Fibromyalgia (Fibromyalgia) is the most common cause of chronic widespread musculoskeletal pain, often accompanied by fatigue, cognitive disturbance, and multiple somatic symptoms.

Fibromyalgia is shown to be a syndrome of low pain threshold and altered pain perception. The exact cause of Fibromyalgia is not known. It is likely to be multifactorial. Genetic predisposition with disease running and families is well recognised. Environmental insults including viral infections, stress (both emotional and physical) and depression in some cases can contribute to the onset of illness. Fibromyalgia can coexist with rheumatic disease like rheumatic arthritis, systemic lupus erythematosus and Sjogren’s syndrome.

It is very common. Upto 3% of the population suffers from it. It is most common around the 4th decade. Fibromyalgia is more common in women but it can occur in men and children too.

The diagnosis is based on the combinations of symptoms, physical examination. Widespread aches and pains affecting both sides of the body are the hallmarks of Fibromyalgia. Neck pain and back pain are the common symptoms. Extreme fatigue, early morning stiffness, non-refreshing and non-restorative sleep, subjective feeling of swelling of limbs and joints, numbness of peripheries are also common. Migraine like headaches, abdominal symptoms like bloating, heart burn, tendency to visit toilet frequently, particularly after food ( irritable bowel syndrome ) and urgency to pass urine frequently (irritable bladder) are other associated symptoms. Fibromyalgia patients also have multiple tender points over the body, which the doctor can identify on examination. So it is the combination of symptoms and the presence of tender points that lead to the diagnosis of Fibromyalgia. As mentioned earlier, there are no laboratory tests in the diagnosis of Fibromyalgia. Many patients are suspected to have other diseases and are investigated extensively before Fibromyalgia is diagnosed.

Usually Fibromyalgia symptoms are mild and patients mange to lead a normal life in spite of the pain. In some cases, pain can be severe. There is no cure. But the symptoms can always be helped. Unlike the pain of arthritis, the pain of Fibromyalgia usually does not respond to pain killers. Different types of medicines may be needed . Antidepressant drugs used in doses much lower than what is needed to treat depression are useful is correcting sleep disturbance and in improving pain threshold. Drugs commonly used are Amitriptyline, nortriptyline, Duloxentine, milnacipran. Anti convulsant drugs like pregablin and gabapentin also help the pain of fibromyalgia. Cognitive behavioural therapy (CBT) will help patients to take control of his of her illness. This is usually done by trained pain psychologists.

Exercise recommend for fibromyalgia patients is cardiovascular fitness training, usually with low-impact aerobic exercise. This approach is supported by various studies in fibromyalgia patients. Exercise can be of significant benefit for pain and function, and may be of benefit for sleep. However, in practice, it can be difficult for fibromyalgia patients to start exercises because patients generally perceive that their pain and fatigue will worsen as they begin to exercise. The specific cardiovascular fitness program should be individualized based upon patient preference and physical status. Before recommending a particular program, it is useful to assess the patient's current level of physical activity, exercise tolerance, and fitness; and preferences or interest in self-directed versus therapist-directed stretching and strengthening exercise and in techniques such as yoga and tai chi. Low-impact aerobic activities such as fast walking, biking, swimming, or water aerobics are most successful among the interventions that have been studied. The type and intensity of the program should be individualized and should be based upon patient preference and the presence of any other cardiovascular, pulmonary, or musculoskeletal comorbidities. Physical therapists or exercise physiologists familiar with fibromyalgia can provide helpful instruction. Some patients need to start with a low level and shorter duration per exercise session and to very gradually increase the intensity and frequency of exercise as tolerated over a number of weeks to months. Optimal cardiovascular fitness training generally requires a minimum of 30 minutes of aerobic exercise three times per week in a range near target heart rate. However, even with gradual increases in exercise, some patients may not achieve this goal, and patients should be encouraged to continue exercising regularly. Additional forms of exercise that have shown some benefit in fibromyalgia but that are not primarily directed at developing aerobic fitness include tai chi and yoga. The more intense the level of physical activity and a lesser amount of sedentary time correlate with better scores for pain and improved quality of life in women with fibromyalgia. Mixed exercise programs that utilize a variety of techniques, including aerobic and strength training, may be better tolerated, although there are insufficient studies to demonstrate superior efficacy over any single exercise modality.