To date, there is an astonishing number of people diagnosed with FIBROMYALGIA. In 2004, the American College of Rheumatology estimates that one in 50 Americans has fibromyalgia. This disorder has been associated with other systemic disorders such as rheumatoid arthritis, chronic fatigue syndrome, ankylosing spondylitis, even systemic lupus erythematosus [SLE]. It is commonly associated with many other conditions but the link between these disorders is poorly understood. It is common among women in child-bearing ages though men may be affected, too. It is the 2nd most common musculoskeletal disorder next to osteoarthritis (ACR, 2004).
Fibromyalgia (FM) is marked by multiple generalized pain, multiple specific tender points, fatigue, disturbed sleep and multiple somatic complaints. It can be misdiagnosed as myofascial pain. The hallmark of FM is widespread multiple tender points whereas myofascial pain is localized and specific to a muscle. Myofascial pain may involve few or several areas with characteristic trigger points that are painful and refer pain to other areas when pressure is applied.
There are multiple risk factors and etiology written as to what causes fibromyalgia. Theories about the risk factors or triggering events for onset of fibromyalgia may include prolonged anxiety and emotional stress, trauma, rapid steroid withdrawal, hyperthyroidism and non viral infections. It is prevalent in minimally fit individuals. Highly trained athletes do not usually develop fibromyalgia. Until the mid 80’s, there was a strong correlation between fibromyalgia and anxiety, depression or other psychological stressors as culprits for developing FM. In the mid 90’s, there were new factors, such as sleep, nociceptive input and neuroendocrine disorders that were linked to the development of FM.
To date, there is no single etiology found, as well as no single “cure.” FM is a chronic condition characterized by generalized and localized musculoskeletal pain. Sleep disturbances, gastrointestinal symptoms, fatigues and ADL impairments accompany this debilitating disorder.
The healthcare clinician is equipped with tools to manage the symptoms and improve the client’s quality of life. It is of utmost benefit to the client if the clinician respects the complexity of this disorder and support the client with a multidisciplinary team approach to manage it.
There are a multitude of resources on managing the different symptoms associated with this disorder made available online. One of the most recent studies conducted by a group of psychologists from Sitrin MedicalRehabilitation Center in New Hartford, N.Y. came up with a clinical pathway of three phases that offer solid treatment options for the client.
Targeted research programs have resulted in significant improvements to the way therapy is being delivered to patients with FM. A multidisciplinary approach that includes physicians, psychologists, occupational and physical therapists is the gold standard for FM management and should be the cornerstone of a successful treatment strategy.
Through information and patient education, people with FM will be better equipped to manage its many effects. The appropriate use of modalities, such as biofeedback, exercise, heat and cold modalities are amongst the physical agents patients are given on the forefront of their symptoms.
Heating modalities can be obtained through infrared lamps, paraffin wax baths, moist heat packs, whirlpool, shortwave diathermy, and ultrasound in the clinical setting. At home, the options are electric heating pads, microwaveable gel packs, hot water baths, or warm compresses. Recently, heat applications are becoming more efficient with Far Infrared Ray technology in heat wraps.
Fibromyalgia is a disorder that warrants the attention and guidance of an interdisciplinary team to manage the patient’s symptoms. Adequate patient education is key to achieving self-sufficiency in managing their own symptoms. With increase in functional skills, patients can resume an active lifestyle, return to work, and recapture the physical and emotional stamina to handle the demands of daily life.
