Fibromyalgia - Arun Health Garden

What is Fribromyalgia ?

Fibromyalgia is a chronic pain syndrome. The pain often spreads throughout the body, especially around areas of muscle, tendon, and soft elastic tissue of the body. Symptoms generally arise in the head, neck, and back, but some may experience pain throughout their body. In some patients, pain may also be accompanied by other symptoms such as fatigue, difficulty sleeping, lack of concentration, memory loss, stress and depression etc.

The widespread pain and numerous additional symptoms of fibromyalgia increase the risk of inaccurate medical examinations. Therefore, most patients often get tested more than once. However, if results do not comply with the specific symptoms that are known to be the cause of fibromyalgia, then the patient may not be suffering from illness, but psychologically believe that are sick when they are actually fine.

This situation is quite common, especially in the society where people are not yet familiar with Fibromyalgia. Research concludes that in the USA, Fibromyalgia is a very common health problem, with 2% of the population reporting symptoms that apparently match the syndrome. Found 8 times more frequently in female than males, the disease is most common in middle-aged people from 35-60 years. Disease severity differs between patients; for example, some are able to carry out normal lives unbothered by symptoms, while for others the pain can be so excruciating that it affects their everyday life. As mentioned above, the additional symptoms can also vary between different individuals. In 2011, researchers found that less people in Bangkok (0.6%) have fibromyalgia compared to the USA. However, the problem is still often found in groups where pain is spread throughout the body.

What causes the disease?

Before, it was believed that this disease was psychological. However, new computerized scanning technology showed that symptoms are actually due to the central nervous system (Brain and spinal cord) becoming over sensitive, especially to pain and stress. They also found that chemicals in the cerebrospinal fluid were out of balance. This is a highly sensitive system; so any triggers from cold, light, sound, or physical touch, could easily cause pain. The patient may also be more sensitive to chemicals than normal people, and could worsen if they do not have a strong fighting spirit. Although no definite cause for the abnormality is known, there is evidence to suggest 3 major contributing factors: body, mind and environment.

1. Body Factor: Someone with a previous history of serious trauma, especially involving the brain and spinal cord. Workaholics are also at a higher risk of fibromyalgia.
2. Mind Factor: People leading the following lifestyle and outlook on life are 3 times more likely to suffer from this disease; puritanical, perfectionist and pessimists, Obsessive Compulsive Disorder, paranoia, stubborn, and depression.
3. Society and Environment Factor: A very important factor which explains why city people are more susceptible to Fibromyalgia. City dwellers face a very busy and competitive lifestyle, with long working hours and inadequate rest. Often, they are forced to work harder than the body can handle, and along with the surrounding urban environment, this can decrease the body’s immune system ability to fight disease.

All the factors mentioned above may contribute to causing the disease, as well as influencing its course and development, and the outcome after treatment.

Sufferers of Fibromyalgia may also experience symptoms alongside other present diseases, and at a higher rate than healthy people. For example, Migraine 22%, SLE 22%, myofascial pain 20%, arthritis 14%, anxiety disorder 32%, people who are puritanical, stubborn and people with obsessive-compulsive disorder 23%, and people with depression 15%

If you are unsure whether you have Fibromyalgia or not then here’s some more information for you.

There are currently no lab investigation that are specific enough to identify the disease, so at present, diagnosis is based on analysing symptoms. However, if you are curious then you can do a primary search by screening with the Wisconsin Pain Initiative (WPI) (measuring the widespread of body pain) together with Symptoms severity (SS) of each symptoms, as shown in the table below.

The results will suggest the patient has Fibromyalgia if the information received matches 3 of the following categories

1. Widespread Pain Index (WPI) > 7 and Symtom Severity (SS) Scale > 5 or Widespread Pain Index  (WPI) between 3-6 and Symtom Severity (SS) Scale > 9
2. Patient has been experiencing the same symptoms for at least 3 months
3. There are no other additional symptoms that could explain the origin of the pain.

This method of diagnosis is 88% accurate. However, doctor will consider the need for a laboratory examination on case-by-case basis.

How to cure Fibromyalgia?

As Fibromyalgia is a newly emerging and poorly understood disease, diagnosis can be slow. In Thailand, a lot of patients seeing the doctor for Fibromyalgia have already been experiencing symptoms for over 9 months! Many of them will be feeling confused, worried, hopeless and scared of the unknown, so the first and most important aspect of treatment is to educate and provide patients with reliable information about their disease.

1. Patient should be informed that Fibromyalgia results from over-sensitiveness of the brain system and spinal cord. The chemical level in the brain that connects to the pain and mood receptors is also unbalanced. Moreover, reassure patients that the disease will not result in paralysis, which is what most patients misunderstand and fear.
2. Investigate possible factors from the body, mind, and environment that may have triggered the disease.

