MY PAIN BLOG

Fibromyalgia (FM)

What is Fibromyalgia and how to treat it?

Fibromyalgia is one of the most common chronic pain conditions of our century. There are about one million people suffering from this condition in Canada. The true physiopathology of this condition is not known yet. I'll share my two cents on it with you here.


The word Fibro comes from Fibers and the word Myalgia means muscle pain. It is diagnosed in patients who complain of a host of complains including being tired most of the times, having problems with sleep, weight managing problems, pain all over the body and mainly on specific spots called trigger points. Trigger point means that if you put pressure on these spots on the body, patient would have a sharp pain, so pressure on these points would trigger the pain. There are eighteen trigger points in fibromyalgia patients that are known and a group of eleven tender points in one patient needs to be found to have the diagnosis of FM.

This is in reality a framework for us (doctors) to be able to classify this type of disease and does not mean that by that we understand it. Nor it means that this is a wide enough classification to incorporate all patients at different stages of this disease. In real world of our daily practice in Toronto Poly Clinic we see hundreds of patients at very early stages of a pain syndrome with all or some of the signs and symptoms but not quite enough to label them as FM patients. It is not really the label for a condition, but what we are going to do for that condition that matters the most. It appears that when we have a pain condition most of muscles go into a degree of spasm. Muscle fibers are like fingers of two hands when we join them together. They can stretch and become longer and thus thinner, or they can contract and become shorter, thus thicker. Now if the muscle fibers go into a state of prolonged contraction due to a pain condition that lasted long enough, some of the muscle fibers may stay in contracted state and gradually change the nature from muscle fiber to fiber fibers.

The difference is that the new fibers are not as flexible or expandable as the muscle fibers. Now when this muscle enters the stretch or expansion stage, they cannot expand and so become painful. Once we have a group of these fibers close to each other, then we have a point that can trigger pain if stretched or receive pressure. These are the fibers that cause pain in muscles and the given condition is called Fibromyalgia. The painful body cannot rest well at night and as a result will be tired in day. Sleep deprivation or over sleeping cause irritability and depressive mood. Not being able to do most of physical activities which are normal for the age adds to the frustration and depression. Disturbed sleep, lack of activities and depressive mood leads to poor weight management along with many resulting health issues.

All these lead to disabilities and disturbed families. This is a downhill spiral of health that needs to be stopped and redirected toward healing again, but HOW? That is the million dollars question. It is very difficult to give direction for treatment of a medical condition when we really don't know the physiopathology, etiology or the cause of it. It is the common understanding of the medical pain specialists that a healthy life style is the best treatment for this condition and prevention of it's progression.

The following is a list of important points to remember but in no way this list is exhaustive of options:

  1. Exercises: A disciplined and guided regime of exercises can help to induce the natural endorphin which would improve the pain and mood, increase flexibilities and physical abilities. It is critical not to push too hard at the beginning as it may aggravate the pain. Over time very carefully the amount of activities can be increased.
  2. Psychotherapy: Psychological interventions for stress management, pain management, behavioral modifications and goal orientations can be very effective to motivate patient for working on the hard road to recovery. Meditation techniques and hypnotherapy can be very helpful. Group therapies are very powerful in providing an environment of not being alone in this fight.
  3. Medications: Medical pain management with appropriate medications for pain, sleep, depression and other co-existing medical conditions is essential for the FM patients treatment.
  4. Injections: A variety of trigger point injections, nerve blocks or botox injections can be helpful to manage the pain and improve the flexibility.
  5. Physical therapy: Low level LASER, Laser or conventional Acupuncture, Ultrasound, TENS, Heat & Cold, Manipulation therapy, Pulsed Magnetic Field therapy among other active and passive modalities are helpful in improving the pain and mobility.
  6. Nutrition: A healthy and balanced diet, low in Carbohydrates and Saturated fatty acids with lots of fruits and vegetables can go a long way.
  7. Natural supplements: A balanced supervised mix of vitamins, minerals and herbal elements can be helpful to control the pain, improve energy, balance sleep and function of gastro-intestinal system. Combined multi-disciplinary approach is the key to improvement.

Remember, if we can't cure we can't give up on improvement and management. FM, Chronic Fatigue Syndrome, Sleep disturbances and Irritable Bowel Syndrome are all parts of the wide spectrum of Chronic Pain Syndrome. The main person at the centre of this spectrum that can help improvement is a patient who has not given up. Our team at Toronto Poly Clinic is more than willing to work with such a patient.

Dr. Kevin Rod

A pain clinic with responsibility in mind.


Copyright Toronto Poly Clinic, 2007. All rights reserved.
All trademarks property of their owners.