Recognising symptoms of fibromyalgia and how to intervene

Fibromyalgia is a condition that is characterised by chronic, widespread/ diffuse musculoskeletal pain and tenderness. This is associated with a wide variety of symptoms including sleep disturbance, fatigue, mental and physical symptoms. It occurs in 2-5% of the population.

Dr Shankar Ramaswamy is an expert pain management specialist in London and here he explains everything that you need to know about fibromyalgia, from the first signs to the possible ways of managing the pain condition.
 

Is fibromyalgia considered to be a chronic pain condition?

In the recent release of International Classification of Disease (ICD)-11 by the WHO, fibromyalgia syndrome is included as a form of chronic widespread pain (CWP) as a subcategory under the chronic primary pain.



In ICD-11, fibromyalgia is defined as pain in at least four of five body regions (in at least three or four body quadrants), which is associated with sleep disorders, cognitive dysfunction, and somatic symptoms.
 

What causes fibromyalgia?

The exact cause of fibromyalgia is unknown but several factors can trigger its appearances, such as physical or emotional trauma, infection or a disease such as rheumatoid arthritis. Also, several theories have been proposed including abnormal hormone function, changes in the chemicals in the nervous system such as serotonin and substance P, genetics and hypersensitivity of the nervous system, otherwise called central sensitisation.
 

What are the first signs of fibromyalgia?

Patients with fibromyalgia often initially complain of:

• Fatigue

• Lack of energy

• Sleeping problems

• Anxiety or depression

• Concentration and memory problems (often called fibro fog)
• 
Headache

• Muscle cramps and twitches
• 
Whole-body pain involving muscles and ligaments.
   

Often patients have other associated conditions such as painful jaw (due to temporomandibular joint problems), abdominal pain due to digestive problems often linked to irritable bowel syndrome and painful bladder symptoms. 



Presence of such multiple painful conditions points toward a more central pain problem involving the nervous system (central sensitisation) as opposed to isolated peripheral pain problem.
 

Who is at risk of fibromyalgia?

The exact cause of fibromyalgia is still unclear. Fibromyalgia is more common in women than men although it can occur in both genders. It usually starts in the middle age group although it can start in childhood. Often there is a significant delay of over five years in diagnosing fibromyalgia.

Recent history of stressful or traumatic events such as a car accident, stressful relationship/ divorce or post-traumatic stress disorder, viral illness, repetitive joint injuries, can precipitate fibromyalgia symptoms.

There is some genetic link as a family history of fibromyalgia is a known risk factor.

Certain inflammatory conditions such as rheumatoid arthritis and lupus increase the risk of developing fibromyalgia.

Fibromyalgia also has a weak association with obesity.
 

What are the best ways to treat fibromyalgia?

The treatment for fibromyalgia mainly revolves around patient education, devising an effective self-management strategy, medications to help with pain, sleep and mental health, psychological and relaxation techniques, exercise and some targeted interventions.



The treatment strategy should be individualised and aimed at managing the multitude of symptoms that the patient is presenting with.


A variety of medications have been used to relieve pain, improve sleep as well as mood, which includes some antidepressants such as Amitriptyline and anti-seizure medication such as Gabapentin.


Targeted interventions include identifying specific trigger points in muscles and injecting with a variety of medications such as local anaesthetics, steroids or botox, or performing radiofrequency treatment at the trigger points. 



Some patients may also need a series of interventions involving a drip with an infusion of a local anaesthetic to combat the widespread pain. These treatment strategies are usually offered under the care of a pain consultant.


You can book an appointment with Dr Ramaswamy via his Top Doctor’s profile here and if you’re currently unable to go far because of the coronavirus ‘stay at home’ measures, he is available via video call thanks to our e-Consultation tool.