Physiotherapy in North America for Fibromyalgia

Q: I am seeing an internal specialist to try and find out what's causing my muscles and joints to ache so. I'm stiff, tired, don't sleep well, and I've lost my appetite. She tells me it might be fibromyalgia because my tests all came back normal. What if it is fibromyalgia? What happens then?

A: Fibromyalgia is a medical term for a condition of aches and pains all over the body along with a laundry list of other symptoms. It can present very much like other problems such as Lyme disease, Epstein-Barr virus, multiple sclerosis, or arthritis. Without a blood test or other way to identify fibromyalgia, physicians rely on the patient's history and clinical presentation to make the diagnosis.

The presence of chronic widespread body pain that lasts more than three months with specific tender points points to a diagnosis of fibromyalgia. The American College of Rheumatology (ACR) criteria includes 11 out of 18 points of pain as a positive test for fibromyalgia. These tender points are located in specific locations along the neck, chest, shoulders, back, hips, elbows, and knees.

Once the diagnosis has been made, then a management program of patient education, medications, physiotherapy, and self-care is advised. There isn't one magic pill patients can take to wipe away the pain, improve sleep, or restore energy. Instead, a wide range of medications are available that can act on the nervous system in a variety of ways. These include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SSNRIs), and anticonvulsants.

Finding the right drugs and the right mix or combination of those medications can take some time. And medication only offers small comfort in the big picture of things. Only about a third of the patients are helped and only about a third of their symptoms are improved by this means.

Many patients find nonpharmacologic treatment works best for them. This means they try to manage the pain, symptoms, and loss of function through the use of exercise, counseling, and alternative care such as hypnosis, acupuncture, or biofeedback/relaxation therapy. Clearly, all of the research so far confirms the need to treat this problem with a multidisciplinary approach. A multidisciplinary team of professionals includes doctors, nurses, physiotherapists, psychologists, pharmacists, and other practitioners in the healing arts.

Patients must learn as much as they can both about this condition as well as about themselves and what works best for them. That's easier said than done. Many times the pain and fatigue keep patients from getting the exercise they need. They become deconditioned and weak, which adds to their pain and loss of function.

In the ideal plan, the patient is really the manager who consults with these other experts to formulate the most effective plan. Reducing and managing symptoms, improving quality of life, and decreasing distress are reasonable goals. But the patient must understand that at the present time, there is no cure for fibromyalgia.

Your physician will help you get started and steer you in the right direction. Look for a support group in your area. Meeting with other people who have fibromyalgia can provide you with many helpful tips for managing and staying on top of the symptoms. You can get your life back but be patient with the process. It can take time and often requires some changes along the way -- both in your thinking and in your lifestyle.

Reference: Dennis C. Turk, PhD, and Hilary D. Wilson, PhD. Managing Fibromyalgia: An Update on Diagnosis and Treatment. In The Journal of Musculoskeletal Medicine. October 2009. Supplement. Pp. S1-S7.