Case study
A 42-year-old female presented at OPD due to muscle pain all over the body since the last 3-4 years. She had been visiting different clinics and hospitals many times for the same problem. All investigations were done; mostly routine blood tests, x-ray chest, ultrasound abdomen, and pelvis Rheumatoid factor, ANA, Anti CCP , TSH, calcium. All the tests showed normal results.

She gave a history of poor sleep and loose stool 2-3 times a day. She received calcium, vitamin D, B12, and E, and other symptomatic treatments like pain reliever, many times. She came to our OPD with all the above-mentioned symptoms. After examination and review of her history, I came to the conclusion that she had fibromyalgia. After we started treatment with Cap Pregabalin and Duloxitine, she became perfectly well, and all her muscle pain problems were resolved.

Fibromyalgia (FMS)
Fibromyalgia is a chronic syndrome that cause muscle pain and tenderness all over the body, along with fatigue. Fibromyalgia is most common in females, though it can also occur in men. It usually starts in middle age. Fibromyalgia does not damage the joints and muscles. If you have other diseases like RA, SLE osteoarthritis, ankylosing spondylosis, etc., you may be likely to have FMS.

The main symptoms of FMS are:
• Chronic widespread pain all over the body. Tenderness on touch at different sites.
• Unexplained fatigue or feeling tired all the time.
• Joints and muscle stiffness.
• Difficulty sleeping.
• Weight gain.
• Pelvic and urinary symptoms.

You may confuse FMS symptoms with other rheumatologic diseases like RA, SLE ankylosing spondylosis, sclerosis, osteoarthritis, etc.

What causes FMS?
Causes of FMS are unclear. It is not due to an autoimmune inflammation of joints or muscle disorder. It can run in families. It does not harm internal organs, and does not cause heart diseases, stroke, cancer, or any physical deformities. A doctor will suspect FMS based on clinical symptoms, such as tenderness to pressure on different points of body parts. There is no specific blood test or other diagnostic tool to detect FMS. The doctor may need different tests to rule out other diseases that can be confused with FMS. Sometimes, drugs like statins (high dose) or prolonged use of steroids may cause muscle pain, which mimics FMS.

Criteria for FMS diagnosis
1. Pain and symptoms over the past week, based on the total of number of painful areas out of 19 parts of the body, plus level of severity of these symptoms:
a. Fatigue
b. Waking un-refreshed
c. Cognitive (memory or thought) problems

Plus number of other general physical symptoms

2. Symptoms lasting at least three months at a similar level
3. No other health problem that would explain the pain and other symptoms

Non Drug Therapies:
There is no permanent cure of FMS. Research shows that the most effective treatment for fibromyalgia is physical exercise. Physical exercise should be used in addition to any drug treatment. Patients benefit most from regular aerobic exercises.
• Stress free
• Good sleep
• Deep breathing exercise
• No alcohol and smoking

For pain, no steroidal anti inflammatory drugs such as Naproxen, indomethacin, etc. For those who cannot take NSAIDs, paracetamol can also be taken. Doctors commonly prescribe medications like duloxetine, amitriptyline, cyclobenzaprine, and pregabalin. Even with the medications, the patient’s self-care is very important. Healthy life style and exercise reduces the pain.

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