Whole body pains- it can be fibromyalgia

Mrs X, looking very worried walked into my OPD chamber with her very concerned family. She has not been keeping well for last few months. Her main problem is having wide spread joints and muscles pain all over her body. She is troubled by sleep disturbance

which makes her feel tired and drained. This is taking emotional toll also as she gets easily irritable. When I examined Mrs X she was very apprehensive and even slightest touch on her joints and muscles will make her scream in pain. Her pain response was out of proportion and her daughter’s expressions said it all. The routine blood investigations done were within normal limits. Everyone believed Mrs X is either over reacting or making up her disease. So what is the problem  here. Mrs X suffers from a very genuine health condition called Fibromyalgia (FM).
Fibromyalgia is a disorder of musculoskeletal system which causes diffuse pain all around the joints and muscles. This does not involve only one part of body like  shoulder or knee only but whole body is affected. There is pain even on lightly touching the affected area. Patient has decreased appetite and always fatigued. For those where symptoms are severe, Fibromyalgia can be debilitating affecting activities of daily life. Pain has been described as stabbing, shooting or deep muscular aching, throbbing, and twitching. This is one of the commonest cause of chronic pain conditions and almost 6 % of population is affected by this. Commonest age at time of diagnosis is between 30-50 years but prevalence increases with increasing age. There is genetic component to this condition. Women who have a family member with fibromyalgia are more likely to have fibromyalgia themselves.

The exact cause of fibromyalgia is not known but association has been reported with a emotionally stressful episode or traumatic events like fall, accident or illness .  For some patients it starts spontaneously. Reserchers are also pointing it to some changes in the genes which make people to react very strongly in more painful way to a stimuli which may be painless for an unaffected person. So this can be due to problem in nervous system about the way pain is received and processed.
New diagnostic criteria were developed by the American College of Rheumatology in 2010 focus upon pain being widespread and accompanied by allied symptoms, such as sleep problems, problems with thinking clearly, and fatigue; lasting for more than 3 months. Since people with FM tend to look healthy and conventional tests are typically normal, a physician knowledgeable about the disorder is necessary to make a diagnosis. Physicians should rule out other causes of the symptoms before making a diagnosis of fibromyalgia.
The treatment for fibromyalgia involves your doctor who has time and patience to deal with this difficult condition along with competency. This is a team approach involving your doctor , physiotherapy, at times a pain management specialist and more importantly “you”. Yours active participation and positive attitude makes a huge impact on outcome. There are some pain killers and anti inflammatory to be used cautiously only under medical supervision for a very short duration. There are some medicines which can help alleviate symptoms. This disease is chronic , has good and bad days but fortunately does not spread to affect internal organs and not fatal or life threatening.
Your positive attitude for life with regular exercises, healthy diet and normal sleep pattern should help you dealing with this condition.