by Cheryl A. Thomas, RDH
What if you always felt like you had the flu? What if that tired, achy feeling never went away? It’s possible that you might have a condition known as fibromyalgia. But if you learn how to manage your disease and have a good support system, fibromyalgia won’t keep you down.
We all breathe a sigh of relief once the height of cold and flu season has passed. No one relishes aching all over for days or weeks on end, finding relief only when - and if - you’re able to sleep. When you’re suffering from a cold or the flu, you can find comfort in chicken soup, rest, and cold medicine, even though at its peak it may feel like you’re never, ever going to be well again. After what often seems like an eternity of suffering (which was really only a few days), you wake up feeling better once the virus has run its course. In a few more days you can go back to your busy and fulfilling life. But what if you always felt like you had the flu? What if that tired, achy feeling never went away? It’s possible that you might have a condition known as fibromyalgia.
At one time or another, you probably have heard or read about fibromyalgia. People who live with fibromyalgia feel like they have the flu almost every day. Fibromyalgia is not a disease, but rather a disorder grouped with arthritis and other rheumatological disorders that afflict an estimated one in 50 people in the United States with widespread, chronic pain. Research dates back to the 1800s.1,2
Providing dental services to patients living with fibromyalgia can be a challenge to both the patient and the provider. Patients typically are plagued with chronic, widespread pain, lethargy (commonly referred to as “fibro fog”), and depression. These symptoms are exacerbated by physically or emotionally stressful events and changes in weather and/or temperature. However, the symptoms often exhibit no discernable pattern whatsoever. Frankly, it’s difficult to predict how patients will respond to different stimuli.
What if a dental hygienist begins to exhibit signs of fibromyalgia? Will he or she be able to overcome chronic pain, fibro “fog,” and depression and remain a valuable, contributing member of the dental team?
What do we know about fibromyalgia?
Fibromyalgia is a complex condition considered to be a form of soft tissue rheumatism. The word “fibromyalgia” is derived from both Latin and Greek. Fibro is Latin for connective tissue (tendons and ligaments), myo is Greek for muscle, and algia is Greek for pain. Manifestations can vary greatly from day to day and from person to person. Symptoms typically follow this pattern: one day profound pain in the neck and shoulders, the next a migraine, and the next severe depression for no reason at all. Therefore, fibromyalgia is considered a systemic pain condition, because symptoms are generally found throughout the body.
Other common symptoms of fibromyalgia include: chronic fatigue, difficulty sleeping, stiffness, headache, pain during menstruation, dizziness, digestive problems, numbness, tingling, sensitivity to weather and temperature changes, and mood changes.5 Because people are often uneducated about the condition and there are no clinically visible symptoms, people suffering from the symptoms of fibromyalgia often find their complaints dismissed by others, even by health-care providers.
Who is at risk?
An estimated 3.5 million Americans are burdened with fibromyalgia. Although almost anyone can develop fibromyalgia, women are seven times more likely to develop fibromyalgia than men4 and are most commonly diagnosed between the ages of 20 and 45.6 Fibromyalgia is strongly linked to stress; however, it does not appear to have a link to perimenopause or menopause (although little research has been done in this area).6 After 200 years of research, the etiology of fibromyalgia is unknown. The most commonly accepted hypothesis is that certain factors such as stress, inadequate or poor quality sleep, and physical or emotional trauma may trigger the condition.5
What is the diagnosis?
Typically, a diagnosis for rheumatological disorders can be time-consuming. It is not uncommon for five years to pass before a diagnosis is made.3 Chronic pain can be a symptom of a multitude of diseases, injuries, and an adverse side effect of medications. Multiple tests should be completed to methodically eliminate each. Health-care providers agree that a rheumatologist is the best trained medical provider to treat fibromyalgia; however, many of the tests needed to eliminate other possibilities could (and should) be provided by a primary health-care provider.
A physician’s diagnosis of fibromyalgia is based upon widespread pain and tenderness, but only after he or she has tested for and eliminated the possibility of other conditions.5 In 1990, fibromyalgia was officially recognized as a rheumatological disorder and a list of trigger points and tender points were established to confirm diagnosis. The National Fibromyalgia Research Association offers a detailed description of trigger points at http://www.nfra.net/fibromyalgia_trigger_point.php.
The role of depression
It is possible that depression is the result of a chemical imbalance that may cause the pain associated with fibromyalgia; however, depression is often an inevitable complication when a person is exposed to long-term pain. Antidepressants, exercise, professional counseling, and support from friends, family, and co-workers have proven to be beneficial.
Many believe disturbed sleep cycles contribute to fibromyalgia. Therefore, many of the treatments for fibromyalgia include medication or biofeedback therapy that is geared toward enhancing sleep cycles. Caffeine (coffee, tea, chocolate, etc.), nicotine, and alcohol should be limited and avoided near bedtime to avoid insomnia.
Stress and mental clarity
As with many other chronic diseases, stress can initiate a flare-up of symptoms. Although stress is an inevitable part of life, removing as many unnecessary stressors as possible can reduce the severity and frequency of flare-ups. Meditation and light exercise will help victims cope with the stresses that come their way as well as beat the fibro “fog.”
