FIBROMYALGIA

Fibromyalgia is characterized by chronic widespread pain, and a heightened and painful response to pressure. It is described as "Central sensitization syndrome" caused by neurobiological abnormalities which  produces a physiological pain and cognitive impairments as well as neuro-psychiatric symptomatology.

SIGNS AND SYMPTOMS
Chronic widespread pain, fatigue, heightened response to tactile pressure.
Tingling of skin, prolonged spasm, weakness in limbs, palpitation, functional bowel disturbance and chronic sleep disturbance.Some may also experience cognitive dysfunction
Other symptom often attribute to fibromyalgia that may possibly include myofacial pain syndrome.


CAUSES
Unknown.
Possible: Genetic predisposition, stress, hypodopaminergia, abnormal serotonin metabolism,deficient growth hormone, physical trauma, poor sleep etc



DIAGNOSIS
There is no single diagnostic test.
Most widely accepted set of classification criteria for research purposes was given  in 1990 by multicentre criteria committee of American College of Rheumatology: a history of widespread pain lasting for >3 months, affecting 4 or more quadrants of body i.e both sides and above and below waist.

                                                Tender points

18 designated points.the patient must feel pain at 11 or more points to consider him for fibromyalgia.

Criteria :
Location throughout

Particularly in neck,shoulder,arm, buttocks,hip,thigh

It hurts when pressed but pain doesn't radiate.




TREATMENT
Psychological/behavioural therapy
Pharmaceutical

Physical therapy
Exercise improves fitness and sleep and may reduce pain and fatigue. Strong evidence suggest that cardiovascular exercise is effective for some patients. Long term aquatic exercises has been proved beneficial as it combines aerobic and resistance training.

AEROBICS
Modes of exercise such as walking and biking can yield long term benefits for fibromyalgia . Startoff with low intensity below your actual capacity and gradually progress.Water aerobics ideal for people with increased pain in patients with chances of worsening of symptoms with exercise

Strength training
To minimize fibromyalgia relates pain.With strength training you focus on one muscle group per session alternate upper and lower extremity training. Isometrics can also be performed.

Avoid eccentric exercises including those with heavy weights which may cause injury.using light weights start with low number of repetitions also rest is very important. Perform exercise 2-3days per week with duration of 25-30 minutes of workout everyday.

Flexibility Stretches should be performed for all major muscle groups.

Combination therapy
Medicine +diet+exercise+cognitive behavioral therapy.


SIGNIFICANCE OF EXERCISE

• It controls pain and fatigue and prevents decline of muscle strength and endurance, improve flexibility, sleep and energy.
• Muscles that are not conditioned use excess energy which can contribute to fatigue and aggravate pain,hence exercise helps to improve oxygen delivery and increase muscle temperature leading to pain relief and relaxation.
• Strengthen ligaments tendons.
• Increase endorphin pain relief.
• Decrease anxiety and depression.

OTHER
Yoga:Which incorporates exercises, stretching, and meditation, is a great way to increase fitness.The physical postures(Asanas)can alleviate aches and pains, concentration exercises help to overcome fibrofog (loss of mental clarity), and meditation helps you to focus on present instead of ruminating about your pain/

Tai-chi has also been found beneficial. It emphasizes on relaxation. Its like"meditation with movement"with dramatic flowing movements instead of forceful movement The goal of Tai-chi is to bring principles of Ying and yang into harmony.


Daily activities and hobbies: Experts say that daily activities a household chores as playing with kids, washing windows, mowing yard, gardening an all be beneficial when it comes to increasing fitness and reducing symptoms.

Qigong and meditation: Its called the mother of Chinese healing. It combines meditation dance movements and breathing exercises.It helps to improve energy, decrease fatigue and alleviate pain.

Heat therapy: dry and moist :helps you to relax and alleviate pain.


NUTRITION
EAT : fruits and veg raw, natural protein.
DON'T EAT: fried food, veg meat, food with white flour, increase sugar caffeinated drinks.

We would love to hear from you, coping up skills you have incorporated in your daily life to deal with fibromyalgia.

How to be comfortable in Labour

The anxiety of pregnancy followed by painful childbirth dogs most women. However, following a few easy steps and making adequate preparations can significantly make labour easy.

Fear of the unknown is one of the biggest factors that contributes to pain. Throughout labour, the woman, if not aware, will be anxious whether the developments in her body are normal or not, which is why it is important to tell women beforehand what to expect.

Everyone's labour is different, and pinpointing when it begins is not really possible. It's more of a process than a single event, when a number of changes in your body work together to help give birth.

