Physical Therapy in Bethesda and Olney for Fibromyalgia
Fibromyalgia is a medical term for a condition of aches and pains all over the body along with a laundry list of other symptoms. Is it a real problem? Is there any way to treat this condition successfully? And how can you tell if this is what you have instead of other similar problems such as Lyme disease, Epstein-Barr virus, multiple sclerosis, or arthritis?
The authors of this review article on the topic of fibromyalgia attempt to answer all of these questions and more. They provide a quick summary of how to recognize this problem, what might be causing it, and then focus more intently on how to treat or manage it.
Because there is no classic clinical presentation for fibromyalgia, recognizing it as the patient's underlying medical condition can be very difficult. Symptoms like fatigue, stiffness, sore muscles, and difficulty sleeping just don't make a diagnosis. Medical testing such as X-rays, urinalysis, or blood testing often come back normal and are not diagnostic either.
The physician must rely on the patient's report of symptoms (especially body pain and tender points) to make the diagnosis. Chronic widespread body pain that lasts more than three months with specific tender points make the most definitive diagnosis. The American College of Rheumatology (ACR) criteria includes 11 out of 18 points of pain as a positive test for fibromyalgia. These tender points are located in specific locations along the neck, chest, shoulders, back, hips, elbows, and knees.
Understanding what causes fibromyalgia is another challenge. All evidence so far points to some kind of mistake within the nervous system in how it recognizes and transmits pain messages. Somehow, the nervous system seems to think even the simplest touch is a noxious (painful) stimuli. It's like a ten-alarm fire signal is sent to the brain when a breeze blows by the barn. Pain as an entity is being studied very carefully and especially chronic pain as it is experienced in conditions like fibromyalgia. Nervous system dysregulation of this type is likely caused by biochemical abnormalities, altered brain blood flow, and problems with the pain processing mechanisms.
Until the exact pathologic pathways are understood, treatment will be more of a management approach. There isn't one magic pill patients can take to wipe away the pain, improve sleep, or restore energy. Instead, a wide range of medications are available that can act on the nervous system in a variety of ways. These include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SSNRIs), and anticonvulsants.
Finding the right drugs and the right mix or combination of those medications can take some time. And medication only offers small comfort in the big picture of things. Only about a third of the patients are helped and only about a third of their symptoms are improved by this means.
Many patients find nonpharmacologic treatment works best for them. This means they try to manage the pain, symptoms, and loss of function through the use of exercise, counseling, and alternative care such as hypnosis, acupuncture, or biofeedback/relaxation therapy. Clearly, all of the research so far confirms the need to treat this problem with a multidisciplinary approach. A multidisciplinary team of professionals includes doctors, nurses, Physical Therapists, psychologists, pharmacists, and other practitioners in the healing arts.
Patients must learn as much as they can both about this condition as well as about themselves and what works best for them. That's easier said than done. Many times the pain and fatigue keep patients from getting the exercise they need. They become deconditioned and weak, which adds to their pain and loss of function.
In the ideal plan, the patient is really the manager who consults with these other experts to formulate the most effective plan. Reducing and managing symptoms, improving quality of life, and decreasing distress are reasonable goals. But the patient must understand that at the present time, there is no cure for fibromyalgia.
Reference: Dennis C. Turk, PhD, and Hilary D. Wilson, PhD. Managing Fibromyalgia: An Update on Diagnosis and Treatment. In The Journal of Musculoskeletal Medicine. October 2009. Supplement. Pp. S1-S7.