Dear Doctor, I have been diagnosed with fibromyalgia. I’m 61 years old, not overweight and reasonably fit. I gym 3 times a week, but find the pain very debilitating even during exercise. I’m also hypertensive with polycystic kidneys and liver. At this stage, I can only take paracetamol and tramacet and trepiline 10mg.
Apart from the above medication, is there any other course that I can take to improve my quality of life? I find that the pain moves from my neck to shoulders to hips and I find that my feet are also troubling me. As I’m a pianist, I have to guard against this affecting my fingers. I do find that my hands are very sensitive and tender to touch especially if people greet me. I really enjoy your honest take on most topical issues and value your professional opinion.

Your letter is appreciated and you certainly represent many other readers with this condition.
Until 10 years ago, Fibromyalgia was frowned upon and often shunned by traditional medical practitioners who knew very little about the international interest and research into the problem. As with many syndromes – pattern recognition and well documented clinical accounts started to spring up as anecdotal reports everywhere. Criteria and similarities were then identified and grouped by practitioners in an attempt to classify the disease clinically and eventually a strong thrust was put behind the pathogenesis (mechanisms) of the condition. The speciality of Rheumatology has played a big role in educating and classifying the syndrome more accurately.
The postulated theories on the causes are certainly interesting and useful when trying to understand the problem. There are associations with certain personality types, the load of psychosocial stressors, comorbid medical conditions like insomnia and increased muscle tension and even diet. Fibromyalgia cripples people with excruciating pain at multiple key body sites with difficulty in movement due to pain. Chronic pain syndromes are well described as causing changes in the levels of the brain neurotransmitters like serotonin and dopamine. This is why long term pain can alter mood as well.

My advice to you is a multifaceted approach – you are getting out, trying to exercise, getting social interaction which is supposed to reduce stress. Look at your immunity and diet. Optimize your efforts with good slow and progressive exercise that is fun and not necessarily gym bound. Outdoor hiking, swimming and even walking can be amazing when dealing with muscle tension. Increasing the blood flow to the body’s vital organs does wonders. Hot long baths or spa sessions in the sauna where your core temperature is raised then cooled – this releases endorphins (feel good hormones). Revise your sleeping habits and address your discipline of good sleep hygiene tips. Be compliant on medication and accept that different people respond at different rates. Lose the negative influences in your life and end the mental drain as soon as possible. Surround yourself with positive people who bring out the best in you. If I could I would prescribe laughter eight times a day for all of us!
Medications used in treating fibromyalgia include anti-depressants, NSAIDS (non-steroidal anti-inflammatory) and pure analgesics. The risk of the pure analgesics is that many cause drowsiness and cannot be taken during the day and codeine is present in many of the combo drugs – Codeine is one of the top causes of constipation in adults. You should also consider the addictive nature of the opiate group of drugs.

I have been diagnosed with fibromyalgia…
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