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 Pains & Aches

july 2010
Of Daily Aches and Pains
Dr Sandeep K Upadhyay
 
You might not be plain lazy, as your in-laws or husband would have expertly diagnosed. Maybe you should tell them about this condition called fibromyalgia.

Do you feel exhausted all the time? Does even a good night’s sleep fail to refresh you, making you wake up tired? Do you complain that it aches all over as if you’ve have been hit by a truck?
Fibromyalgia is a frequently misunderstood complex condition that has been the subject of speculation and research among neurophysicians, rheumatologists and psychiatrists for the past several decades. Because there is no lab test or X-ray to confirm a diagnosis of fibromyalgia, most physicians believed that this condition was literally “all in the mind” – meaning that symptoms were primarily mood-driven or even wholly psychosomatic. Doctors used to think that such patients were simply overly sensitive and just needed to calm down to cure themselves of their symptoms.
However, fibromyalgia is a real medical condition of widespread chronic pain, with other core symptoms of sleep disturbance and fatigue. Today, it afflicts an estimated 35 to 40 million people worldwide and is indeed very common among Indian women.

Pain Processing
  • Fibromyalgia presents many ‘tender points’ in specific locations on the body. When these points are pressed, people with fibromyalgia feel pain, while people without the condition only feel pressure. Such patients are also overly sensitive to heat and cold stimuli. This gives fuel to the theory of central sensitisation: a central dysfunctional hyper-excitability in pain processing.
  • Other studies that include ‘functional’ MRI studies of the brain point to an enhanced transmission of pain sensations and pain inputs. It also shows the brain’s inability to shut out incoming messages of pain from the neurons.
  • Patients with fibromyalgia also complain of a ‘fogging’ of the brain or ‘fibrofog’. This is associated with depression, anxiety, impaired memory, and sleep disorder of deep stages of sleep, causing the patient with fibromyalgia to wake up un-refreshed after even eight hours of sleep.
Risk Factors
  1. Fibromylagia is strongly familial. If your mother or sister suffers from this disease, the odds that you may be affected too are roughly eight times more, compared to others!
  2. If there are close relatives who see psychiatrists for mood disorders, anxiety, eating disorders, then the possibilities for your being affected similarly, or even suffering with fibromyalgia increase dramatically.
  3. Even if someone in your family suffers with common physiologic abnormalities like Irritable Bowel Syndrome (a condition that makes people prone to abdominal pain and diarrhoea/ constipation) and migraine, the chances their relatives being afflicted with fibromyalgia increase.
  4. Lack of exercise, post-traumatic stress disorder, hormonal imbalance and menopause are other factors.
What can be done for me?
  1. Medicines for fibromyalgia include SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors - a newer class of anti depressent) and Pregabalin (an anticonvulsant drug). These medications help the body pains, fatigue and stiffness of the morning hours. Moreover, patients with depression and poor sleep get dramatic relief of their symptoms.
  2. Graded exercises, stretching, swimming and aerobics are very helpful.
  3. Education of family members and work colleagues is important. So also is counselling and psychiatric referral.
  4. A regular follow-up at a specialised rheumatology centre has also been shown to be effective. Specialised care would be needed for the correction of local joint and back problems.
Are there different types of pneumonia?
When you catch such infections, primarily from being in public places (except a hospital), it is called community-acquired pneumonia. Hospital-acquired pneumonia on the other hand, is acquired during or after hospitalisation for another illness or procedure. You get it within 72 hrs of admission – so be careful of the kind of hospital you get into.

Do I need to see the doctor soon?
While there are many microbes that can cause bacterial pneumonia, the most frequent culprit is a bug called streptococcus pneumonia. It’s important to understand that symptoms of pneumonia need immediate medical evaluation. Physical examination by a doctor may prevent life-threatening spread of the infection from lung to rest of body through bloodstream, a condition called sepsis.

What would my doctor do?
Typically he would ask for chest x-rays, blood test, examination of the cough, and sometimes chest CT (computed tomography). Most cases of pneumonia can be treated without hospitalisation with oral antibiotics, rest and fluids. However for those with serious symptoms, other medical problems, and for the elderly, he would ask them to be hospitalised for intravenous antibiotics and other supportive measures like oxygen, intravenous fluids and sometimes in serious cases, ventilation.

Could I have prevented this?
Not always, but do get treatment for underlying illnesses (such as AIDS). Stop smoking, if you do. Children and the elderly could use with vaccinations against certain bacteria.

Women between the ages of 25 and 60 have the highest risk of developing fibromyalgia. Doctors aren't sure why, but women are 10 times more likely to have this condition than men! Some researchers believe genetics may play a role, but no specific genes have been identified yet.

Fatigue
Interfering with activities of daily living
Body pain
Resistance to sleep
Other co-morbid conditions (arthritis, anxiety, depression, migraine, IBS, etc.)
Myalgia: pain in a muscle or group of muscles
Dr. Sandeep K. Upadhyay is Consultant Rheumatologist at Apollo Indraprastha, New Delhi


    
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