Several prescription medications have been used to treat the symptoms of fibromyalgia. The most common are trycyclic antidepressants. Trycyclic antidepressants reduce pain by interfering with the chemical processes in the brain that allow victims to feel pain as well as depression. Common forms of trycyclic antidepressants include: Amitriptyline (Elavil), Desipramine (Norpramin), Doxepin (Sinequan), Imipramine (Tofranil), Nortriptyline (Aventyl, Pamelor), and Protriptyline (Vivactil). Tryclyclic antidepressants do not create a chemical dependency, but they can cause drowsiness. Other side effects include: xerostomia, constipation, difficulty with urination, weight gain, and changes in blood pressure.
Although side effects usually manifest quickly after the initiation of antidepressant therapy, it can take several weeks before pain relief occurs. Because various drug therapies work for some people, but not others, several different medications are often used until one is found that eases the symptoms of fibromyalgia.
Other common prescription medications that prove to be useful are muscle relaxants, antiepileptic and antianxiety medications, sleep enhancements, and prescription pain medicine - each having similar adverse side effects as antidepressants.
Several over-the-counter medications (acetaminophen, aspirin, and ibuprofen) can eliminate or reduce pain short term, but the long-term side effects should be discussed at length with a physician. In addition to over-the-counter analgesics, some patients have found relief with cold medications (guaifenesin and some antihistamines).
In addition to medications, massage therapy, acupuncture, and meditation are often helpful. Direct application of heat - either dry heat from a heating pad or moist heat from a hot/wet cloth, steam, or a hot bath - usually will provide some relief. Topical, over-the-counter ointments that contain minute amounts of anesthetic used for aches and muscle strains work well for some patients living with fibromyalgia.
Although an exercise program has to be initiated slowly to avoid exacerbating symptoms, mild aerobic exercise has been proven to provide some relief. A gradually increased exercise plan of walking, swimming, and riding a stationary bicycle is a smart way to exercise and find relief. People living with fibromyalgia tend to go through a cycle of “good days” and “bad days.” When they feel good, they tend to do all they can, which then typically results in several bad days.
Finding the right physician
After a diagnosis of fibromyalgia, the first step is to find a rheumatologist. Typically, the primary care provider can recommend a rheumatologist, but references can also be found through these resources:
• The American College of Rheumatology at http://www.rheumatology.org/.
• The American Academy of Pain Medicine (AAPM) is a new resource in the field of pain management. A pain specialist uses many different approaches to treat chronic pain, including biofeedback, physical therapy, surgery, and medicine. To locate a pain specialist, go to www.painmed.org or call (847) 375-4731.
• Often the best therapy for chronic illness is support groups. Just knowing that others are living successfully with fibromyalgia can help. Another benefit of networking is to find out what therapy works for others and what new treatments are available. There are multiple online news groups and support groups including Fibromyalgia Network, http://www.fmnetnews.com, P.O. Box 31750, Tucson, AZ, 85751-1750, or call (800) 853-2929.
Clinical advice from a hygienist living with fibromyalgia
Relax. You’re going to be OK. Be patient and find a physician who will not only treat you for fibromyalgia, but who will collaborate with you on your own care. Being active in your health care and taking a hands-on approach to your illness is the first step to recovery. Visualize your medical treatment as a football team. You want to be the quarterback. Look for a physician who is willing to play the role of “coach” to help you achieve the ultimate results.
Once you have a diagnosis, be patient. Finding the right treatment protocol for you will probably take some time, so make a plan. Organize your life to be structured and put in stress breakers (humor) where you can. Keep a written journal of your days and identify and remove those variables that result in “bad days.”
Learn when to say “No, I need to rest,” but resist the temptation to become secluded. Life with chronic disease is all about balance. Learn how to ask for help. You don’t have to do everything by yourself. Your friends and family will feel that they are playing an active role in your recovery.
Lastly, don’t quit working! As long as you don’t overdo it, working can be beneficial. Structure your operatory as an ergonomic/low stress environment (see chart of tips).
1 National Institute of Arthritis and Musculoskeletal and Skin Diseases. March 2005. Online. Internet. Available Aug. 17, 2005, http://www.niams.nih.gov/hi/topics/fibromyalgia/fffibro.htm.
2 Wikipedia. Nov. 18, 2005. Online. Internet. Available http://en.wikipedia.org/wiki/Fibromyalgia#History.
3 Mazur J. Take charge of your fibromyalgia. Barnes & Noble Health Basics. 2005. Barnes & Noble, Inc.
4 Arthritis Foundation. Online. Internet. Available Nov. 8, 2005, http://www.arthritis.org/research/research_program/fibromyalgia/default.asp.
5 Mayo Clinic on Chronic Pain. 2002. Second Edition. Mayo Foundation for Medical Education and Research.
6 Staud R. Fibromyalgia for dummies. Wiley Publishing, Inc. 2002, Indianapolis, Ind.