Nov. 19, 2010


chua.photo

By PHILIP S. CHUA, M.D., FACS, FPCS

What is myalgia?

Myalgia means muscle aches and pains. There is a condition called Fibromyalgia, which is a disorder that causes achy pain, tenderness, spasm and stiffness of the muscle, areas of the tendons and ligaments. These tender points are common around the neck and shoulders, in the front of the knees, elbow, hip joints, chest, low back, thighs and calf (lower leg) muscles.

What is Primary Fibromyalgia Syndrome?

Abbreviated as PFS, the typical pattern of this condition is generalized, idiopathic (of unknown cause) fibromyalgia accompanied by anxiety, fatigue, impaired sleep and irritable bowels, with no evidence of underlying diseases contributing to the symptom complex. PFS afflict healthy young or middle-aged women who are anxious, stressed, tense, depressed. Children and adolescents (usually females) and older adults who have PFS may also have osteoarthritis of the spine. Men usually have localized fibromyalgia which is related to recreational or occupational strain.

How common is PFS?

About 5 percent of the population, including children, have fibromyalgia, and some of this may be hereditary, with similar symptoms among family members.

What are the symptoms?

The onset of the pain and stiffness is gradual and diffuse. The pain may be a deep ache or burning, is worsened by straining and overuse, and may be constant but varies in severity in response to weather changes, stress and activity. The pain may move around the body. There may be spasms or muscle tightening. Most sufferers feel fatigued or out of energy, have problem sleeping and a few may have diarrhea/constipation, difficulty swallowing, gas, heartburns and abdominal cramps. There may be sensation of tingling or numbness in various parts of the body. Many patients have super sensitivity to odor, loud noise, bright lights, or even to medicines. Headache and pains in the jaws may also be present.

Sometimes, they have dry eyes or problem focusing on objects that are near, imbalance or dizziness. Others may have palpitation or shortness of breath. Women with fibromyalgia may have urinary complaints, pelvic pains, painful menstrual periods, or even painful sexual intercourse.

Could fibromyalgia be due to some illnesses?

Yes, the following may cause the same symptoms: generalized osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica, polymyositis and other connective tissue diseases, and hypothyroidism. A minority of fibromyalgia cases may be caused by psychophysiologic abnormality.

Does any permanent damage result?

No, permanent damage to any organ in the body results from fibromyalgia. The condition, while chronic and causing many bothersome symptoms, is not life-threatening either.

Does exercise aggravate fibromyalgia?

No. As a matter of fact, exercise is one of the best therapies for fibromyalgia. Starting with gentle, low-impact, stretching exercises, like walking, bicycling and aerobics.

So, what is the treatment for fibromyalgia?

The comprehensive management of fibromyalgia includes ruling out or treating diseases causing the symptoms, reassurance from the attending physician that the condition is benign and not hopeless, stretching and aerobic exercises, local application of heat and gentle massage, improvement in sleep and medications.

Aspirin and NSAIDS (non-steroidal anti-inflammatory drugs) may be tried but they are usually not sufficient. Tramadol, a prescription drug, has been found to help ease the pains.  For severe persistent tenderness, local injection with 1 percent lidocaine (alone or in combination with hydrocortisone) has been effective.

Antidepressants (Duloxitine, Milnacipran, Fluxetine, etc.) and anti-seizure drugs (Gabapentin, Pregabalin, etc.) have also been found useful for fibromyalgia, under the supervision of a physician.

Physical exercise and counseling are vital part of the regimen in the management of Fibromyalgia.

What are the side effects of these drugs?

Some of the side effects of these medications include drowsiness, dryness of the eyes and the mouth, increased appetite, constipation and nightmares. These symptoms are usually worse at the beginning and diminish with time. The best is to discuss the details of the treatment with the attending physician.

What is the prognosis?

Functional prognosis is usually very good with aggressive and comprehensive treatment. Fundamental in the success of therapy is patient-motivation, involvement and discipline. Armed with these three, the person with fibromyalgia is soon on her way to a more comfortable, happier, more productive and a fulfilling life.

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