Q. My 62-year-old mother frequently complains of muscle aches all over her body. These aches last for days and then recur after a few weeks to months. We already consulted a physician but all the tests conducted on her have shown normal results. What is wrong with her? Is she suffering from arthritis? Is there a medication she can take?
   
--Lorna P., Makati City

A. Your mother aches all over and yet results of medical tests performed on her are normal. She probably has fibromyalgia, the collective name for several disorders that are characterized by recurring attacks of achy pain and stiffness in muscles, tendons, and ligament. Fibromyalgia is different from arthritis, bursitis, and tendonitis because these latter conditions are characterized by inflammation, something which does not exist in fibromyalgia.

Fibromyalgia can be generalized (i.e., the pain and stiffness is widespread all over the body) or localized (i.e., limited to a particular area of the body or a few muscle groups). Localized fibromyalgia is often the result of occupational or recreational muscle overuse (muscle strain). Generalized fibromyalgia (the form which you mother evidently have), on the other hand, occurs without any underlying cause in a vast majority of cases. Only occasionally can an underlying cause such as hypothyroidism be identified. 

Many experts opine that people with fibromyalgia have a lower threshold for pain because of increased sensitivity of the brain to pain signals. This increased sensitivity of the brain to pain probably results from the interplay of several factors including genetics (the disorder runs in families), infection and physical or emotional trauma.

Generalized fibromyalgia is seven times more common in women than in men. The risk of developing the condition increases with age although it usually initially appears during early or middle adulthood.

An attack of generalized fibromyalgia can affect any muscle, tendon or ligament in the body but those on the neck, shoulders, chest, lower back, and thighs are likely to be painful. The pain and stiffness in the involved soft tissues usually develop gradually. Sometimes they are triggered by physical or emotional trauma but in many cases there appears to be no trigerring event. In any case, the soft tissue pain and stiffness are aggravated by muscle fatigue or overuse, physical or mental stress, lack of sleep, and damp and cold weather. They persist for days, sometimes weeks, before subsiding spontaneously.

Typically, during an attack of generalized fibromyalgia, there are tender points all over the body. These are discreet muscle areas where fingertip pressure when applied causes pain. These tender points are often located on the back of the head, between the shoulder blades, top of the shoulder, front sides of the neck, upper chest, outer elbow, upper hips, and side of hips.

Fibromyalgia is not a progressive condition. It does not lead to other complicating conditions or diseases. But the pain can cause depression and sleep problems that may interfere with the person’s ability to function at home and in the job site.

Treatments for fibromyalgia include drugs and/or other modalities.

Analgesics (pain-relievers) and nonsteroidal anti-inflammatory drugs are often prescribed to patients with fibromyalgia, but they usually offer very limited benefit.  Some doctors also prescribe antidepressants and drugs used in the treatment of epilepsy.

Non-drug treatments are usually more helpful than drugs in managing fibromyalgia. Beneficial modalities include muscle stretching and conditioning exercises, application of heat to the affected areas, gentle massage, keeping the body warm, and measures designed to reduce psychological and emotional stresses.

(E-mail inquiries on health matters to: medical_notes@yahoo.com or wellbeing@mb.com.ph.)