have poor concentration.
How is fibromyalgia diagnosed?
To make a firm diagnosis, symptoms should include widespread pain involving both sides of the body, above and below the waist, as well as the neck, back and pelvis, and have been present for at least three months. A doctor's examination will find tenderness in various parts of the body. During the examination a doctor may press firmly with a thumb on various parts of your body. The amount of pressure used does not cause pain in people without fibromyalgia. However, the pressure typically causes people with fibromyalgia to wince with pain. The increased sensitivity to pressure (being tender to mild pressure) can be in many places in the body, and may be all over. However, a doctor may press on certain specific sites (as shown in the diagram). These sites are generally fairly sensitive areas and the easiest to check for tenderness which is typical in people with fibromyalgia. Apart from finding areas of tenderness, the examination by a doctor will usually find no other abnormality. There is no laboratory test that confirms the condition. However, tests are advised in some cases to rule out other diseases that can cause similar symptoms. For example, your doctor may do some blood tests to rule out an underactive thyroid, early arthritis, etc. Is fibromyalgia serious?Fibromyalgia is not an arthritis, it is not due to cancer, and does not damage any joint or tissue. It does not shorten expected lifespan. In some cases, symptoms ease or go after a few months. However, in many cases it is a chronic (persistent) condition which tends to wax and wane in severity. Quality of life can become affected. What is the treatment for fibromyalgia?There is no single or simple cure for fibromyalgia. Treatments aim to reduce symptoms as much as possible. Over the years a range of different treatments have been advocated with variable rates of success. ExerciseExercise helps to improves symptoms in a good number of cases. If you are able, consider gradually building up to more and more exercise. Walking, cycling and swimming are thought to be the best form of exercise to improve symptoms. Stretching exercises such as yoga also helps. A doctor or physiotherapist can advise on a suitable programme for your particular circumstances. The aim is to exercise safely and without increased pain. A typical goal to aim for is to build up exercise daily for at least 20 to 30 minutes a session. Each person was encouraged to gradually increase the amount of exercise. When people first started they usually did two sessions of exercise per class lasting about six minutes. By three months some people had increased to doing two sessions in each class lasting 25 minutes. At three months, about 1 in 3 people who did the exercise programme rated themselves as much, or very much, better. General measures to help treat fibromyalgia/rheumatoid arthritis/osteoarthritis/spondylitis/spondylosis![]() Weight control
If you are overweight, try to lose some weight as the extra burden placed on back, hips, and knees can make symptoms worse. Even a modest weight loss can make quite a difference. Braces or supports may also be helpful for other joints affected by OA. For example, a support around the thumb for painful thumb OA. Daily walking for 30 to 45 minutes with or without Walking aids
If you have OA of your hip or knee, when walking try using a cane (walking stick). Hold it in the hand on the opposite side of the body to the affected joint. This takes some pressure off the affected joint and helps to ease symptoms in some cases. Diet - Vitamins, minerals, calcium should be obtained from natural dietary resources and not by 'vitamin tablets/capsules' which can increase your risk of 'medicinal side-effects'. Fruits, Salads, green vegetables/leaves, Sprouts -250 grammes Curd/Yoghurt -250 grammes, Lemon juice with little salt/sugar. Water -5-6 lit per day or more, daily slow sustained yoga type physiotherapy exercises as given in website is essential for good health of bones and body. Daily brisk/speed walking for 1 hour, getting enough vitamin D from your diet, sunlight will decrease your risk. Cycling outdoors and non-gym outdoor exercises such as brisk walking, using stairs at home and office, walk at work bring overall improvement in health, well being besides controlling and curing many diseases such as Hypertension, diabetes, depression, cancer, osteoporosis, arthritis, muscular pains and joint pains. Physical activity. Not exercising and being inactive or staying in bed for long periods can increase your risk. Smoking. Smokers harm their blood circulation, damage all tissues in body by free radicals of smoke and absorb less calcium from their diets. Medications. Some commonly used medicines can cause loss of bone mass. These include steroids used to control arthritis and asthma; some drugs used to treat seizures; some cancer drugs; and, too much thyroid hormone. Low body weight. Women who are very thin – and small-boned – are at greater risk for osteoporosis.Physiotherapy help if unable to follow correct exercises
Sometimes advice or treatment from a physiotherapist is helpful. For example:
Manipulation and stretching around affected joints may be helpful. This is something that physiotherapists may also be able to help with. http://www.bbc.com/news/health-24933090Why I take the stairs at the BBC
Stair climbing is officially classed as "vigorous exercise", burns more calories per minute than jogging and improves cardiovascular fitness and muscle strength. Apparently you burn one and a half calories for every 10 upward steps and one calorie for every 20 steps down. Every action, even a single step on a stair or standing up for a few seconds, can put you on a positive path to better health. One study has even found that if you have more plants and flowers around your house you are not only more likely to have a diverse array of bacteria on your skin, you are also less likely to be allergic People of all ages should be encouraged to take more exercise according to a report by England's chief medical officer. Sir Liam Donaldson says that exercise is a key factor in reducing the risk of cancer, heart disease and diabetes. Adults should take 30 minutes of moderate exercise five times a week, children and young people 60 minutes. Possible activities include walking to work or mowing the lawn. How can I cut down on sugar?
