Doctor – Is My Pain Real?

Gone are the days when fibromyalgia was a catch-all label for the difficult to diagnose patient with multiple pain symptoms.

Fibromyalgia is real and doctors no longer have the excuse of it just being pain that is all in the head.  It is surprisingly common and occurs in 2-4% of the general population with it being four times more common in women.

Fibromyalgia is a disease in its own right. Now that it is recognised as so, there is no excuse for neglect of people who suffer from the often characteristic debilitating pain.

Diagnosis of fibromyalgia is no longer by exclusion of other causes of pain. There are associated symptoms.

It is clinically defined as widespread pain above and below the waistline that lasts for 3 months or more and the presence of plus the finding of 11 positive out of a possible total of 18 tender points.

These tender points are painfully sensitive to touch. They are in the soft tissues and muscle areas and are separate to joints. Joint pain is characteristic of arthritis.

Fibromyalgia tender points occur in:

  • Front of the neck.
  • Front chest area near the second rib.
  • Back of the neck.
  • Near the back of the shoulder.
  • In the area of the shoulder blade.
  • Near the elbow.
  • At the top of the buttocks.
  • The back of the hip.
  • Around the knee.

Fibromyalgia can be a complex syndrome with many different symptoms and features. As well as pain there may be other symptoms including dizziness, sore throat, breathlessness, chest pain, features of IBS, increased sensitivity to temperature changes, bright lights, strong smells and loud noises and multiple food allergies.

It also may overlap with chronic fatigue, headaches, and chronic back pain. And it may co-occur with other conditions such as arthritis and iron overload.

Up to half of the cases of fibromyalgia may arise spontaneously with no known cause or reason. However, there are abnormalities seen in the nervous system and in specific neuroendocrine chemicals – these are hormones produced as part of the functioning of the nerves.

Specific anomalies have been seen in the brain and in the pituitary gland of people with fibromyalgia using medical imaging techniques. Some of these areas are involved in the normal pain pathways. It is thought that fibromyalgia may be a disease in which these pain pathways go array.

If a patient has a history of pain, stiffness and fatigue, along with the finding of the non-specific tender points on examination then a diagnosis can be made.

Making a diagnosis will aid in the treatment. In some patients, physiotherapy, water therapy or treatment with specific antidepressant drugs called tricyclics can help alleviate the pain.

Fibromyalgia can cause significant impairment. Making a diagnosis gives the patient back some control over their illness and stops them from being sent around the houses and removes their uncertainty about the illness and perhaps the worry that it has a more sinister cause.



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