Fibromyalgia: An Overview

Perhaps most distressing of all these patients are often shunned by physicians and a public who simply don’t understand the disease. Not so here!

Fibromyalgia has for years been a confusing syndrome for patients and physicians alike. Patients often feel misunderstood and marginalized. Physicians are often confused about where the fibromyalgia ends and other comorbid conditions begin. Some even doubt the existence of the disease, severely straining the doctor patient relationship. Recent advances in diagnosis and treatment are however, beginning to demystify the condition and hold out the hope for more rational treatment regimens.

To begin with it appears that fibromyalgia, as many have thought, may not be a single disease, but rather a spectrum of related disorders. The sine qua non of the condition is migratory and variable muscle aches and pains, but studies of the muscles and neuromuscular junctions in the periphery have repeated failed to demonstrate any consistent abnormalities. Relatively new work using functional MRI techniques have shown consistent abnormalities in the brains of patients with fibromyalgia, which appear to correlate with disease activity.

Along with the realization that fibromyalgia may be a functional disorder of the central nervous system, treatment options are also beginning to become clearer. The fact that narcotics have for years been show to be of little or no value while antidepressants and antiepileptic agents are sometimes surprisingly effective suggests a neuropathic condition. But this is a strange form of neuropathy with diffuse, dull, aching pain instead of the usual localized burning or lancinating pain.

Finally certain similarities with arthritic conditions are pointing to a neural feedback mechanism for the disorder and may help to explain some of the similarities when it comes to physical therapy and exercise. We have long known that moderate daily exercise, such as yoga, is probably one of the most positive interventions for anyone with fibromyalgia, but that during exacerbations of their disease even mild exertion seems impossible. Furthermore, patients often seem to “get stuck” in these exacerbations. Even when resting pain begins to ease these patients often find it difficult to return to their previous level of activity despite a strong desire and clear knowledge of past benefits.

In the pages that follow we will explore some of the important new trends in diagnosis and treatment as well current ideas on the pathophysiology of the disease. We will do this because knowledge is always power and especially in disorders as confusing and difficult to treat as this sometimes it is the only thing to hold on to.

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