Fibromyalgia is a chronic pain disorder characterized by muscle pain throughout the person’s body, general tiredness, and soreness at specific locations of the body known as pressure points. The Centers for Disease Control and Prevention (CDC) categorizes fibromyalgia as a type of arthritis; however, fibromyalgia does not cause damage to the joints or other tissues the way that other types of arthritis do. Fibromyalgia was first defined as a disease in 1976 and accepted as a cause of workers’ disability in 1987. Because fibromyalgia does not have symptoms that are unique to it, however, some doctors question whether it is really a distinctive disorder. The controversy became heated in January 2008, when Dr. Frederick Wolfe, one of the doctors who had been responsible for the diagnostic criteria drawn up by the American College of Rheumatology (ACR) in 1990, stated that he had changed his mind about the disorder. He now regards it as a physical reaction to stress, worry, and depression. Dr. Wolfe was quoted as saying, “Some of us in those days thought that we had actually identified a disease, which [fibromyalgia] clearly is not. To make people ill, to give them an illness, was the wrong thing.”
Fibromyalgia is a chronic disorder characterized by widespread muscle pain, chronic fatigue, and specific areas or points of soreness on the body. It is considered a syndrome because it is a collection of signs and symptoms that occur together but cannot be traced to an identifiable cause. Most people who develop fibromyalgia are middle-aged adults. It may appear either gradually or suddenly, and may be accompanied by headaches, insomnia, and other symptoms. Most people with fibromyalgia are able to continue working, but some end up working only part-time or changing to a less demanding job.
Fibromyalgia can affect anyone in any age group, but it is most common in women between the ages of twenty and fifty. According to the ACR, between 3 and 6 million people in the United States have fibromyalgia, or one person in every fifty in the general population.
Females are nine time more likely to have fibromyalgia; some of the men who are diagnosed with it are Gulf War veterans.
Nursing Care Plan Signs and Symptoms
Researchers do not agree about the possible causes of fibromyalgia, partly because it often
occurs together with such other disorders as irritable bowel syndrome, rheumatoid arthritis, and restless legs syndrome, and partly because many do not think of it as a separate disorder
in its own right. Fibromyalgia has been attributed to a number of different psychological as well as physical causes:
• Genetic factors
• A virus that affects the patient’s perception of pain
• Childhood abuse or other traumatic incidents
• Lyme disease
• High levels of substance P in the spinal fluid (Substance P is a chemical that transmits and intensifies pain signals between the brain and the rest of the body.)
• Female sex hormones
• Emotional stress
• Sleep disorders
• A buildup of excess calcium and phosphate in the muscles
• Psychological depression
• Toxic substances in the environment
In addition to muscle pain and fatigue, people with fibromyalgia may have the following symptoms:
• Headaches
• Irritable bowel syndrome
• Disturbed sleep
• Problems with memory and concentration (This symptom is sometimes called “fibro fog.”)
• Chronic pain in the chest, abdomen, or pelvic region
• Changes in body weight
• Allergies; hypersensitivity to light, noises, and odors
• Shortness of breath
• Having to urinate more often
• Dizziness
Nursing Care Plan Diagnosis
There is no laboratory test or imaging study that can detect fibromyalgia. The diagnosis is based on the patient’s history and a physical examination. In 1990 the American College of Rheumatology (ACR) specified that the patient must have widespread pain for at least three months and soreness at eleven out of eighteen specific pressure points. These points are located on the neck, shoulders, chest, rib cage, lower back, thighs, knees, elbows, and buttocks.
Nursing Care Plan Treatment
Treatment of fibromyalgia is usually broadbased, consisting of recommendations about exercise and regular sleeping habits as well as medications. A variety of different drugs have
been prescribed for fibromyalgia, including muscle relaxants, tranquilizers, antidepressants, and pain relievers; however, many doctors are cautious about these drugs because of the possibility that the patient will become dependent on them. A new drug called Lyrica was approved by the FDA in the summer of 2007 as a treatment for fibromyalgia. The new drug was originally developed to treat seizures and nerve pain associated with diabetes. It is controversial as a treatment for fibromyalgia, however, because it has several potentially serious side effects, such as weight gain, blurred vision, swelling of tissue, sleepiness, and dizziness. In addition, Lyrica may not provide patients with long-lasting benefits, as people with fibromyalgia frequently change from one drug to another every few months.
In some cases the patient’s doctor may recommend psychotherapy to help the patient regain a sense of control over his or her life and to learn better ways to cope with physical pain. Relaxation techniques may be useful. Some complementary and alternative treatments appear to be beneficial to people with fibromyalgia. These include therapeutic massage, acupuncture, and chiropractic. It is better, however, for patients to use approaches that get them involved in their own healing, such as regular exercise, losing weight if they are too heavy, and endurance and strength training, rather than therapies in which they are simply receiving treatment from another person.
Nursing Care Plan Prognosis
Fibromyalgia can last for years but is rarely fatal. The patient’s symptoms may get better on occasion and then worsen again during stressful periods; one survey found that fibromyalgia patients average ten outpatient visits to their doctor every year and are hospitalized once every three years.
Nursing Care Plan Prevention
There is no known way to prevent fibromyalgia.
The Future
It is uncertain whether fibromyalgia will be diagnosed more frequently in the future. Since the disorder was identified only a few decades ago, it is possible that it will be redefined at some point, along with other similar pain and chronic fatigue syndromes.
No comments:
Post a Comment