Neurological Disorders: Fibromyalgia

Fibromyalgia is not an uncommon health condition and is characterized by chronic pain syndrome & other myriad neurological and non neurological manifestations. What exactly causes this condition is still not clear and it is more common in women than men. A Neurologist is frequently involved in the care of these patients.

There is a growing tendency in the medical community to accept that this condition is not psychiatric, rather medical in origin. The chronicity & general refractoriness on the back ground of an otherwise normal neurological examination gave a notion that this condition is non-organic in nature.

Although still there is no compelling evidence at this moment to show that it is indeed a non psychiatric medical condition however there is growing consensus in this direction.

The following symptoms are somewhat typical including;

• Chronic diffuse pain
• Headache
• Numb feeling
• Tingling (pins & needles)
• Chronic fatigue or tiredness
• Disrupted sleep pattern etc

The pain is diffuse and generally can involve almost any area on the body including arms, legs, muscles, joints, back, neck, head etc. On examination many of these patients reveal what are called as tender spots, and on pressing these areas one can precipitate or exacerbate pain.

There is increased incidence of certain health conditions in these patients and few examples include;

• Depression
• Anxiety disorder
• Migraine headache etc

Although the scientific community is more & more accepting this condition as a real disease but as to what causes it is still a mystery. One thing commonly noticed in these patents is chronic pain and it is assumed that there is a heightened pain perception in these patients. But whether this derangement originates in the brain or periphery, or both and also what neurochemicals are invoved in mediatng the symptoms are not known yet.

Currently this is a rule out condition; means before declaring somebody as having this disease it is necessary that all the known conditions that precipitate pain are ruled out. It is a common practice to order a bunch of blood tests, special neurological investigations, radiological tests etc to rule out these other conditions like neuropathies, MS (multiple sclerosis), rheumatoid arthritis, lupus, spine diseases etc. The presence of tender areas further strengthens the diagnosis.

It is a chronic health condition that can cause significant disability in the personal, social and professional spheres of life of an affected individual due to varieties of long standing and nagging symptoms as discussed above.

The diagnosis is done on a rule out basis means we need to make sure that patient is not suffering from any diseases that mimic this condition (examples mentioned above). So after thorough clinical examination a bunch of tests are ordered. Generally these tests include Vitamin B12, Folate, ESR, RA factor, ANA, RPR, thyroid tests, EMG/NCS (electromyography and nerve conduction studies), an MRI of the brain and/or spine, r-ray of joints depending upon the clinical presentation. Not every patient will require all these investigations.

There is no curative treatment for fibromyalgia so the treatment is symptomatic and supportive.

This may include (prescribed on case to case basis);

• NSAIDs like tramadol
• Nerve pain pills gabapentin, pregabalin, duloxetie, milncipran
• Amitryptiline
• Muscle relaxants like baclofen, tizanidine
• Anti anxiety agents
• Anti depressants
• Physical therapy
• Massage therapy
• Frequent reassurances etc.