Png Siok Lee, 69, suffered from chronic pain that was so debilitating that it disturbed her sleep. As a result, she was not well-rested, which led to a cycle of feeling even worse. She has comorbidities, including other autoimmune conditions, and it was when she was warded in hospital for another health issue in the early 2000s that she was diagnosed with fibromyalgia — a chronic disorder that causes pain, fatigue and sleep issues.
The retiree currently lives independently without a caregiver. She takes medication for fibromyalgia and reveals that she felt a sense of relief after her diagnosis, as she was finally able to put a name to this pain and was able to have a solution for it.
Dr Bernard Lee Mun Kam, senior consultant pain specialist at Singapore Paincare Center, describes fibromyalgia as a chronic condition characterised by widespread musculoskeletal pain and stiffness in the muscles, ligaments, tendons and joints.
Studies show that fibromyalgia affects up to 5% of the world population, with a higher female predominance – between 80 to 96%. The SingHealth website states that most female fibromyalgia patients are aged between 35 and 55.
Dr Jacklyn Yek, consultant, department of pain management at Singapore General Hospital, says that the hospital sees about 60 patients a year with fibromyalgia. Majority are female, aged 40 and above.
She lists the most common symptoms:
- Chronic (more than three months' duration), widespread pain throughout the body or in multiple areas. Pain is often felt in the arms, legs, head, chest, abdomen, back and buttocks. People often describe it as aching, burning or throbbing.
- Fatigue or an overwhelming feeling of being tired.
- Insomnia or having trouble sleeping.
- Mental fog, also known as 'fibro fog'. This can cause a range of symptoms such as difficulty concentrating, forgetfulness and having issues remembering new information, difficulty holding a conversation, feeling spaced out or 'mentally numb'.
- Abdominal pain with nausea, poor appetite, irritable bowel syndrome or urinary symptoms.
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The difficulties of diagnosing fibriomyalgia
Agnes Tan Gek Noi, a 50-year-old retiree, experienced a chronic dull ache on the right side of her head when she was 32. She soon started feeling nauseous and the pain got progressively worse that by her late 30s, “it felt like I was repeatedly slammed against a wall”.
An MRI scan ruled out tumours and her doctor suggested her migraines were probably caused by the stress of being a full-time working mother with four young sons. Over the next five years, Agnes took a variety of pain medications and, when she became Dr Lee’s patient in 2012, he prescribed her with a nerve stabiliser known as duloxetine.
While it has helped to eliminate her headaches, she also experiences pain in other parts of her body, such as her knee, back and stiffness in her shoulder. She was eventually diagnosed with fibromyalgia.
Credit: SGH
"Not everyone presents with all the symptoms at outset and the symptoms may happen gradually over time. Some symptoms are also non-specific to fibromyalgia such as fatigue and sleep disturbances. These symptoms are also subjective, and rely on patient reporting, making it challenging to measure objectively."
Dr Yek further shares that the current criteria for diagnosing fibromyalgia was developed by the American College of Rheumatology in 2010. There are two parts to this diagnosis – the first calculates the number of body parts affected by pain over the past week and the second calculates the symptom severity.
There is also no single laboratory test, imaging study or biomarker to definitively diagnose fibromyalgia, says Dr Yek.
Diagnosis is based on clinical evaluation and is a diagnosis of exclusion – meaning that it can only be diagnosed after rheumatological or autoimmune markers and viral markers are tested negative. Hence, it can be challenging for patients who may feel they have gone through a battery of tests to no avail.
While the exact cause of fibromyalgia remains unknown, Dr Lee reveals that researchers believe patients with fibromyalgia have abnormal levels of neurotransmitters in the brain. These are the body’s chemical messengers used by the nervous system to transmit messages between neurons to muscles, which alters the way the central nervous system processes pain signals.
Credit: Singapore Paincare Center
Dr Lee adds that gender and genetics are shown to play a role in fibromyalgia. He cites information from the Center for Disease Control in the United States, which says that fibromyalgia is twice as common in women than men.
Also, a study published on arthritis and rheumatism found that 28% of children whose mothers have fibromyalgia also developed the disorder.
Additionally, environmental risk factors can trigger the condition. Dr Lee gives examples such as prolonged psychosocial stress caused by severe accidents or emotional/physical abuse and trauma, as well as illnesses or infections such as pneumonia and dengue fever.
He reveals that a fibromyalgia treatment plan generally involves medications such as anti-convulsants and anti-depressants, regenerative therapy such as platelet-rich plasma (PRP) treatments and exercise.
Treating fibromyalgia requires a multi-dimensional approach involving a combination of both non- and minimally-invasive treatments, as well as lifestyle changes, including regular exercise and a healthy diet.
Living with fibromyalgia
Agnes underwent platelet-rich plasma treatment, prescribed by Dr Lee. She has also made lifestyle changes – such as weight- and high-intensity interval training – to help with her condition.
Her advice for fellow fibromyalgia patients is to seek help from a pain specialist at the earliest sign of discomfort than wait till the pain gets worse, “as pain conditions tend to be more complex and expensive to treat the longer you wait”.
Credit: Png Siok Lee
Similarly, Siok Lee wants anyone in pain to know that they can seek treatment. She maintains a very positive outlook as she believes that one’s quality of life is based on self-perception. She also sees the importance of social interaction – don’t cut yourself off socially, stay engaged but don’t push yourself.
She shared an example of how her friends like to go shopping along Orchard Road. While she knows she can’t handle the entire duration of the outing, Siok Lee doesn’t reject it outright but instead offers an alternative, like a coffee break in the middle where she can join. This lets her maintain some social engagement without overdoing it.
Dr Yek recommends anyone who wants to support their loved one with fibromyalgia to educate themselves about the condition to better understand what they are experiencing. Also, provide emotional support by being patient as well as a listening ear and help out with household chores, grocery shopping or errands during flare-ups. You can also offer to accompany them to medical appointments or therapy sessions.
"Recognise that they may have limitations on their physical and mental energy. Respect their need for downtime or quiet moments."
People who suffer from fibromyalgia could be in constant pain so a little patience and understanding of the condition is important to make them more comfortable.
This article is part of a series on invisible disabilities, an umbrella term that refers to types of disabilities, chronic conditions or medical/neurological conditions that are not immediately apparent to others. We seek to understand more about these invisible disabilities and how we, as loved ones or as general members of society, can better support others going through it.
