Doctors must approach Fibromyalgi patients, mostly women, with empathy!

Clinicians must be prepared to accept fibromyalgia syndrome as a real condition that exerts a tremendous impact on the patient’s life and must approach with empathy, writes Dr Pushpinder Singh Mehta, Associate Consultant Pain Medicine, Indian Spinal Injuries Centre, New Delhi

dr-pushpinder-singh-mehtaAbout Author: Dr Pushpinder Singh Mehta is working as Associate Consultant in Pain Medicine at the prestigious Indian Spinal Injuries Centre. With a DNB post graduation in anaesthesiology, he has undergone training in Pain Management at Institute of Medical Sciences, Banaras Hindu University, which has the oldest running Pain Clinic in India. Dr Mehta has won some national accolades like Alok Saxena award for best poster presentation on Percutaneous balloon compression for Trigeminal Neuralgia at ISSP (Indian society for study of pain) conference in Nagpur in 2013. He is a member of various professional societies such as Indian Society for study of pain (ISSP) and Indian Society of Anaesthesia.

Fibromyalgia is a chronic pain condition that causes widespread diffuse body pains. It is the most common cause of generalised musculoskeletal pain in women between 20 and 55 years. Many patients also experience fatigue, sleep disturbances, headaches and mood disturbances such as depression and anxiety. Although some degree of muscle pain is always present, it varies in intensity and is aggravated by conditions such as anxiety or stress, poor sleep, exertion or exposure to cold or dampness. Muscle stiffness is typically present upon awakening and tends to improve as day progresses.

Persistent fatigue occurs in more than ninety percent people along with complains of unusually light non-refreshing or non-restorative sleep. Patients may also feel numbness, tingling or unusual crawling sensations in arms and legs. Other pain syndromes such as migraines or muscular headaches, irritable bowel syndrome or urinary complaints such as bladder pain and urinary urgency and frequency are commonly seen.

Fibromyalgia is thought to be the result of change in pain perception, a phenomenon termed ‘Central sensitisation’, which might be due to genetic predisposition, stressors including physical or emotional trauma, sleep disturbances or other medical conditions. There is no specific laboratory or imaging test used to diagnose fibromyalgia as no abnormalities are detected in underlying muscles or other tissues.

Fibromyalgia is a treatable condition. The objectives of treatment are to reduce pain, improve sleep, restore physical function, maintain social interaction and re-establish emotional balance. To achieve these goals patient will need a combination of social support, education, physical modalities and medication. A multidisciplinary team comprising of a Pain Physician, Psychologist and a Physiotherapist would be ideal for managing the condition of patient.

While a positive attitude change is needed in patients, the attitude of family members, employers, policy makers all have an impact on patient’s condition. Clinicians must be prepared to accept fibromyalgia syndrome as a real condition that exerts a tremendous impact on the patient’s life and must approach with empathy. Patients need to be educated and understanding is power when it comes to maintaining a proper attitude, adapting to limitations and taking active role in therapeutic program. Aerobic exercises not only helps to maintain function in everyday activities but also to reduce pain, improve sleep, balance mood, restore cognition and facilitate a sense of well- being. The application of heat in the form of hot bath, hot water bottle, electric heat pad or sauna can relax muscles, facilitate exercise and improve a sense of well-being. There have been new medications that have been developed and tested for this condition which include analgesics, antidepressants in low doses and a few anticonvulsant medications which are useful in managing this condition.

Fibromyalgia should not therefore be a diagnosis of exclusion. A correct diagnosis along with a multidimensional approach to management and with patient and family education and participation can help these patients’ lead better lives.