In early labour, also called the latent phase you may feel: 

• Persistent low back or abdominal pain, usually accompanied by the crampy premenstrual feeling.
• A bloody show (a brownish or blood-tinged mucus discharge). If you pass the mucus plug that blocks the cervix, labour could be imminent or it could be several days away. But it's a sign that things are moving along.
• Painful contractions occurring at regular and increasingly shorter intervals and become longer and stronger in intensity.

How you feel in early labour depends on whether you've had a baby before, how you perceive and respond to pain, and how prepared you are for what labour may be like.

What should be done in early labour?

This will depend on what time of day it is, what you like doing and how you're feeling. Keeping calm & relaxed will help your labour to progress and help you cope with the contractions.
This could mean watching a favourite film, relaxing, or asking a friend or relative over to keep you company. You could alternate between walking and resting, or try taking a warm bath or shower to ease any aches & pains. If you can, try to get some rest to prepare you for the work ahead. 
During early labour, you may feel hungry so eat & drink if you feel like it. This will help to comfort you and help you to rest. 
Early labour is a good time to try out various positions & breathing techniques to see if they help you cope with the contractions.

How make yourself comfortable during labour?
One's posture tells a vivid story about the person's state of mind. When tensed, we tend to curl into a ball, like a new born baby. Our shoulders get hunched, we tuck are chin in, bend our elbows & pull in out arms. When pain is felt, we adopt a similar position.
Some of the strategies that can be used to relax during labour include:

• Postural Awareness
• Relaxation Posturing
• Visualization & Imagery
• Breathing Patterns
• Labour Positions
• Touch & Massage

Postural Awareness:
Being aware of your posture can be used when you are tensed or in pain. Relaxation can be obtained when consciuosly you move from a posture of pain to a posture of relaxation.
Relaxation Posturing:
Irrespective of which posture you choose, maximum relaxation can be obtained when the whole body is completely supported. This can be achieved by taking complete support from in the chosen position & with the use of pillows.
In Sitting-

Sit with complete back support, from buttocks to neck, arms resting on arm rests & feet on the floor. If your feet do not reach the floor, keep a pillow or a stool to place your feet on. Hips & knees both should be at 90 degrees.

Leaning forward, resting your head on a table is also a good posture for relaxing. Make sure the edge of the table is not pressing against the baby.

In Lying-

        

Visualization & Imagery:

Visualization & imagery is an technique which depends on your imagination. You can picture & relive a happy experience. Relive the sounds, touch, emotions & all sensations pertaining to that memory. If not, you can visualize a scenery-beach, mountains, the calm ocean, & experience the sounds of the waves/birds chirping/feeling of the wind on  our face/feel the sand between your toes etc.

Breathing Patterns:

Breathing Deeply increases the oxygen content in the body & induces relaxation on exhalation.

How To- Keeping your shoulders relaxed, take a deep breath in through your nose. On exhaling through your mouth, feel the tension leaving your body.

Labour Positions:
Adopting different positions is helpful in dealing with the contractions. Breathing techniques can be used in these positions. It is advisable to practice these positions from 7-8th month onwards, so that you can decide which positions are comfortable for you. Few of the commonly used positions are shown.

Above shown positions help in reducing low back ache ( No.3-All Fours/No.5-Squatting) during contractions & increases blood supply to the baby. The Squatting position (No. 5) helps the baby to descend and gets the head locked in the birth canal. The baby's head gets fixed in the right position, which helps during labour. However, make sure you consult an expert before engaging in this exercise.
The breathing patterns used to relax during contractions can be practiced in these positions.
Massage:
Massage in labour is a very personal thing. It is most important that whoever is giving the massage is sensitive to your changing needs- with regard to location, depth, technique & well supported positioning.
Back pain in early labour is commonly felt in the low back region & can intensify as labour progresses.

Performed usually with you sitting & leaning forwards on your hands. Using the heel of their hand, your partner can gently knead your low back & increase or decrease pressure according to your comfort.

Performed either in side lying or in the sitting position. Slow rhythmical stroking using fingertips from the neck to the tail bone, single or double handed, can relieve tension & induce relaxation. Can be performed over the spine or parallel to it. Pressure can become slightly deeper as the hands descend.

The lower half of the stomach is the most common site of pain. This massage can be done using fingertips of both hands.

Side to Side stroking over the area of pain, will give relief. Perform using fingertips/ palms of both hands.


We hope these tips have been useful to you to prepare for your labour. We would like to hear about your experience.


(Read about Breathing Patterns in How to Breathe during Labour)