Chronic pain conditions include: fibromyalgia, neuropathic pain, hand pain, foot pain, joint pain, back pain, knee pain, persistent headaches & cancer pain
Fibromyalgia
Fibromyalgia is an illness that affects both the connective tissues and the locomotor system. It is characterised by chronic, widespread pain and muscle tenderness. The pain and tenderness must have been present for more than three months in order for a diagnosis of fibromyalgia to be made.
The pain and tenderness are felt on both sides of the body, above and below the waist, including the axial spine (usually the paraspinal, scapular, and trapezius muscles).
The pain can be so severe that even the slightest touch becomes sensitive. Stiffness can also be present.
The 2010 revised diagnostic criteria specify that fatigue, unrefreshed sleep and cognitive dysfunction most also be present to a significant degree
Fibromyalgia is a diagnosis of exclusion and other disorders that could be the cause of the symptoms need to be ruled out first.
The incidence is 2- 5% of the population. It affects woman four times more than men.
Research shows that it could be due to an immune response.
There is a proven link with depression. The co-occurence of one increases the likelihood of the other. The presence of depression with fibromyalgia is also inked to more pain and decreased quality of life.
Management
Exercise and physiotherapy is considered first line eg Stretching, aquatic exercise, balneotherapy, biofeedback therapy.
Psychology
CBT, guided imagery and relaxation have been proven to be effective.
Medication
Medication should be used when symptoms are uncontrolled and should be discontinued when possible eg amytriptilene, duloxetine, yelate. Tramadol is considered a 3rd line treatment.
Dietary supplements
Probiotics might be effective.
Complications
Extreme allodynia (hypersensitvity) with high levels of distress
Opioid or alcohol dependence
Marked impairment in functioning
Severe depression and anxiety
Obesity and physical deconditioning
Metabolic syndrome