You Might have a Condition Known as Fibromyalgia
No one relishes aching all over for days or weeks on end, finding relief only when – and if – you’re able to sleep. After what often seems like an eternity of suffering (which was really only a few days), you wake up feeling better once the virus has run its course. It’s possible that you might have a condition known as fibromyalgia.
At one time or another, you probably have heard or read about fibromyalgia. People who live with fibromyalgia feel like they have the flu almost every day. Fibromyalgia is not a disease, but rather a disorder grouped with arthritis and other rheumatological disorders that afflict an estimated one in 50 people in the United States with widespread, chronic pain. Research dates back to the 1800s.1,2.
Providing dental services to patients living with fibromyalgia can be a challenge to both the provider and the patient. Patients typically are plagued with chronic, widespread pain, lethargy (commonly referred to as “fibro fog”), and depression. These symptoms are exacerbated by physically or emotionally stressful events and changes in weather and/or temperature. The symptoms often exhibit no discernable pattern whatsoever. Frankly, it’s difficult to predict how patients will respond to different stimuli.
What if a dental hygienist begins to exhibit signs of fibromyalgia? Will he or she be able to overcome chronic pain, fibro “fog,” and depression and remain a valuable, contributing member of the dental team?
What do we know about fibromyalgia?
Fibromyalgia is a complex condition considered to be a form of soft tissue rheumatism. The word “fibromyalgia” is derived from both Greek and latin. Fibromyalgia is considered a systemic pain condition, because symptoms are generally found throughout the body.
Other common symptoms of fibromyalgia include: chronic fatigue, difficulty sleeping, stiffness, headache, pain during menstruation, dizziness, digestive problems, numbness, tingling, sensitivity to weather and temperature changes, and mood changes.5 Because people are often uneducated about the condition and there are no clinically visible symptoms, people suffering from the symptoms of fibromyalgia often find their complaints dismissed by others, even by health-care providers.
Who is at risk?
An estimated 3.5 million Americans are burdened with fibromyalgia. Almost anyone can develop fibromyalgia, women are seven times more likely to develop fibromyalgia than men 4 and are most commonly diagnosed between the ages of 20 and 45.6 Fibromyalgia is strongly linked to stress; however, it does not appear to have a link to perimenopause or menopause (although little research has been done in this area).6 After 200 years of research, the etiology of fibromyalgia is unknown. The most commonly accepted hypothesis is that certain factors such as stress, poor or inadequate quality sleep, and physical or emotional trauma may trigger the condition 5.
What is the diagnosis?
It is not uncommon for five years to pass before a diagnosis is made.3 Chronic pain can be a symptom of a multitude of diseases, injuries, and an adverse side effect of medications. Health-care providers agree that a rheumatologist is the best trained medical provider to treat fibromyalgia; however, many of the tests needed to eliminate other possibilities could (and should) be provided by a primary health-care provider.
A physician’s diagnosis of fibromyalgia is based upon widespread pain and tenderness, but only after he or she has tested for and eliminated the possibility of other conditions.5 In 1990, fibromyalgia was officially recognized as a rheumatological disorder and a list of trigger points and tender points were established to confirm diagnosis. The National Fibromyalgia Research Association offers a detailed description of trigger points at http://www.nfra.net/fibromyalgia_trigger_point.php.
The role of depression
It is possible that depression is the result of a chemical imbalance that may cause the pain associated with fibromyalgia; however, depression is often an inevitable complication when a person is exposed to long-term pain. Antidepressants, exercise, professional counseling, and support from friends, family, and co-workers have proven to be beneficial.
Many believe disturbed sleep cycles contribute to fibromyalgia. Many of the treatments for fibromyalgia include medication or biofeedback therapy that is geared toward enhancing sleep cycles. Caffeine (coffee, tea, chocolate, etc.), nicotine, and alcohol should be limited and avoided near bedtime to avoid insomnia.
Stress and mental clarity
As with many other chronic diseases, stress can initiate a flare-up of symptoms. Although stress is an inevitable part of life, removing as many unnecessary stressors as possible can reduce the severity and frequency of flare-ups. Meditation and light exercise will help victims cope with the stresses that come their way as well as beat the fibro “fog.”.
Several prescription medications have been used to treat the symptoms of fibromyalgia. The most common are trycyclic antidepressants. Trycyclic antidepressants reduce pain by interfering with the chemical processes in the brain that allow victims to feel pain as well as depression. Common forms of trycyclic antidepressants include: Amitriptyline (Elavil), Desipramine (Norpramin), Doxepin (Sinequan), Imipramine (Tofranil), Nortriptyline (Aventyl, Pamelor), and Protriptyline (Vivactil). Tryclyclic antidepressants do not create a chemical dependency, but they can cause drowsiness. Other side effects include: xerostomia, constipation, difficulty with urination, weight gain, and changes in blood pressure.
Side effects usually manifest quickly after the initiation of antidepressant therapy, it can take several weeks before pain relief occurs. Because various drug therapies work for some people, but not others, several different medications are often used until one is found that eases the symptoms of fibromyalgia.
Other common prescription medications that prove to be useful are muscle relaxants, antiepileptic and antianxiety medications, sleep enhancements, and prescription pain medicine – each having similar adverse side effects as antidepressants.
Several over-the-counter medications (aspirin, ibuprofen, and acetaminophen) can eliminate or reduce pain short term, but the long-term side effects should be discussed at length with a physician. In addition to over-the-counter analgesics, some patients have found relief with cold medications (guaifenesin and some antihistamines).
In addition to medications, massage therapy, meditation, and acupuncture are often helpful. Direct application of heat – either dry heat from a heating pad or moist heat from a hot/wet cloth, steam, or a hot bath – usually will provide some relief. Topical, over-the-counter ointments that contain minute amounts of anesthetic used for aches and muscle strains work well for some patients living with fibromyalgia.
An exercise program has to be initiated slowly to avoid exacerbating symptoms, mild aerobic exercise has been proven to provide some relief. When they feel good, they tend to do all they can, which then typically results in several bad days.
People who live with fibromyalgia feel like they have the flu almost every day. Fibromyalgia is not a disease, but rather a disorder grouped with arthritis and other rheumatological disorders that afflict an estimated one in 50 people in the United States with widespread, chronic pain. Fibromyalgia is considered a systemic pain condition, because symptoms are generally found throughout the body.
Almost anyone can develop fibromyalgia, women are seven times more likely to develop fibromyalgia than men4 and are most commonly diagnosed between the ages of 20 and 45.6 Fibromyalgia is strongly linked to stress; however, it does not appear to have a link to perimenopause or menopause (although little research has been done in this area).6 After 200 years of research, the etiology of fibromyalgia is unknown. Several prescription medications have been used to treat the symptoms of fibromyalgia.