22-28 February 2013 #644

Fighting fibromyalgia

Treatment shall be focused on improving function and quality of life which includes aerobic exercises and yoga techniques
Dhanvantari by Buddha Basnyat, MD

For 38-year-old Sita Rana the throbbing pain throughout her body was becoming unbearable. In the last three months, she was having difficulties concentrating and sleeping and feeling very tired. She also had a long history of anxiety. Taking ‘brufen’ (ibuprofen) didn’t make her feel any better. During a regular check-up, the doctor discovered tenderness on the muscles of her neck, back, arms, and legs, but there was nothing unusual in her laboratory tests.

Sita suffers from fibromyalgia. It is a common infliction that affects about five to ten per cent of Nepalis and is not specific to geography, ethnicity or climate. The causes are unclear, but the disease occurs in a 9:1 female-to-male ratio and is associated with disturbed sleep and abnormal pain perception as in Sita’s case.

Earlier, the diagnosis criteria for fibromyalgia required patients to demonstrate pain at 11 of 18 tender pre-determined sites (back of neck, arm, hip etc). However, this strict guideline has been left out in updated diagnosis manuals because it led to massive under-diagnosis.

Ten years ago if patients like Sita showed up at our clinics, we would usually refer them to the ‘bone’ doctor (an orthopedic surgeon). Today there are experts like Buddhi Paudyal, a rheumatologist at Patan Hospital, who deal with the disease. But general internists should be able to help patients with fibromyalgia as well.  

Doctors mostly prescribe anti-depressants like amitriptyline which can also double up as pain and sleep medicines. However, since many are still not aware about fibromyalgia, they might recommend pain killers like ibuprofen which have little effect.  

The focus of treatment, however, should not be only to eliminate the pain, but also to improve function and quality of life through various exercises like aerobics and strength training and relaxation techniques like yoga and Tai Chi.