Fibromyalgia: Know more about the autoimmune disease and how an exercise schedule can help

Last week, Indian filmmaker Vikram Bhatt revealed he had been suffering from an autoimmune condition called Fibromyalgia for the last 18 years. Bhatt's revelation came after he spoke out in support of Indian actor Samantha Ruth Prabhu, who in October had shared with her fans that she had been diagnosed with myositis, another autoimmune condition, a few months ago.

Mid-day Online reached out to Mumbai health experts Dr. Sunilkumar Singh, consultant, rheumatology, Kokilaben Dhirubhai Ambani Hospital and Rohini Samant, consultant rheumatologist, PD Hinduja Hospital & MRC in Mahim to understand more about the condition. While Singh and Samant delve into the causes, symptoms and treatment, they suggest adopting an exercise regime and having good sleep hygiene to help deal with the condition.

What is Fibromyalgia?

Singh: Fibromyalgia is a pain syndrome where the body gets excessively sensitised to pain and the patient feels generalised pain across their body. Apart from generalised pain, there are other components of fatigability, sleep disturbances and thinking problems. Most importantly the pain is truly felt by the patient due to sensitisation to pain by centres in the brain.

Samant: Fibromyalgia is a relatively common disease that affects 1 per cent of the population. It is characterised by diffused widespread muscle pains all over the body and severe fatigue which cannot be explained by any other medical condition.

Can people identify Fibromyalgia themselves?

Singh: It can only be diagnosed by a doctor. Although patients can understand the symptoms and can feel the pain, it's difficult for patients to diagnose this because there are many other possibilities that can have signs and symptoms similar to Fibromyalgia. Many patients who have thyroid issues or Vitamin D or Calcium deficiency might have pains similar to fibromyalgia. The patient can have a perception of the pain but the diagnosis will only be possible by the doctor.

Samant: Doctors will need to identify the condition. One common cause which can cause this kind of widespread pain is Vitamin D deficiency. This definitely needs to be excluded before diagnosing fibromyalgia.

What are the causes of fibromyalgia?

Singh: There is no one single cause that has been identified for fibromyalgia. There are multiple factors like genetic tendency, stressful events, viral illness which disrupts the way a patient perceives pain and that leads to fibromyalgia. Sometimes, it's secondary to other underlying diseases like arthritis.

Samant: It is usually triggered by emotional stress, excessive physical stress, or some injury.

Are there different types of fibromyalgia?

Singh: There are no specific classifications, but we see patients who have a dominant component of fibromyalgia. Some have dominant pains while others have excessive tiredness and some have cognitive impairment where patients find it tough to remember things or do simple tasks. Primary fibromyalgia means that there is no other underlying illness whereas secondary fibromyalgia is where some diseases are already diagnosed and fibromyalgia comes along with this.

Which age group is more prone to getting fibromyalgia? Is it seen more in any particular type of body?

Singh: We've seen dominantly young to middle age females between the ages of 30 years to 50 years suffering from fibromyalgia.

Samant: It usually affects people in the working age group; active professionally or at home i.e young and middle-aged people. Women are affected far more than men. The accompanying symptoms of fibromyalgia are migraines, acidity, and lack of refreshing sleep. The lack of refreshing sleep largely contributes to the fatigue and muscle pain that is perceived in fibromyalgia.

Can people prevent the onset of this condition by consuming certain kinds of foods?

Singh: I don't think there is enough evidence currently for the linkage of any food to the prevention of fibromyalgia. There is no preventive strategy as such.

Samant: There are no foods that can prevent or help in fibromyalgia.

What are the precautions that people can take?

Singh: There are no direct precautions that people can take to avoid fibromyalgia. However, a healthy lifestyle, good sleeping habits, avoidance of addictions, can indirectly help in preventing fibromyalgia.

Samant: The precautions that need to be taken are to be mindful of how you cope with stressful situations and doing physical exercise in the form of walking or swimming and also doing exercises to strengthen the muscles. These need to be done gradually so as to not cause aggravation of the pain.

What is the kind of treatment that people have to undertake? Do they have to follow a particular lifestyle post-diagnosis?

Singh: There is a lot of scope for lifestyle measures, exercise programmes, psychotherapy, and medications in solving the problem. We need a combination of things which can give a 10 to 20 per cent of relief in each parameter so that cumulatively the patient feels an overall sizeable improvement in their condition. It is equally important to have a good exercise programme and proper sleep hygiene as much as the importance of a drug is. A correct combination of all components leads to the betterment of the patient

Samant: There are quite a few effective treatments. Although there is no cure for the condition, it can be well controlled with treatment. So, drugs like pregabalin have been approved by the US FDA for the treatment of fibromyalgia. Other drugs like antidepressants like Duloxetine also helps. Gabapentine is also a drug that is useful in Fibromyalgia. For immediate relief of pain drugs like Paracetamol, Tramedol can be used to alleviate the pain. However, the drug treatment has to be accompanied by a proper physical activity programme, yoga and meditation. All of which will create a positive impact on these patients.

Does Covid-19 have any kind of bearing on the condition?

Singh: Sometimes viruses have been implicated as the cause of fibromyalgia. I have seen a few patients who have been diagnosed with fibromyalgia post Covid-19, hence the virus has had an impact.

Samant: Covid-19 definitely had a negative impact on the patients as it in general increased anxiety regarding Covid which leads to the worsening of symptoms of fibromyalgia.

Do people with other muscle conditions need to take special care in case of such a condition?

Singh: An independent problem will be treated and along with it, overall fibromyalgia will be taken care of. More importantly, this is challenging for the doctor to differentiate between which component is dominating - the primary muscle problem or the fibromyalgia. For the patient, it just worsens or aggravates their pain perception.

Just to give you an example, an arthritis patient who develops fibromyalgia might feel that their condition is not improving because they are in constant pain and fatigue. However, when the doctor observes the patient, purely from an arthritis point of view, they might see that the patient is doing well because the joints have responded but the patient may still have pain because of the condition of fibromyalgia.

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