Middle class and middle age women are more prone for fibromyalgia widespread pain
CHRONIC WIDESPREAD PAIN ( FIBROMYALGIA OR FIBROSITIS SYNDROME )
Fibromyalgia is a useful diagnosis of exclusion although it is not universally accepted as a diagnosis.Patients value a name to explain symptoms previously dismissed or attributed simply to psychological or social problems.A typical features of fibromyalgia is tender trigger points.The tenderness is not all over a point which distinguishes it from anxiety states.The patient is usually a middle aged ,middle class woman who struggles on with her work and /or housework despite the pain .
Such individuals are difficult to live with and there is often family discord.Many patients have sleep disturbances ,so they awake unrefreshed and have poor concentration.The pain is a widespread ,unremitting ,aching discomfort.There are often other health problems.Such as chronic fatigue syndrome ,irritable bowel syndrome,premenstrual syndrome ,tension ,headache,anxiety and depression , doctors sometimes inappropriate label them 'heart sink ' patients.The patient's frustration is compounded by the fact that most tests are normal ,and they fear doctors believe it is all in their mind.
The controversial condition of unknown aetiology overlaps with chronic fatigue syndrome,with both conditions causing fatigue and sleep disturbance,Diffuse muscle and joint pains are more constant and severe in chronic widespread pain ,although the tender points previously consideed to be pathognomonic are now known to be ubiquitous ,associated with psychological distress,and of no diagnostic importance .Chronic widespread pain occurs most commonly in woman aged 40-65 years old,with a prevalence in the community of between 1 and 11% ,There are association with depressive and anxiety disorders,other functional disorders ,physical deconditioning and a possibly characteristic sleep disturbance
TREATMENT
The first principle is the identification and treatment of maintaining factors ( e.g dysfunction beliefs and behaviors ,mood and sleep disorders ).
Communication
Explanation of health ,including diagnosis and causes .
Education about management ( including self-help leaflets )
Stopping drugs 9e.g caffeine causing insomnia ,analgesics causing dependence )
Rehabilitative therapies.
Cognitive behavior therapy ( to challenge unhelpful beliefs and change coping strategies ).
Supervised and graded exercise therapy ( to reduce inactivity and improve fitness ).
Pharmacotherapies .
Specific antidepressants for mood disorders ,analgesia and sleep disturbamce.
Symptomatic medicines ( e.g appropriate analgesia ,taken only when necessary ).
Management consist of symptomatic analgesia ,reversing the sleep disturbance,and a physically oriented rehabilitation programme .A recent meta analysis suggests that tricyclic antidepressants that inhibit reuptake of both serotinin and norepinephrine ( noradrenaline ) have the greatest effect on sleep ,fatigue and pain.The doses used were too low for antidepressant efficacy and the drugs may work through their hypnotic and analgesic effects.
A sympathetic approach is appropriate ,with reassurance for the patient that fibromyalgia often improves and is not inevitably disabling.Encouragement should be given to undertake a graded aerobic exercise regimen.When depression is present ,it should be treated ,but potentially addictive anxiolytic agents are best avoided.A behavioral psychologist may persaude the person to pace their life more effectively and to cope better, although patients often resist reffered for psychological help.
DRUGS
Analgesics or NSAIDs help in some cases but are best used intermittently.
Low doses of sedative antidepressant drugs ,such as amitriptyline or dosulepin ( dothiepin ) help when taken a few hours before bedtime .It should be explained that these doses are analgesic and not antidepressant , and their side effects should be outlined.
CHRONIC WIDESPREAD PAIN ( FIBROMYALGIA OR FIBROSITIS SYNDROME )
Fibromyalgia is a useful diagnosis of exclusion although it is not universally accepted as a diagnosis.Patients value a name to explain symptoms previously dismissed or attributed simply to psychological or social problems.A typical features of fibromyalgia is tender trigger points.The tenderness is not all over a point which distinguishes it from anxiety states.The patient is usually a middle aged ,middle class woman who struggles on with her work and /or housework despite the pain .
Such individuals are difficult to live with and there is often family discord.Many patients have sleep disturbances ,so they awake unrefreshed and have poor concentration.The pain is a widespread ,unremitting ,aching discomfort.There are often other health problems.Such as chronic fatigue syndrome ,irritable bowel syndrome,premenstrual syndrome ,tension ,headache,anxiety and depression , doctors sometimes inappropriate label them 'heart sink ' patients.The patient's frustration is compounded by the fact that most tests are normal ,and they fear doctors believe it is all in their mind.
The controversial condition of unknown aetiology overlaps with chronic fatigue syndrome,with both conditions causing fatigue and sleep disturbance,Diffuse muscle and joint pains are more constant and severe in chronic widespread pain ,although the tender points previously consideed to be pathognomonic are now known to be ubiquitous ,associated with psychological distress,and of no diagnostic importance .Chronic widespread pain occurs most commonly in woman aged 40-65 years old,with a prevalence in the community of between 1 and 11% ,There are association with depressive and anxiety disorders,other functional disorders ,physical deconditioning and a possibly characteristic sleep disturbance
TREATMENT
The first principle is the identification and treatment of maintaining factors ( e.g dysfunction beliefs and behaviors ,mood and sleep disorders ).
Communication
Explanation of health ,including diagnosis and causes .
Education about management ( including self-help leaflets )
Stopping drugs 9e.g caffeine causing insomnia ,analgesics causing dependence )
Rehabilitative therapies.
Cognitive behavior therapy ( to challenge unhelpful beliefs and change coping strategies ).
Supervised and graded exercise therapy ( to reduce inactivity and improve fitness ).
Pharmacotherapies .
Specific antidepressants for mood disorders ,analgesia and sleep disturbamce.
Symptomatic medicines ( e.g appropriate analgesia ,taken only when necessary ).
Management consist of symptomatic analgesia ,reversing the sleep disturbance,and a physically oriented rehabilitation programme .A recent meta analysis suggests that tricyclic antidepressants that inhibit reuptake of both serotinin and norepinephrine ( noradrenaline ) have the greatest effect on sleep ,fatigue and pain.The doses used were too low for antidepressant efficacy and the drugs may work through their hypnotic and analgesic effects.
A sympathetic approach is appropriate ,with reassurance for the patient that fibromyalgia often improves and is not inevitably disabling.Encouragement should be given to undertake a graded aerobic exercise regimen.When depression is present ,it should be treated ,but potentially addictive anxiolytic agents are best avoided.A behavioral psychologist may persaude the person to pace their life more effectively and to cope better, although patients often resist reffered for psychological help.
DRUGS
Analgesics or NSAIDs help in some cases but are best used intermittently.
Low doses of sedative antidepressant drugs ,such as amitriptyline or dosulepin ( dothiepin ) help when taken a few hours before bedtime .It should be explained that these doses are analgesic and not antidepressant , and their side effects should be outlined.
Trigger point injections with local anaesthetic,corticosteroids or acupuncture are sometimes helpful.Oral corticosteroids ar not helpful.
