Is Fibromyalgia a Disease?

Physiotherapy in Burlington for Fibromyalgia

Scientists are slowly uncovering the mysteries of fibromyalgia syndrome (FMS). Instead of seeing this condition as a painful musculoskeletal problem, it's looking more and more like a complex nervous system disorder affecting (in part) how pain messages are processed.

Pain has always been a key feature of fibromyalgia. For a long time, diagnosis has been based on the number and location of tender points. But with the presence of anxiety, depression, and sleep problems, there's been a shift away from diagnosis by tender points to a more whole person approach.

Besides the typical physical symptoms that characterize fibromyalgia syndrome, there's also a common past history (e.g., abuse, prematurity, growing pains as a child) and possibly some environmental factors. But since the past can't be changed, treatment is now what we call multimodal management. That means the many problem areas are addressed all at the same time instead of just treating the painful symptoms.

Patient education is first and foremost for a successful outcome. Affected individuals must understand that their pain, depression, and fatigue can be improved but it may take weeks to months. Patients must be patient with the process.

Moderately intense exercise is prescribed and supervised by a physiotherapist. Having a therapist guide individual patients to find the optimum program that works for them is essential. Exercise will help reduce pain and depression, as well as improve sleep. Getting good sleep at night also improves muscle pain and boosts mood.

High-intensity aerobic activity is not the goal. In fact, patients are advised to avoid intense exercise. It's far better to establish a consistent program of 20 to 30 minutes of physical activity and exercise four to five times each week than to start off at a pace patients can't keep up with.

There are many things patients with fibromyalgia syndrome can do to manage their own symptoms, In addition to regular exercise, attending a local support group can give patients a place to vent their frustrations and worries, meet other people with similar symptoms and challenges, and find out what others are doing that's working. Support groups help everyone stay on target with their program and are considered a very valuable part of disease management.

So, is fibromyalgia syndrome a disease? If the term disease is used to describe a condition in which the body-mind complex is not at ease, then yes, fibromyalgia syndrome can be considered a disease. We have certainly moved away from seeing this condition as one defined (and diagnosed) just by tender points of the muscles.

Recognizing the diagnosis requires more than identifying tender points, new tools are being used to objectively assess patients. A new scale called the symptom intensity scale (SIS) charts regional areas of pain, measures pain levels, and monitors fatigue. Other ways to assess mood, quality of life, and function include the Mood Disorder Questionnaire (MDQ), Patient Health Questionnaire (PHQ), Sleep Scale, and Fibromyalgia Impact Question (FIQ).

What's next for patients with fibromyalgia syndrome? Until more is known about how pain is processed and what goes wrong, we can't fix or cure this condition. The focus will remain on examining different treatment approaches and objectively measuring results. There may be one best treatment method that can be used with all fibromyalgia patients. But for now, it looks like management will remain multimodal and individualized for each patient.

Reference: Atul Khasnis, MD, and William S. Wilke, MD. Diagnosing Fibromyalgia: Moving Away From Tender Points. In The Journal of Musculoskeletal Medicine. April 2010. Vol. 27. No. 4. Pp. 155-162.

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