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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Bone, Muscle and Joint Disorders Fibromyalgia diagnosis and treatment

Fibromyalgia diagnosis and treatment

Fibromyalgia is a condition characterized by long standing generalized body ache with multiple tender points where in the pain worsens on pressure

 

Diagnosis

There is no specific diagnostic laboratory test for fibromyalgia. The diagnosis of fibromyalgia is by exclusion. There is high index of suspicion required by the treating physician when treating a case of chronic generalized body pain.

Investigations are done to rule out the other diseases

  • Complete blood count
  • Routine urine examination
  • Blood urea and serum creatinine
  • Rheumatoid factor
  • X- ray examination

AMC criteria for the diagnosis of the fibromyalgia

  • Chronic Generalized body pain for more than 3 months affecting all parts of the body with no specific etiology.
  • Tender points- there are 18 tender points been identified. In 18 at least 11 or more should be tender after applying pressure of 4 kilograms for the diagnosis of fibromyalgia

Treatment

Treatment of fibromyalgia is symptomatic. There is no specific treatment available as no specific cause is identified. Pharmacological and non pharmacological measures are used in combination to get a good control of pain and for a long symptom free period

Pharmacological measures

  • Pain reliving drugs- NSAID’s are the initial drug of choice followed by short course of low dose steroids when needed
  •  Antidepressants- SSRI and SSNRI are used in selected cases
  • Anti seizure drugs- gabapentin and pregabalin are used for the relief of pain 
  • Dopamine agonists-pramipexole and ropinirole
  • 5-HT3 receptor antagonist tropisetron and guaifenesin

Non pharmacological measures

  • Psychological therapy- psychoanalysis and cognitive behavioral therapy (CBT) are offered to people suffering from sleep, cognitive and other mental disturbance.
  • Relaxation and stress management technique-as stress is the responsible for the worsening of the fibromyalgia symptoms.
  • Yoga and pranayama- for anxiety and stress relief
  • Physical massage- threading and knead ling technique for the relief of pain and stiffness
  • Wax therapy,  ultrasound and infra red technique- to relieve pain
  • Acupuncture and acupressure in some cases may relieve pain and discomfort
  • Muscle stretching and strengthening exercise- this if overdone will cause increased pain and stiffness
  • Aerobic exercise and swimming-offer some improvement in the pain and muscle stiffness
  • Diet – a good nutritional balanced diet is required fish oil, magnesium and malic acid has some advantage in reducing the severity of pain.