Archive for November, 2009

FIBROMYALGIA: The Bane of Modern Society

Friday, November 6th, 2009

Dr. Sanjay Kumar, MD,
New Bern Medicine and Sports Rehabilitation

You might have it and not even know!!

Chronic pain is one of the most pervasive and intractable medical conditions.  Fibromyalgia afflicts more than 6 million Americans (Newsweek, June 4, 2007)

Fibromyalgia is a commonly encountered disorder that can be very disabling, with widespread musculoskeletal pain and stiffness.  The disease generally presents insidiously but in many cases is triggered by emotional stress, medical illness, surgery, hormonal and endocrinal disorders and trauma.

Fibromyalgia generally affects women nine to ten times more commonly than men.  It can have a varied presentation and generally runs a long protracted course over decades and can remain undiagnosed for many years causing untold suffering, pain and anguish not only to the patient but also their families and can exact a heavy toll from society.  The prevalence rates in certain specialized clinics can be as high as 20%.

Fibromyalgia can affect all aspects of the patient’s life: their job, their family life, their recreation and even their sleep.  Dr. Kumar mentions, “To add to the patient’s misery, they get told by their near and dear ones that they look fine, that it’s all in their head or that they are just lazy and making excuses.”

Dr. Kumar states that fibromyalgia can have a very varied presentation but generally presents with diffuse aches and pains along with stiffness most marked in the trunk, hip and shoulder girdle areas.  Other patients complain of low back or neck pain with some radiation into the legs and the arms and stiffness in the shoulder areas.  Patients also complain of specific muscle pain and easy fatigability even after mild exertion.  Some degree of baseline pain is almost always present.  Some of the other symptom of fibromyalgia are prolonged sleep latency, light interrupted sleep, unrefreshing sleep, persistent headaches, irritability, nervousness, depression, difficulty concentrating, chronic fatigue, lack of energy (especially in the afternoon), irritable bowel syndrome, cold hands and feet and tingling in the extremities.

Dr. Kumar further adds, “As one of my patients so aptly puts it: “fibromyalgia feels like the arthritis of the muscles.”  The etiology of fibromyalgia remains an enigma.  Many different theories have been suggested ranging from complex sleep cycle disturbances in REM and NREM sleep with alpha wave intrusions, complex neurotransmitter changes involving Substance P, altered growth hormone curve with the circadian rhythm, diminished cortisol response to CRH, autonomic dysfunction and many more.

The diagnosis of fibromyalgia requires a physician who has had experience in dealing with and treating fibromyalgia patients, having a high index of suspicion regarding fibromyalgia and taking your time with the patient to be able to get a detailed history and do a thorough physical examination.  “There is no substitute for the latter two things even in this era of modern medicine,” adds Dr. Kumar.  He further states, “If you feel that you might have fibromyalgia, it is imperative for you to go and see a physician who specializes in the diagnosis and treatment of fibromyalgia.  Many autoimmune and mixed connective tissue diseases and chronic infectious diseases present with signs and symptoms like fibromyalgia.  It is important to distinguish between the two because treatment is radically different.”

With regards to treatment for fibromyalgia, Dr. Kumar states that the word “cure” should be used cautiously.  The word “control” is more appropriate.  An integral part of the treatment requires medications to alleviate depression and anxiety and more importantly to correct the altered sleep pattern.  Physician prescribed and supervised exercise program (word of caution, some exercise programs can hurt fibromyalgia patients and make their malady worse!), physician prescribed manual therapies focusing on myofascial release trigger point therapy and deep tissue mobilization, some physical therapy modalities and trigger point injections for persistent sore spots in the muscles.”  Majority of my fibromyalgia patients have had a significant reduction in their pain levels and have been able to function better in everyday life.” states Dr. Kumar.

At New Bern Medicine and Sports Rehabilitation you can get these entire treatment options conveniently under one roof.  For questions and inquiries and to schedule your appointment, please call Dr. Kumar at (252) 635-1699.