The focus of curing the disease is to relieve the symptoms, which is the main concern. General symptoms include pain, sleeping problems, anxiety, and depression. Some patients can be treated with medicine only, while others can be treated without any drug prescriptions. Despite this, research has found that in some cases, treating patients together often produce a more positive outcome that could reduce the amount of drugs required.

Treatment with medicine

• If the pain is the only problem then take painkillers: Minor pain – Paracetamol. Major pain – Tramol (a weak morphine drug that should not be taken continuously over a long time). Do not combine these with other morphines and steroids due to risk of addiction and long-term problems. Painkillers are not recommended because they have low effectiveness and are not worth the risk of developing additional diseases. Only administer painkillers if necessary.
• If the main problem is pain, sleeping disorders or anxiousness, then anticonvulsant drugs are used. These drugs (gabapentin and pregabalin) can reduce the speed of the brain and spinal cell firing.
• If the main probelm is combined pain, sleeping probelm, anxiousness and depression, then anti-depressants are usually the drug of choice. This does not suggest that the patient is suffering from a mental illness, but rather the drug is used for its ability to slow nerve cell conduction. Examples include amitriptyline, duloxetine, milnacipran etc.

Non-medicine treatment

Many treatments can be carried out without the use of medicines.

• Exercise: Many types of exercises (e.g. aerobic dancing) can help with sleeping problems, but start off slowly as the patient’s muscles are sensitive to pain. Exercises in the swimming pool, especially in warm water, can reduce muscle pain from exercising. Yoga and Tai Chi can also reduce aching and stress.
• Massage: Can reduce muscle pain, assist with relaxation, and help patients sleep better. This method of treatment is a very convenient alternative for countries like Thailand.
• Acupuncture: Relieves pain and helps with sleeping problems.
• Meditation: Can alleviate pain from changing of the nervous system, and reduces nerve cell conduction speed. This results in stress reduction, and also helps with concentration, which follows the Buddhist way of life.

Both Medical and Non-medical Treatments mentioned earlier will assist in a reducing central nervous system over-sensitivity, and also help to balance the chemicals in the cerebrospinal fluid and brain ventricles that are controlling mood and pain.

Regardless of the method of treatment, treatment plans should start of slow and gradual to avoid/minimize side effects such as drowsiness, nausea, vomiting, dizziness, palpitations, anxiety, as well non-medical treatment effects including symptoms such as rankle from exercise, intense massage, or acupuncture. Where appropriate, doctors will adjust treatments to follow improvement in symptoms.

Furthermore, new treatments for Fibromyalgia have been introduced. This includes giving pure oxygen therapy under high pressure within a chamber (hyperbaric oxygen therapy), treatment with laser beams (laser therapy), and brain stimulation with electromagnetic waves (transcortical magnetic stimulation). But due to insufficient studies, the outcome of these treatments cannot be clearly referenced yet.

Alternative treatment               

Fibromyalgia is one the many conditions where patients turn to alternative treatment to help cure the disease e.g. massage, acupuncture, and homeopathy.

Can the treatments cure fibromyalgia permanently?   

Our knowledge and understanding of fibromyalgia has steadily improved over the years, but to speed the progress up will require extra effort and cooperation between both patients and physicians.

To help with understanding, the outcome of treatment this disease can be compared to the case of migraine. If medication is adjusted appropriately and the patient learns to avoid or cope with stimulating factors well enough, symptoms will eventually subside and medication even terminated in some cases. Research shows that 24% of patients who underwent at least 2 years of follow-up treatment report diminishing symptoms, and the severity of 47% of those symptoms have been reduced until it is no longer recognized as fibromyalgia. After 2 years of continued treatment, only 10-25% of patients still experience persisting severe symptoms that impair daily life activities. Treatment failure is mainly attributed back to our lack of understanding of the symptoms, which leads to confusion, anxiety, fear, and disillusionment within patients that may cause symptoms to intensify beyond control.

Useful Tips

1. Fibromyalgia can be diagnosed rapidly and treatment often yields good outcomes. If diagnosis has been delayed, treatment can still be done successfully, but may take longer.
2. Observing and identifying the stimulating factors is beneficial to almost every patient.
3. Often, the patient’s state of mind such as anxiety, fear, confusion, impatience, and discouragement are more difficult to cure than pain from the disease itself.
4. Understanding the causative factors and acquiring the skills to deal with symptoms is the key to successful treatment of fibromyalgia.

Arun Health Garden Clinic has a team of doctors and healthcare professionals with extensive experience in comprehensive care, as well as fully equipped facilities, to assist with treatment of patients with chronic pain resulting from fibromyalgia. At Arun Health Garden, we also adopt special examinations to measure the level of energy flow in the body with a BEM machine in order to locate abnormalities in the functioning of various internal organs, as well as rehabilitation through exercise in a heated pool under the professional supervision of a personal trainer.