Fibromyalgia With Therapeutic Insight From Homoeopathy
Fibromyalgia is a clinical syndrome characterised by persistent, diffuse pain in the body. Typically described by the patient as “pain all over the body” including joints, muscles and spine. However, there is no clinical discernible evidence of inflammation at any of these sites, and therefore, this condition is classified as soft tissue rheumatism.
Although Fibromyalgia is defined primarily as a pain syndrome, patients also commonly report associated neuro-psychological symptoms of fatigue, unrefreshing sleep, cognitive dysfunction, anxiety, and depression.
This is more commonly seen in young or middle-aged women and the pain is accompanied by a number of other symptoms including: fatigue, depressed mood, sleep disturbance, headaches and social isolation.
Clinical examination reveals multiple, soft tissue tender points over bony prominences, muscles and tendons. Symptoms of Fibromyalgia often have their onset and are exacerbated during periods of perceived stress.
Previously, The American College of Rheumatology (ACR) classification criteria in vogue required tenderness on pressure (tender points) in at least 11 of 18 specified sites and the presence of widespread pain for diagnosis. Widespread pain was defined as axial pain, left and right-sided pain, and upper and lower segment pain. Recently, the American College of Rheumatology has proposed diagnostic criteria for fibromyalgia that do away with tender point examination and permit a symptom-based diagnosis.
Fig.: Tender-point assessment in patients with fibromyalgia.
Diagnosis:
A patient satisfies diagnostic criteria for fibromyalgia if the following three conditions are met:
1. Widespread pain index (WPI) >7 and symptom severity (SS) scale score >5 or WPI 3-6 and SS scale score >9.
2. Symptoms have been present at a similar level for at least 3 months. 3. The patient does not have a disorder that would otherwise explain the pain. The WPI score ranges from 0 to 19 while the SS score ranges from 0 to 12.
Common Conditions in the Differential Diagnosis of Fibromyalgia
- Inflammatory Polymyalgia
- rheumatica Inflammatory
- arthritis: rheumatoid arthritis, spondyloarthritides
- Connective tissue diseases: systemic lupus erythematosus, Sjögren’s syndrome
- Infectious
- Hepatitis C
- HIV infection
- Lyme disease
- Parvovirus B19 infection
- Epstein-Barr virus infection
- Noninflammatory
- Degenerative joint/spine/disk disease
- Myofascial pain syndromes
- Bursitis, tendinitis, repetitive strain injuries
- Endocrine
- Hypo- or hyperthyroidism
- Hyperparathyroidism
- Neurologic Diseases
- Multiple sclerosis
- Neuropathic pain syndromes
- Psychiatric Disease
- Major depressive disorder
- Drugs
- Statins
- Aromatase inhibitors
Laboratory or Radiographic testing
Routine laboratory and radiographic tests yield normal results in FM. Thus diagnostic testing is focused on exclusion of other diagnoses and evaluation for pain generators or comorbid conditions.
Routine
- Complete blood count (CBC)
- Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
- Thyroid-stimulating hormone (TSH)
Guided by History and Physical Examination
- Complete metabolic panel
- Antinuclear antibody (ANA)
- Anti-SSA (anti–Sjögren’s syndrome A) and anti-SSB
- Rheumatoid factor and anti–cyclic citrullinated peptide (anti-CCP)
- Creatine phosphokinase (CPK)
- Viral (e.g., Hepatitis C, HIV) and bacterial (e.g., Lyme) serologies
- Spine and joint radiographs
Management
The successful management of fibromyalgia requires both non-pharmacological and pharmacological measures, with particular emphasis on patient education, in order to explain the nature of the disease and to highlight that joint or bone damage will not occur in this condition, unlike untreated inflammatory arthritis. A suitable programme of graded exercises can be very helpful in maintaining adequate mobility and improving functional capacity. Psycho behavioural management can also help and these include psychotherapy, hypnotherapy and relaxation response therapy, where available.
Therapeutics
Arnica
Limbs and body ache as if beaten; joints as if sprained. Bed feels too hard. Rheumatism of muscular and tendinous tissue, especially of back and shoulders. inability to perform continuous active work. cannot bear pain; whole body oversensitive. Cannot walk erect, on account of bruised pain in pelvic region.
Bryonia
Aching in every muscle. The general character of the pain here produced is a stitching, tearing; worse by motion, better rest. Every spot is painful on pressure. Constant motion of left arm and leg. Painful stiffness in nape of neck. Knees stiff and painful.
Calendula
Rheumatic drawing in the right side of neck, agg. when bending the neck over to one side and when raising the arm. Rheumatic drawing pains, only during motion. Intense depression. Pressure and feeling of heaviness in the occiput.
Cimicifuga
Muscular and crampy pains, primarily of neurotic origin, occurring in nearly every part of the body. Agitation and pain. Mania following disappearance of neuralgia. Uneasy,
restless feeling in limbs. Aching in limbs and muscular soreness. Rheumatism affecting the belly of muscles, especially large muscles.
Kalium Iodatum
Diffused sensitiveness. Severe bone-pains. Painful weakness of legs. Tearing in back part of the left heel when sitting; in right heel when standing, > walking. Spasmodic contraction of the muscles. Sticking in left lower jaw, in tibia, left thigh, left forearm in bones in forenoon, then in left ear, at last in tendon of hollow of left knee.
Mercurius Solubilis
Weakness of limbs. Bone-pains and in limbs; worse, night. Bruised pain in small of back, especially when sitting. Tearing pain in coccyx; better, pressing on abdomen. Weary of life. Rheumatic pains, with profuse sweat, which affords no relief.
Mezereum
Pains of various kinds, with chilliness and sensitiveness to cold air. Bone pains. Burning, darting sensation in the muscles. Pain in neck and back; worse, motion and at night; intolerant of all touch.
Ruta
All parts of the body are painful, as if bruised. Feeling of intense lassitude, weakness and despair. Legs give out on rising from a chair, hips and thighs so weak. Contraction of fingers. Pain in nape, back and loins. Backache better on pressure and lying on back.
Reference
1. API Textbook of Medicine 9th edition
2. Harrison’s Principles of internal medicine 20th edition
3. Pocket manual of Homoeopathic material medica & Repertory by William Boericke 4. A dictionary of Practical material medica by J. H. Clarke.
