Fibromyalgia is a disease that is mainly characterized by muscle pains and pain around the joints. Other than that, there are other symptoms like disturbance in sleep pattern, tiredness and weakness as well as low mood.
Fibromyalgia is a complex disease. How do you know if you are suffering from this disorder? The process of diagnosing fibromyalgia is not an easy one. For one thing, pain is a very personal thing. For one person, it may not be a lot while another would be totally debilitated by the same amount of pain. Also, the disease has no specific diagnostic test. There is nothing in the blood or any specific ultrasound or X-ray that can be used to diagnose the disease. This is why doctors take a lot of time before labeling a person with fibromyalgia.
What Is The Pain Of Fibromyalgia Like?
Fibromyalgia is characterized by pain in different body parts. The pain is mainly in various body muscles, and people may describe it as having “pain all over”. Pain affects several muscle groups, resulting in general feeling of tiredness, weakness and being unwell.
Pain can occur usually around joints. However, joints themselves are spared from the pain. Fibromyalgia is a chronic pain condition and this is why it can result in significant low mood as well as depression.
There are some features of fibromyalgia that the disease is characterized by. Pain mostly occurs at some specific points in the body. These points are known as “pain points” or “tender points”. Tender points means that when these areas are pressed with a finger, they cause pain to the person suffering from the disease. These points are present around the joints.
Why Are Tender Points Important?
Tender points are important because they may be used to diagnose the condition. As there are no tests for definitive diagnosis, the disease is diagnosed on clinical examination. This means that your doctor will press a finger against these points and you will be required to answer when it hurts.
In total, there are 18 tender points on the body. A diagnosis of fibromyalgia requires that a patient feels pain in at least 11 of these points.
What Is The Size Of Tender Points?
Tender points or pain points are small areas of pain. They may be as large as a penny. However, the pain caused by pressing on one of these points is enough to make a person pull back. This is why doctors know where pain points are located and press them specifically to elicit a response.
Now that we know exactly what pain points are and what is their importance, it is time to know just how fibromyalgia can be diagnosed with the help of these areas of pain. The location of tender points or pain points is important. They are present on front as well as back of the body, starting from the lower head and extending to the legs.
On the front of the body, the highest pain or tender points are on the neck on each side. These points are present on each side of the larynx. The next two points are on the upper chest, just beneath the collar bone. After this, pain points are on the elbows, one point on each elbow. These are situated on the outer side of the elbows. Patient may feel pain on the forearms near the elbows. Moving down, there are tender points on knees, one on outer side of each knee. Together, these total 8 pain points on the front of the body.
On the back, the highest pain points are on the back of the head. These are two in number and present at the base of skull. Then, tender points are present on the neck and back. Two points are present on the back of neck, or they can be on the shoulders, just beneath the bottom of neck. After this, the next two points are on upper back, in the region where shoulder blades meet the muscles of back. The last two pairs of tender points are on the hips. One each is present on the upper outer side of each hip and the last two points are on the lower outer side of each hip. This amounts to total 10 tender points on the back of the body. So the total tender points on the whole body are eighteen in number.
Your doctor will press these pain points in turn, asking you if it hurts. The pain may be high, causing you to flinch, but it is an examination method that is very important in fibromyalgia diagnosis.
Other Diagnostic Factors:
Pain points are just one modality used to diagnose fibromyalgia. This is not the only symptom of the disease and this is why whenever anyone with suspected fibromyalgia visits the doctor, other than asking and examining tender points, the doctor will ask other questions too. These include questions about other symptoms such as sleep disturbance, mood changes, fatigue etc. There will be questions regarding any family history since if a patient has one affected direct relative like parents or siblings, their chances of having fibromyalgia are higher.
How Can Tender Points Be Managed To Decrease Pain And Discomfort?
Fibromyalgia is mainly a disease that causes pain. Other symptoms may be directly related to the pain or its effects, such as lack of sleep may be because the person suffering from fibromyalgia has too much pain and is therefore too uncomfortable to sleep. Decreased sleep can lead to tiredness and fatigue which in turn may cause low mood and depression. Therefore, when talking about treating fibromyalgia, the basic management goal is to manage the pain symptoms so discomfort and pain at tender points is less.
Because the exact cause of fibromyalgia is not known, its exact management is also not very clear. Unfortunately, fibromyalgia is not a disease that can be completely treated. This means that it is a chronic pain condition where the pain can be partially managed but not totally eradicated. As a result, the treatment options are multi-factorial and require, as the very first step, patient education. People need to understand that this is a condition that they have to live with and they need to make several lifestyle changes if they want to live a productive, comfortable life. They should know that there is no single magic medicine that will cure them; rather a combination of medicines, exercise and stress management is required to improve their quality of life.
The drug treatment is composed of giving pain killers or analgesics to reduce the pain at tender points. Another medicine class that is very effective, although exact mechanism is not known, is use of anti-depressants. These improve the pain symptoms and also lead to better sleep and improved mood. Other things that can be done to reduce pain include taking hot baths and using hot compresses on the tender points. While not curative, these therapies can give pain relief. There are alternative methods of pain control as well which include massage as well as acupuncture. These methods are useful but again, for a short period of time. Ultimately the pain symptoms tend to reappear.
There are other factors in management of this disease. As a rule, people should be advised not to completely cut off their physical activity or stop working. While strenuous exercise is not advised, there is nothing wrong with mild to moderate exercise like walking for fifteen minutes three or four times a week. People affected with the disease must try to carry on as normally as they can. The more they keep themselves busy and distracted with work and other activities, the lesser pain they will feel.
As pain is a very subjective symptom, different people may experience it differently. This is why talking to patients, listening to them and assuring them that their disease is real, can go a long way. Moral support counts for a lot. Also, people who suffer from fibromyalgia often report that the calmer and happier they are, the better they can cope with their pain symptoms. This is why behavioral therapy is sometimes advised to patients. Other things they can do are meditation and yoga. This calms the mind as well as the body, reducing stress and improving quality of life.
Flare-ups of The Disease
Pain in tender points is not always static; it may wax and wane over different durations. Flare-ups of the disease can occur, leading to worse pain and tenderness at tender points. Some factors that cause these flare-ups include infections, excessive exercise, severe sleep deprivation or stress. In these cases, heavier doses of pain killers may be required. Patients should be educated to realize which situations can cause flare-ups and how best to manage them.
Fibromyalgia is a complex disease, which no clear-cut known cause or fully effective treatment. However, with the right positive approach, medication and changes in lifestyle, the disease can be managed so the sufferer has a god quality of life and is not debilitated by the pain in tender points.