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2019 definition of International association for the study of pain (IASP) defines Fibromyalgia syndrome (FMS) as a form of chronic widespread pain (CWP), that is associated with sleep disorders, cognitive dysfunction, and other somatic symptoms. CWP is associated with significant emotional distress and /or functional disability. They have retained the label FMS which refers to a musculoskeletal process with muscle and joint identified as the foundation symptoms. FMS is probably only one part of an even more generalized condition that includes irritable bowel syndrome (IBS), chronic headaches, regional migratory numbness, temporomandibular joint (TMJ) syndrome, and others.
FMS is exhausting to the patient because the pain never lets up. It may not be very severe on a 1-10 scale but it is the sheer constancy of pain which does not allow any pain free respite that exhausts the physical and mental reserves of the patient. There is always some pain somewhere in the body but there is no constancy to the area of pain which keeps migrating from place to place. Even when the pain with which the patient presents is relieved, they come back with some other pain at a different location.
Current research indicates altered connectivity and brain chemistry in brain regions within the pain processing system of FMS patients. fMRI has shown altered functional connectivity between brain areas and exhibit abnormal activity in FMS patients.
Thus, medical management to target these brain functions forms the mainstay of FMS treatment. In general FM patients are sensitive, intelligent women/ men who are trying their level best to cope with their situation but are stumped at every step by their pain and disability, particularly by the temporary and sometimes unreliable nature of pain relief provided by most treatments. Medications as well as Physical therapy help temporarily but often a partially and unfortunately, attempts at stepping up the intensity or repetitions of physical therapy exercises causes exacerbations of original pain or a new pain elsewhere.
How are we different?
At our clinic, in addition to medications in accordance with the above description and physiotherapy we also utilize certain combination treatments which have been very effective.
Pulsed radiofrequency (PRF), of the nerves supplying the area of pain, USGDN of the painful muscles and USG guided BOTOX as and when needed jumpstart the pain relief. We have found that all these 3 modalities make significant difference to the patient’s pain, sleep disorders and self-confidence.
When we do USGDN, we have a visual evidence and an external objective confirmation of FMS pain. Ultrasound visualization of needling shows obvious local twitch reflexes in the muscles that the patient points to as being painful. And what is more, after the needling, that particular pain is consistently relieved.
Thus, for FMS the treatments available at our clinic are,
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