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Early diagnosis vital

Wednesday 16 December 2009

Pain signalsThe Star Online has an article about the advantages of early diagnosis with Fibromyalgia:

Early diagnosis vital


GIVING a name to the pain you have provides some relief. Although fibromyalgia was known some 20 years ago, most doctors doubted that it was an actual neurological condition. Instead, they put it down as an imaginary one.

Only in the past five to 10 years was the existence of fibromyalgia confirmed, said Dr Henry Lu, head of the Makati Medical Centre Pain Control Clinic in the Philippines.

Dr Lu described fibromyalgia as a chronic pain condition characterised by increased pain sensitivity – the extreme end of a spectrum of abnormal pain perception and processing.

Assoc Prof Dr Pradit Prateepavanich, Thailand’s leading pain specialist, said that for fibromyalgia patients, the severity of pain was more than usual, the distribution was widespread and there was poor response to stress. Dr Prateepavanich, who is also president of the Thai Association for the Study of Pain, said that, on average, 2% of the general population in America and Europe suffered from fibromy-algia.

Data obtained from Pfizer Inc indicated that 1% to 3% of the general population worldwide – that is, 14 to 40 million people – suffered from fibromyalgia.

Dr Lu and Dr Prateepavanich were speaking at a media conference for the regional launch of the South-East Asia Fibromyalgia Awareness, Concerns and Trends Survey (FACTS) in Bangkok recently.

Dr Lu noted that the symptoms for fibromyalgia included sleep disturbance, fatigue, tenderness, stiffness, mood disorders, flu-like aching and headache. Data from the United States showed that muscular pain, fatigue and insomnia were present in at least 86% of patients. Joint pain (72%) and headaches (60%) were the next most common symptoms.

‘Fibromyalgia is a chronic pain condition characterised by increased pain sensitivity,’ says Dr Henry Lu.

A Dutch study of the general population of the Netherlands showed that people felt fibromyalgia was more debilitating than conditions such as knee osteoarthritis, rheumatoid arthritis and osteoporosis.

The exact cause of fibromyalgia is not known but central sensitisation is emerging as the leading theory. Apparently, the brain’s pain receptors show an abnormal increase in certain chemicals that signal pain. In addition, they seem to develop some sort of memory of that pain and become oversensitive despite the pain being relatively milder.

Factors such as gender, genes, trauma or abuse (physical or psychological), infection and persistent stress – or a combination of these – can make one vulnerable to fibromyalgia.

Current data seem to indicate that women are more prone to fibromyalgia. In the United States, for instance, it is estimated that it occurs in 3% to 5% of women compared with 0.5% to 1.6% in men.

In 1990, the American College of Rheumatology (ACR) developed criteria to assess fibromyalgia – the patient must have a history of widespread pain for at least three months. A clinical test was developed to identify fibromyalgia if a patient felt pain upon application of pressure on at least 11 of the 18 tender point sites. Dr Lu added that the test was more for academic purposes. Results had to be taken in consideration with other factors, so a patient with perhaps three tender sites could still be diagnosed with fibromyalgia.
‘For fibromyalgia patients, the severity of pain is more than usual,’ says Assoc Prof Dr Pradit Prateepavanich.

There is another method of testing for fibromyalgia, albeit a costly one. Dr Pratee­pavanich pointed out that a Functional Multiple Resonance Imaging (MRI) would show up distinct traces on certain parts of the brain and this would only appear in patients with fibromyalgia. Besides the prohibitive cost, very few medical facilities have Functional MRIs.

Even so, Dr Lu said better diagnostic tools were needed and physicians needed more training in recognising the condition.

Once the difficulties of diagnosis are tackled, one has to consider the treatment options. Dr Lu said a multi-disciplinary approach was needed. To control symptoms such as pain and fatigue, medications like analgesics, anti-anxiety drugs, muscle relaxants, and anti-depressants, taken in combinations, could provide some relief.

Pregablin [sic] is the first drug to be approved by the US Food and Drug Administration for the treatment of fibromyalgia. It is said to be effective in reducing pain, disturbed sleep and fatigue. It works by modulating the hyper-excited neurotransmitters.

Patients also need to manage fibromyalgia by educating themselves on the condition, doing aerobic exercises, and learning stress reduction through psychological and behavioural management.

The burden is not only physical, mental and emotional; there is also an economic cost involved. A survey done in South Korea last year showed that one in every five fibromyalgia patients were not able to work because of their condition, and a quarter of them stated that they could only work at times. So fibromyalgia also indirectly affects the employers of patients. It is a burden on the healthcare system. Thus early diagnosis is essential on all fronts to reduce unnecessary costs and burdens.

The above originally appeared here.


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