Is fibromyalgia pain real?
Fibromyalgia syndrome (FMS) is a widely misunderstood and sometimes misdiagnosed chronic condition, commonly characterized by widespread muscle pain, fatigue, concentration issues, and sleep problems. It is a common medical condition with prevalence ranging from 2% to 12% in the general population. Middle aged women are four to seven times more likely to be affected than men of similar age. The risk factors for the development of fibromyalgia may include physical trauma, febrile illness or a family history of fibromyalgia.
Patients complain of widespread body pain present for more than three months but the clinical manifestations are usually more complex than body pain alone. Patients often describe disordered sleep, fatigue, cognitive dysfunction, dizziness, stiffness, headaches, depression, dysesthesias or burning sensations in the hands, irritable bowel/bladder syndrome.
The sensations that a fibromyalgia patient experiences as pain are as real as any other pain. The current consensus is that fibromyalgia is not a problem with the muscles, joints, or tendons, but rather a problem with the central nervous system. It is most likely a result of Central sensitization, or unusual responses in the nervous system with regard to pain perception. There seems to be an increased release of substance P after painful stimulus or even in the absence of stimulus. In addition, the brain’s regulatory effect, which sends “down signals” to turn off pain, also appears to be abnormal in patients with fibromyalgia – so when a painful stimulus does occur, it gets amplified rather than dampened.
The management of fibromyalgia is multidisciplinary. The objective is to reduce pain, improve sleep, restore physical function, maintain social interaction and re-establish emotional balance. A six step outline of therapy called ADEPT (attitude, diagnosis, education, physical modalities, treatment with medication and living) is mostly used to manage fibromyalgia. The medications which include analgesics, antidepressants and anticonvulsants are used along with various lifestyle changes to control various symptoms.
Fibromyalgia is thus not a diagnosis of exclusion and the suffering is real. Patients should be recognized early and guided for appropriate management so as to help them lead better quality of life.