Physio East Grinstead, Fibromyalgia
Fibromyalgia is a chronic condition of widespread pain and profound fatigue. The pain tends to be felt as diffuse aching or burning often described as head to toe. The fatigue ranges from feeling tired to the exhaustion of flu-like illness.Physio East Grinstead and Horsham.
1 The name fibromyalgia is a combination of three terms-fibro from latin which is fibrous tissue such as tendons and ligament, Greek prefix ‘myo’ indicating muscles and ‘algia’ from Greek indicating of pain.
2 It is known as a syndrome because it is a collection of symptoms rather than a specific disease process that is well understood.Physio East Grinstead & Horsham contact us on firstname.lastname@example.org
The definition of fibromyalgia syndrome (FMS) as stated by the American College of Rheumatology (ACR 1990)3 is as follows:
1. A history of widespread pain for at least 3 months.
Pain is considered widespread when all of the following are present: pain in the left side of the body, the right side of the body, below the waist and above the waist. In addition, there should be axial pain (cervical spine or anterior chest or thoracic spine or low back).
2. Pain (with the patient reporting ‘pain’ and not just ‘tenderness’) in 11 of 18 tender point sites.
The sites are all bilateral and are situated:
- At the suboccipital muscle insertions (close to where rectus capitis posterior minor inserts)
- At the anterior aspects of the inter-transverse spaces between C5 and C7
- At the midpoint of the upper border of upper trapezius muscle
- At the origins of supraspinatus muscle above the scapula spines
- At the second costochondral junctions, on the upper surface, just lateral to the junctions
- 2cm distal to the lateral epicondyles of the elbows
- In the upper outer quadrants of the buttocks in the anterior fold of gluteus medius
- Posterior to the prominence of the greater trochanter (piriformis insertion)
- On the medial aspect of the knees, on the fatty pad, proximal to the joint line
- DIAGNOSTIC CRITERIA
To confirm the diagnosis the concomitant systemic diseases should be ruled out and common coexisting conditions should be recognized.
According to American College of Rheumatology criteria, there should be chronic widespread of pain for at least 3 months on a more or less continuous basis.3
Sign and symptoms
Pain should be present at multiple fibromyalgia tender points when pressure (approximately 4 kg/cm2) is applied manually, with pressure increases gradually at the rate of 1 kg per second over 4 seconds, as depicted in the image below. The pressure should cause no referred pain.5
Besides pain and fatigue fibromyalgia symptom often include:
- Unrefreshing sleep – waking up tired and stiff
- Headaches – ranging from ordinary to a migraine
- Irritable bowel frequent diarrhea or constipation sometimes accompanied by gas in the abdomen or nausea
- Cognitive disturbance including lack of concentration and word mix up
- Clumsiness and dizziness
- Sensitivity to changes in the weather and to noise, bright light, smoke and other environmental factors
PHYSIOTHERAPY ASSESSMENT TOOLSNumerous instruments have been used in clinical trials of fibromyalgia syndrome. Pain – Vastly used and validated methods are
- Visual Analog Scale (VAS)
- Numeric rating scale
- McGill Pain Questionnaire
Many rheumatologists recognize 2 types of fibromyalgia6
Primary fibromyalgia is the most universally accepted form of fibromyalgia and is normally diagnosed when no underlying causes are present (such as arthritis, lupus etc) and at least 11 of 18 designated points are confirmed. The cause of primary fibromyalgia syndrome is unknown but it can be induced by trauma, infection, stress, inflammation or their factors.Secondary fibromyalgia may be triggered by conditions such as RA, Lupus, hypothyroidism, HIV. It may also be triggered by physical trauma. Secondary fibromyalgia is sometimes referred to as post-traumatic fibromyalgia. It is also known as regional fibromyalgia and is present in the patient who experiences pain at fewer than 11 of the 18 positive tender pointsPhysio East Grinstead and Horsham- for more details please visit www.anrc-uk.com.
ANRC Physiotherapy clinic East Grinstead and Horsham
The etiology of fibromyalgia is multifactorial and includes both environmental and genetic factors.
Biologic variablesCertain biologic variables contribute to the development and persistence of fibromyalgia (eg, physical trauma, exposure to toxins).
FMS has a genetic predisposition. First degree relatives of individuals with FMS display an eightfold greater risk of developing fibromyalgia than those in the general population.
Sex-related effects are important in fibromyalgia and with pain in general. Aversive stimuli and stressful tasks are more likely to evoke SNS, HPA axis, and psychological responses in females than in males.
Almost all patients with fibromyalgia sleep poorly, and a night of poor sleep is followed by a more painful day. This contributes to negative mood and cognitive difficulties.
Age is a variable; most cases occur between the ages of 20 and 50 years. Physical de-conditioning is also a variable.
Physiotherapy management of Fibromyalgia please contact Physio East Grinstead