Fibromyalgia

FIBROMYALGIA

Fibromyalgia/ Fibromyalgia syndrome (FMS), is a chronic (long duration) condition that results in pain all over the body.

Apart from widespread pain, patients with fibromyalgia may also have:

What causes fibromyalgia?

• increased sensitivity to pain
• fatigue (extreme tiredness)
• muscle stiffness and full body pain
• difficulty sleeping
• problems with memory and concentration
• headaches
• irritable bowel syndrome (IBS) – a digestive condition that causes stomach pain and bloating

The exact cause of fibromyalgia is unknown. In many cases, the condition appears to be triggered by a physically or emotionally stressful event, such as:

• an injury or infection
• giving birth
• having an operation
• the breakdown of a relationship
• the death of a loved one

Who's affected?

Fibromyalgia can develop in anyone, although it affects 7 times as many women as men. It generally develops between 30 and 50 years of age, but may occur at any age. Fibromyalgia can be a difficult condition to diagnose as there is no specific test to diagnose fibromyalgia, and the symptoms can be similar to a number of other conditions.

Conventional treatment methods include medication to reduce the pain and include pain relievers, antidepressants, and anti-seizure drugs followed by physical therapy to improve the strength, flexibility and stamina.

Alternative treatment methods at Beth Yehuwdah Arthritis Centre, Pullad & Daystar Clinic, Alappuzha:
& Neural & Soft Tissue Infilteration Therapy (NESTIT)

Low Dose Steroid Infilteration/ Neural & Soft Tissue Infilteration Therapy (NESTIT):  Steroid tablets and injections of the group Corticosteroids, (which are very different from Anabolic steroids misused by some athletes) have been repeatedly proven medically for the last 70 years in the successful treatment of inflammatory conditions due to its potent anti-inflammatory effect. Though corticosteroids are very effective in reducing inflammation, they carry numerous potential side effects, which are undesirable. To circumvent this problem, and in order to utilize the potent anti-inflammatory effects of steroid injections, at the same time taking appropriate measures to considerably lower its side-effects, Dr Tejaz Koshy John in 2010 while working as an Orthopaedician in his private clinic in Guyana, South America developed NESTIT. NESTIT stands for (Juxta) Neural and Soft Tissue Infilteration Therapy. It consists of injecting small amounts of diluted anti inflammatory steroid solution indirectly near (juxta) nerve CCPs- (chronic constricting points) in the lower back/ hip/ neck/ shoulder regions, in order to reduce juxtaneural and perineural inflammation, as well as in certain soft tissue sites including but not limited to trigger points (painful muscle “knots”)/ myofascial syndrome and/or enthesitis (inflammation of soft tissue-bone junctions) and/or sites of nerve inflammation (neuritis/ radiculitis) and/or bursitis (inflammation of fluid filled cushions called bursa) and/or additional sites causing pain referrals (referred pain) to distant sites; in order to obtain a reduction in inflammation and pain in the concerned joint/ region/ limb. It is preferably given for those patients who have Rheumatoid Arthritis, Inflammatory Arthritis, Synovitis, Inflammatory Low Back Pain, Spondyloarthropathy & Nerve and Nerve root irritation. It is not a substitute for DMARDS (Disease modifying anti rheumatoid drugs), however when given with low dose DMARDS, in Dr Tejaz John’s clinical experience it may result in significant reduction of local inflammation, pain and improvement of joint function in most cases, also indirectly reducing side effects of high dose DMARDS.

