Fibromyalgia- Causes, symptoms, and investigation

Fibromyalgia is the commonest cause of multi-region musculoskeletal pain, it occurs at any age, and most females are more affected by fibromyalgia more than males. Fibromyalgia is also linked to psychosocial distress, like alcoholism in the family, disharmony in marriage, divorce, assault, low income, and self-reported child abuse. Fibromyalgia is not present mainly in young women but is prevalent in women of more than 50 years. The risk of an increase of fibromyalgia increases with age. Fibromyalgia is not common in children, but can also occur in children.

Fibromyalgia also occurs in patients without any psychiatric problems.

Cause of fibromyalgia:

1. Disturbed sleep: Nonrestorativee sleep or awakening from unrefreshing sleep, is mostly found in patients with fibromyalgia.
2. Reduced pain threshold to pain perception and tolerance at characteristic sites throughout the body is the main feature of fibromyalgia, fibromyalgia affected people have spinal cord pain amplification as evidenced by exaggerated skin flare response to the topically applied capsaicin.

Symptoms of fibromyalgia:

1. Multiple regional pain mostly in the neck and back. The characteristic feature of fibromyalgia is the demonstration of a specific site that is more tender or painful than the same site in a normal person.
2. Fatigue, mostly in the morning is found in the patient with fibromyalgia.
3. Disability, usually the sufferer is unable to perform routine tasks like housework, shopping, etc.
4. Nonresorative broken sleep, due to pain is common in fibromyalgia.
5. Irritability, weepiness.
6. The concentration is poor.
7. Forgetfulness.
8. Morning stiffness.
9. Swelling of hands and finger
10. Numbness, tingling of fingers.
11. Some variable non-locomotor symptoms like hyperacusis, dyspareunia, allodynia (feeling of discomfort on touching), the fullness of urinary bladder, increased frequency to urinate at night, colicky pain in the abdomen, bloating in the abdomen, symptoms of irritable bowel syndrome, non-throbbing pain in a headache which bifrontal in location as in tension headache.
12. The patient may complain about low back pain, which may radiate to the legs and buttocks.
13. The patient may feel colder than other people in the home and some may experience a Raynaud-like like phenomenon or sometimes the actual Raynaud’s phenomenon.

At the start, there is only one or a few regions are involved, but as time passes pain increases its range to both arms legs neck, and back. The pain has one more characteristic that this pain does not respond to analgesics and NSAIDs and it becomes worse with the use of physiotherapy. The patient challenges major difficulties at work because of pain and fatigue.

The patient may complain of pain and tightness in the neck and across the upper back of the shoulders. The patient also complains of pain in muscles even after slight exertion, there is the presence of some pain all the time.

Symptoms of migraine-type headaches are also common, some experience episodes of depression, anxiety, dizziness, and lightheadedness.

Factors that make the symptoms of fibromyalgia worse:

1. Stress
2. Anxiety.
3. Cold, damp weather.
4. Overexertion.
5. Infections
6. Other medical illnesses, surgery, hypothyroidism, and trauma.

Fibromyalgia may be found in some patients suffering from hepatitis C, HIV, Parvovirus B19 infection or Lyme disease, it is also associated with IBS, irritable bladder, headaches, dysmenorrhea, premenstrual syndrome, restless leg syndrome, noncardiac chest pain, etc.

Patients of fibromyalgia sometimes feel better during warm-weather vacations. Symptoms of fibromyalgia increase and decrease in some patients while in some patients symptoms of pain and fatigue are persistent even if treatment is on.

Investigations:

Fibromyalgia is not associated with any abnormality in any medical investigation, even then the full blood count to rule out anemia, ESR, and CRP to rule out any inflammatory disease like ankylosing spondylitis and rheumatoid arthritis, thyroid function test to rule out hypothyroidism.

Diet :

1. A magnesium-rich diet is good for fibromyalgia like:
   1. Green leafy vegetables like spinach, potato with skin, and okra.
   2. Fruits like Avacado, raspberries, figs bananas.
   3. Fish like tuna, and salmon.
   4. Green-colored vegetables like cabbage, peas, and broccoli.
   5. Nuts
   6. Black beans and kidney beans.
   7. Oats, brown rice.
   8. Tofu.
2. Flax seeds and chia seeds provide omega-3 fatty acids.
3. Eggs, tuna, swordfish, and fish oil supplements.
4. Preserved meat and smoked meat are to be avoided.
5. Processed food must be avoided like refined carbohydrates (white flour, white rice, white pasta).
6. Whole grains to be used like wild or brown rice, barley, buckwheat, cracked wheat, millet, and oats.
7. Avoid food that contains Glutamate.
8. Artificial sweeteners to be avoided, and excess sugar must be avoided, in fibromyalgia.
9. Spices like Red pepper, garlic, cloves, ginger, cumin, fennel, and basil can be taken.
10. Food rich in saturated foods must be avoided.
11. Chicken and fish are to be used as they have lean protein.
12. Dairy products that have low fats must be promoted.

Essential oils in fibromyalgia:

Essential oils are not for oral use, they are only for topical use, after mixing or diluting with some carriers like oil like olive or jojoba oil and then apply to the skin with slow movement or by doing slight massage.

1. Ginger oil.
2. Capsicum oil.
3. Nutmeg oil.
4. Cedarwood oil.
5. Eucalyptus oil.
6. Basil oil.
7. Peppermint oil, it can be mixed with eucalyptus oil.
8. Lavender oil.
9. Rosemary oil.
10. Wintergreen oil.