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Dealing with fibromyalgia

Tuesday, April 17, 2018

Medication and meditation can work wonders in relieving pain, says Dr Naresh Shivdasani

Orthopaedics is often perceived by the layman as something to do with bones and fractures. Most Orthopods do, in fact, practice mainly fracture treatment and surgery.

There is however, a world of pain out there, where the patients suffer not from bone pains but from pain in the muscles and limbs. Many patients go from doctor to doctor to get relief. X-rays, blood tests and MRIs are done, money is spent in huge amounts in order to get some diagnosis. Many patients are diagnosed as having a 'disc' or 'carpal tunnel syndrome' and are subjected to surgery, with no relief of symptoms.

The purpose of writing this article is to educate suffering patients on the disease of Fibromyalgia. This term was coined in 1990, and was found to be a condition in which normally used medicines like Non-steroidal Anti-inflammatory Drugs (NSAIDS) were not effective. Ibuprofen, Diclofenac and the like are NSAIDS. These are commonly used to treat painful conditions. However, when a patient is taking medicines without much effect, there are usually negative thoughts generated in the patient's mind. 'Am I suffering from cancer or some incurable disease?' 'Can the doctor not find the cure?'

Chronic pain generates feelings like—the pain is due to 'Punishment for past actions—Karmo Ka Phal!' That the pain is due to the aging process, and such pain is to be expected with age. Many patients feel that death is near and go into depression. There is fear of taking medicines, especially Opiods, or 'strong' medicines which can cause a reaction. There is a fear of a serious illness being diagnosed if more tests are done. The man of the house especially has a fear of being considered ‘weak’.

Pain has its advantages too—spouse and children show more concern. At work it can be an excuse for leniency from tough deadlines and assignments. Pain can be fun!

Fibromyalgia is a common entity, often misdiagnosed and misunderstood.
Common symptoms Patients wake up totally unrefreshed. The whole body feels stiff in the morning, there may be numbness of hands and normal everyday sounds are disturbing. It is common in child-bearing age.  Headaches, stomach cramps and running to the toilet often are also seen. The symptoms worsen in cold and damp weather. It is a common cause of chronic pain and doctors’ visits. There is loss of sleep and depression.

Patients come with a long list of investigations and thick files, having seen multiple specialists. Many have surgeries done—i.e. carpal tunnel, spine, appendix, urinary bladder or gall bladder. If an X-ray shows changes of degeneration (spondylosis), it is seen as the causative factor and treatment given for spondylosis. Examination of the spine and neurological status need to be seen. Usually signs of depression are present, in a female anxious patient. Though there is a blood test for diagnosis, it is not available in India. (It is also very expensive). Other diseases like hypothyroidism, Vitamin D insufficiency, hyperthyroidism, hypervitaminosis D, primary muscle diseases such as Polymyositis, Malignancy, and viral diseases like Hepatitis and AIDS need to be ruled out.

There are 18 symmetrical tender points on the body and if 11 are present, the diagnosis is more or less confirmed. Ortho surgeons give local steroids in the tender points. Patients do feel better after this.

Management Reassurance is important as patients have fear of cancer or other serious disease. Management includes gentle exercises and stretching taught in spite of pain.

Many patients ask if hot fomentation or cold fomentation should be used.  Fibromyalgia patients tolerate heat better than cold. Acupuncture and spinal manipulation also help in relieving the symptoms. Swimming in a heated pool would help.

Relaxation techniques should be learnt for pain relief. The workplace should be organised so that there is less chaos, hence stress is also reduced. Lifestyle changes need to be done. Stressful situations should be handled calmly, without getting agitated. Drugs like ibuprofen and diclofenac (NSAIDs) do not work, hence paracetamol and muscle relaxants should be used. Medication and meditation can work wonders.

Dr Naresh Shivdasani (D.Orth, M.S. (Orth) is a Senior Orthopaedic Surgeon, with interest in Acupuncture and Spinal Manipulation. He believes that most disease originates from stress and lifestyle issues.

Short Takes

  • The term Fibromyalgia was coined in 1990, and was found to be a condition in which normally used medicines were not effective.    
  • Management includes gentle exercises and stretching taught in spite of pain.
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