Fibromyalgia is a particularly challenging form of rheumatic pain affecting up to 1 in 25 people with women being more commonly troubled than men.
The presentation is of widespread bodily pain with subjective sensations of swelling and altered sensation and characteristic trigger point tenderness.
It is characteristically associated with severe chronic fatigue, poor sleep patterns and depression
It is frequently associated with irritable bowel, atypical migraines and headaches, pelvic pain.
The cause is still poorly understood but is believed to be due to ‘re-programming’ of central nervous system pain pathways to make them over sensitive and transmit false information to the thinking part of the brain.
There are no abnormalities in the tissues where the discomfort is perceived as coming from and no damage occurs. Blood testing is normal. Despite this it is frequently an incapacitating condition.
· A regular exercise programme with emphasis on aerobic and range of movement components
· Cognitive behavioural therapy with a trained psychologist of counsellor
· Correction of the underlying sleep disturbance with low doses of a tricyclic antidepressant. Treatment with muscle relaxants and simple analgesics or NSAIDs.
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Complex regional pain syndrome (CRPS) is a localised chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems. Typical features include changes in the colour and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling.
CRPS I is frequently triggered by tissue injury; the term describes all patients with the above symptoms but with no underlying nerve injury.
Patients with CRPS II experience the same symptoms but their cases are clearly associated with a nerve injury.
Older terms used to describe CRPS are "reflex sympathetic dystrophy syndrome" and "causalgia."
The prognosis for CRPS varies from person to person. Spontaneous remission from symptoms occurs in certain people. Others can have unremitting pain and crippling, irreversible changes in spite of treatment. Early treatment is helpful in limiting the disorder, but this belief has not yet been supported by evidence from clinical studies. More research is needed to understand the causes of CRPS, how it progresses, and the role of early treatment.
Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms so that people can resume their normal lives. Treatment is usually administered through the services of the pain clinic and physiotherapy if available.