"We need to reduce sugar intake but should not swap from sugar to fat", said Prof Susan Jebb of the University of Oxford. "A greater proportion of our plate should be fruit and vegetables and more fibre-rich carbohydrates and whole grain." https://in.lifestyle.yahoo.com/world-vegetarian-day-2014-health-094251813.htmlHealth benefits of a vegetarian dietOccupational therapy
An occupational therapist may be able to help if you need aids or modifications to your home to cope with any disability caused by OA. Special devices, such as tap turners to help with turning on a tap, may mean that you can carry out tasks around the house more easily. Other therapiesMedicines used to treat fibromyalgia/rheumatoid arthritis/osteoarthritis/spondylitis/spondylosis
Paracetamol
Paracetamol is the common medicine used to treat OA. It often works well to ease pain. It is best to take it regularly to keep pain away, rather than 'now and again' when pain flares up. A normal adult dose is two 500 mg tablets, four times a day. It usually has little in the way of side-effects, and you can take paracetamol long-term without it losing its effect. Anti-inflammatory painkillers
You may find that a topical preparation of an anti-inflammatory painkiller that you rub onto the skin over affected joints is helpful instead of, or in addition to, paracetamol tablets. This may be particularly helpful if you have knee or hand OA. Compared to anti-inflammatory tablets, the amount of the drug that gets into the bloodstream is much less with topical preparations, and there is less risk of side-effects (see below).
Codeine
Codeine is sometimes combined with paracetamol for added pain relief. Constipation is a common side-effect from codeine. To help prevent constipation, have lots to drink and eat a high fibre diet. Capsaicin cream
This cream is made from chilli peppers and it works by blocking the nerve signals that send pain messages to the brain. It may be helpful if you have knee or hand OA. It takes a while for the effects of this cream to build up and may take around one month to get the maximum benefit. You should rub in a pea-sized amount of cream around the affected joint four times a day, and not more often than every four hours. An injection of antiinflammatory medicine
An injection directly into a joint is useful if a joint becomes badly painful / inflamed. Treatments that are not normally recommendedGlucosamine, cartilage regenerative drugs are Usually not helpful in long term as no reliable studies on them. besides they may affect liver function and kidneys.Hyaluronic acid
The use of regular injections of hyaluronic acid directly into a joint is a relatively new treatment that has been tried for OA. The theory is that it may help with 'lubrication' and 'shock absorption' in a damaged joint. It may produce a small beneficial effect in some people. However, the National Institute for Health and Clinical Excellence (NICE) has looked at the use of hyaluronic acid as a possible treatment for OA and does not recommend its use. This is because there is little evidence that it is effective. Chondroitin
This is another food supplement that has become popular as a potential treatment for OA. It is a chemical that is part of the make-up of normal cartilage. A recent big study showed that chondroitin has little, or minimal, effect on reducing symptoms in people with OA. Also, NICE does not recommend the use of chondroitin for the treatment of OA. This is because they could find no clear evidence from studies to show that it is an effective treatment. Surgery for osteoarthritis/spondylitis/fibromyalgia/rheumatoid arthritis/osteoarthritis/spondylitis/spondylosis Most people with OA/spondylitis do not have it badly enough to need surgery. However, OA of a joint may become severe in some cases. Some joints can be replaced with artificial joints. Hip and knee replacement surgery has become a standard treatment for severe OA of these joints. Some other joints can also be replaced. Seldom is surgery used to treat spondylosis. Most patients respond well to non-surgical treatment for spinal osteoarthritis.Heated pool treatment with or without exerciseHeated pool treatment (balneotherapy) has been shown to improve symptoms in some cases. Some trials that looked into this included exercise in addition to heated pool treatment, and some did not. Both with and without exercise seemed to help in some cases. Cognitive behavioural therapyCognitive behavioural therapy (CBT) may be of benefit to some people with fibromyalgia. CBT is one type of psychotherapy ('talking treatment'). It is used as a treatment for various mental health and physical problems. Unlike other types of psychotherapy it does not involve 'talking freely', or dwelling on events in your past. CBT tends to deal with the 'here and now' - how your current thoughts and behaviours are affecting you now. CBT is problem-focused and practical. CBT may actually help to ease pain symptoms. But it can also help you to take control of the extent to which pain, tiredness, or other symptoms interfere with your life. Other therapiesThe guideline recommended that other therapies may be useful, depending on the individual person’s needs. The therapies thought to be useful included relaxation, physiotherapy, and psychological support. PainkillersPainkillers such as paracetamol, anti-inflammatory painkillers such as ibuprofen, or codeine may help to ease pain. However, they often do not work very well in fibromyalgia. AntidepressantsAn antidepressant drug is a common treatment for fibromyalgia. Research studies have confirmed that antidepressants are often helpful for easing pain and improving overall function. They may also help with disturbed sleep. Although they are called antidepressants, they are not used in fibromyalgia to treat depression. Tricyclic antidepressants ease pain separately to their action on depression. Antidepressant drugs are used to treat various conditions apart from depression. Other drugsDrugs called pramipexole, and pregabalin have been recently studied in people with fibromyalgia. These drugs are usually used for other conditions (pramipexole for Parkinson's disease, and pregabalin for nerve pain). So far, the studies looking into their effect on easing pain in people with fibromyalgia have been promising. They seem to reduce pain in some people with fibromyalgia. One of these drugs may be advised if other treatments have not helped very much. Further research is needed to clarify their role in fibromyalgia and to study their long-term effects. Other treatmentsSome people try complementary or alternative treatments such as acupuncture, aromatherapy, massage, etc. There is little evidence that such treatments relieve the core symptoms of fibromyalgia. However, some people find that certain treatments help them to relax, feel less stressed, and feel better in themselves which helps them to cope better with their condition. Fibromyalgia Association UKPO Box 206, Stourbridge, West Midlands, DY9 8YL FibroAction46 The Nightingales, Newbury, RG14 7UJ References
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