Body pain

Dr Arun Oommen | 01-June-2014

Detailed News

Dr Arun Oommen,
Consultant Neurosurgeon,
Lakeshore Hospital and Research Centre,
Kochi 

I’m a 44 year old lady.I have been having recurrent pain over back, neck and shoulder for a long time . There is also tingling sensation over feet, thigh and hands. I don’t feel any weakness but this sensations prevent me from doing my work properly,… I even can’t sleep properly  on many days. I have consulted many doctors. Even an MRI of spine was done which does not show any major problem… What is my problem and how can I get rid of it?

Rajani Suresh , Abu Dhabi

Your problem seems to be Fibromyalgia which is a common and disturbing ailment. Fibromyalgia is estimated to affect 28% of the population, with a female to male incidence ratio of approximately 9:1. Fibromylgia is basically a functional somatic syndrome ie a physical response to depression and stress.

Exact cause is unknown but is believed to involve psychological, genetic, neurobiological and environmental factors. The same genes causing fibromyalgia  are also associated with other functional somatic syndromes and major depressive disorder. The central symptom of fibromyalgia, namely widespread pain, appears to result from neuro-chemical imbalances including activation of inflammatory pathways in the brain which results in abnormalities in pain processing..

Fibromyalgia patients have a lower threshold for pain because of   increased reactivity of pain-sensitive nerve cells in the spinal cord or brain . Neurochemical abnormalities that occur in fibromyalgia also regulate mood, sleep and energy, thus explaining why mood, sleep and fatigue problems are commonly co-morbid with fibromyalgia

Mode of inheritance is currently unknown, but it is most probably polygenic

Clinical presentation

Fibromyalgia is  characterised by chronic widespread pain and allodynia (a heightened and painful response to pressure. Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some people also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling and cognitive dysfunction. Pain may be localised in areas such as the shoulders, neck, low back, hips, or other areas. Not all people with fibromyalgia experience all associated symptoms.

Precipitating/associated factors

Fibromyalgia is frequently associated with stress-related disorders such as chronic fatigue syndrome, posttraumatic stress disorder, irritable bowel syndrome and depression A systematic review found significant association between fibromyalgia and physical and sexual abuse in both childhood and adulthood,. Poor lifestyles including being a smoker, obesity and lack of physical activity may increase the risk of an individual developing fibromyalgia

Treatment

No universally accepted treatment for Fibromyalgia..more over response to treatment is all poor and inconsistent. Treatment plans that incorporate medication, patient education, aerobic exercise and cognitive-behavioral therapy have been shown to be effective in alleviating pain and other fibromyalgia-related symptoms

Cognitive Behavioural Therapy and related psychological and behavioral therapies have a small to moderate effect in reducing symptoms of fibromyalgia. The greatest benefit occurs when Cognitive Behavioral Therapy  is used along with exercise

Medications

Commonly used include anti depressants like duloxetine and milnacipran and the tricyclic antidepressants (amitriptyline) Anti-seizure medication like gabapentin and pregabalin may be used. Weak opioid like tramadol may be tried but not strong opioids..The combination of tramadol and paracetemol has demonstrated efficacy. The use of NSAIDs is not recommended as first line therapy. A combination of antidepressants and anti epileptics for 3-6 months may be required to produce some improvement in symptoms

Exercise

Improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia In particular, there is strong evidence that cardiovascular exercise is effective for some patients. Long-term aquatic-based exercise has been proven beneficial as it combines cardiovascular exercise with resistance training

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