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Fibromyalgia - also known as Restless Leg Syndrome and Chronic Fatigue Syndrome
Fibromyalgia - also known as Restless Leg Syndrome and Chronic Fatigue Syndrome
By: Daniel E. Batlan, MD
Fibromyalgia is one of the most prevalent causes of pain in North America. The disease affects perhaps five million Americans, and it can lead to functional loss, debilitation and depression.
Fibromyalgia principally is a syndrome in which patients experience diffuse spasm involving most of the large muscle groups of the body. Other names that are commonly utilized in place of Fibromyalgia are Fibromyositis and Myofasciitis. In addition, "Restless Leg Syndrome" and "Chronic Fatigue Syndrome" frequently overlap with Fibromyalgia [and are indeed considered to be different manifestations of the same syndrome by some physicians].
It is incumbent upon healthcare providers to recognize that patients with Fibromyalgia truly do suffer from the pain associated with this disorder. The patient's symptoms must be accepted as genuine as a starting point in the treatment of this disease. I have treated hundreds of patients with Fibromyalgia, and I believe that many of them have demonstrated an excellent clinical response to treatment because they recognize that I understand and empathize with their condition.
Patients who suffer from Fibromyalgia typically complain of aching and gnawing pain in the neck, shoulders, low back, and buttocks. Patient may also complain of radiating pain into the arms and legs. Moreover, patients may describe numbness of the hands or feet. Whereas the numbness that is secondary to "sciatica" [caused by a displaced intervertebral disc] will typically be limited to the distribution of the nerve that is irritated by the displaced disc, the "numbness" that patients describe in Fibromyalgia is more diffuse - involving the entire hands and feet in a diffuse manner. Finally, patients almost uniformly describe generalized weakness.
Patients who suffer from longstanding Fibromyalgia often present with functional compromise as well as psychological impairment. Their ability to pursue daily activities is often diminished - whether engaging in recreational activities with their family or maintaining employment that requires prolonged standing, walking, or exertion. In addition, patients may experience anxiety, depression and even panic attacks.
The treatment program for Fibromyalgia has three [3] goals:
- Reducing or eliminating pain
- Improving functional capacity
- Attention to psychological support.
Specific treatments for Fibromyalgia include: Medication Management, Physical Therapy, Swimming Therapy, Biomedical Electronic Devices [e.g. TENS Unit], Nerve Blocks [e.g. Epidurals], and Psych Counseling.
The role of Physical Therapy or other exercise program cannot be overemphasized. Patients should replace a sedentary lifestyle with a more active routine that includes regular exercise. Indeed, many physicians believe that a formal Physical Therapy program is a cornerstone of treatment for Fibromyalgia. In order to provide adequate pain relief such that patients can participate in an exercise program, the judicious use of medications [including agents that treat muscle spasm as well as low dose narcotic analgesics] are often utilized.
However, for many Fibromyalgia sufferers, a variety of simple procedures such as Epidural "Cortisone Injections" can provide much more profound and immediate relief than medications. An Epidural is a comfortable procedure in which medications are injected in order to "calm" irritated nerve fibers that are responsible for the transmission of pain. Epidurals and other "Nerve Blocks" are conveniently performed on an outpatient basis using local anesthesia and intravenous sedation.
A TENS Unit is a biomedical electronic device that is simple to use and often quite effective.A TENS Unit is a battery operated device the size of a cellular telephone, and it can be worn on the patient's belt. Small wires connect the TENS Unit to pads that can be placed on the body overlying areas of muscle spasm. TENS Units are effective in diminishing the gnawing and burning pain of large muscle groups in Fibromyalgia.
Finally, anxiety and depression are often reactive to [or secondary to] the longstanding pain associated with Fibromyalgia. Attention to psychological support must be given whether, through formal Psych Counseling or the use of antidepressant medications.
Often, people who suffer from longstanding Fibromyalgia consider their situations to be hopeless. However, there certainly is hope for these individuals, and physicians who are knowledgeable about and empathetic to the condition of Fibromyalgia patients can make a significant impact in their lives.
Daniel E. Batlan, MD
Daniel E. Batlan, MD
Medical Director
Specialized Pain Management
Doubly Board Certified
The American Board of Anesthesiology
The American Academy of Pain Management
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