NESTIT involves 

1. Administeration of low dose local steroid via infilterative type of injection technique rather than giving oral steroids (as cumulative daily dosage of oral steroids over a 6 week period could exceed the dose of local steroid injection by almost 5 to 10 times) or conventional single injection into joints directly.
2. Reduce the dosage of Steroid given via injection and the use of a sliding scale according to patient’s body weight and height to regulate dosage. A 40 kg woman of 4 feet 9 inches should not receive the same dosage as a 100 kg male of 6 feet height.
3. Dilute the low dose steroid injection upto 80% with sterile water and local anesthetic.
4. Administer relatively insoluble low dose steroid via multiple infilterations locally in inflamed tissues in very small amounts indirectly near (juxta) nerve CCPs- (chronic constricting points) in the lower back/ hip/ neck/ shoulder regions as per requirement, in order to reduce juxtaneural and perineural inflammation, as well as in certain soft tissue sites including but not limited to trigger points (painful muscle “knots”)/ myofascial syndrome and/or enthesitis (inflammation of soft tissue-bone junctions) and/or sites of nerve inflammation (neuritis/ radiculitis) and/or bursitis (inflammation of fluid filled cushions called bursa) and/or additional sites causing pain referrals (referred pain) to distant sites; in order to obtain a reduction in inflammation and pain in the concerned joint/ region/ limb.
5. Identification of high risk patients and risk stratification to reduce possibility of side effects, for eg. Patients suffering from serious heart & liver conditions tuberculosis, infections, significant osteoporosis, immuno-compromised patients, menstrual irregularities, already having Cushing’s syndrome, ongoing significant hair loss etc.
6. Regular monitoring of body weight and physical appearance for early detection of Cushingoid features, if it occurs (rarely), to delay/ avoid further injections.
7. Control of High Blood Pressure and Diabetes prior to giving injections.
8. Doing skin sensitivity tests to rule out allergic reactions to the drugs.
9. Explaining possibilities of common & rare side effects to the patient and taking precautions regarding other common side effects wherever possible.
10. Opting for/ Shifting to regenerative treatments like Platelet Rich Plasma and Dextrose Prolotherapy wherever there is secondary degenerative disease / soft tissue damage, once the severe inflammation subsides.

In Dr Tejaz John’s clinical experience, the patient benefits of Low Dose Steroid Infilteration/ Neural & Soft Tissue Infilteration Therapy (NESTIT) treatment are:

• Minimally invasive treatment method
• Almost painless injection technique using very thin needles under local anesthesia
• Significantly reduces the symptoms associated with Fibromyalgia.
• Reduced risk of adverse events compared to oral steroid tablets which are taken daily, due lower dosage (very low steroid dosage compared to cumulative oral steroids over 6 week period).
• Reduced risk of side effects/ adverse effects due to prior risk stratification and identification of high risk patients vs. low risk patients by doing precautionary steps and tests prior to giving injection.
• Reduced incidence of post-injection pain due to highly diluted steroid solution.
• More effective treatment method in Fibromyalgia in Dr John’s experience.
• Faster recovery.
• NESTIT treatment usually results in significant, effective, progressive improvement of pain, function and reduction of symptoms if given in series.

2) Prolotherapy for treatment for fibromyalgia

Dr Tejaz John’s experience in Prolotherapy has taught him that many patients with Fibromyalgia may respond well to Prolotherapy, especially when given in areas of Trigger points and near specific Soft tissue sites in the neck, and lower back/ lumbar spine and pelvic regions.

Prolotherapy is an almost painless injection technique under local anesthesia where very thin needles are used to inject high concentrations of dextrose solution (sugar similar to glucose) in to loose and damaged ligaments, tendon and muscle attachments around Joints and Soft tissues. Prolotherapy  works by increasing the glucose concentration in the fluid outside the cells. This results in movement of fluid from inside the cells to the outside of the cells thereby shrinking the cells and causing temporary cell damage (hyperosmolar damage). As the cells are temporarily damaged, they release many biosignals to the body which results in stimulation of the immune system of the body to accelerate the inflammatory process locally resulting in increased local blood circulation, fibroblast (fibrous cell) proliferation, ligament regeneration, tightening and repair. In Dr Tejaz John’s experience Prolotherapy can result in significant local symptomatic improvement in Fibromyalgia patients.

Patient Benefits of Prolotherapy:

• Minimally invasive treatment method
• Almost painless injection technique using very thin needles under local anesthesia
• Prolotherapy may significantly reduce the symptoms associated with Fibromyalgia locally.
• Reduced risk of adverse events
• Repairs and tightens ligaments / muscle attachments/ trigger point areas breaking local pain cycle in Fibromyalgia.
• Safe and effective treatment method
• Faster healing and recovery

At Beth Yehuwdah Arthritis Centre, Pullad and Daystar Clinic, Alappuzha we tailor customized treatment plan to treat patients suffering from Fibromyalgia. To know more about treatment plans and treatment costs, book an appointment now.