Mother of four boys, Agnes Tan, endured years of chronic migraines and debilitating pain before she was diagnosed with fibromyalgia and treated by a pain specialist.

Agnes Tan Gek Noi was 32 when she began experiencing a persistent, dull ache on the right side of her head. While it was easily manageable with paracetamol tablets at first, the pain gradually intensified over the years that she became nauseous and constantly moody.

“After two years of chronic migraines I consulted a neurologist at Gleneagles Hospital Singapore. Thankfully an MRI scan ruled out tumours, and the neurologist attributed my migraines to the stress of juggling a full-time job and raising four young sons. Convinced that stress and anxiety were the culprits, I turned to a psychiatrist three months later. I was prescribed with alprazolam, but after two months, it became evident it wasn’t providing the relief I needed,” says Agnes Tan, who was working as an administrator in her husband’s office, managing the day-to-day operations.

By her late 30s, the pain had reached a point where she felt like she was being repeatedly slammed against a wall. By then, Agnes was taking up to eight paracetamol tablets daily and then resorted to non-steroidal anti-inflammatory drugs (NSAIDS) but relief remained out of her reach. “I grew increasingly frustrated that there was no cure or treatment for my condition. It seemed I was destined to live with migraines permanently,” shared Agnes.

Dr. Bernard Lee, Senior Consultant Pain Specialist of Singapore Paincare Center

Dr. Bernard Lee, Senior Consultant Pain Specialist of Singapore Paincare Center

Finally, a diagnosis

In 2012, when Agnes was 39, she learned about Dr. Bernard Lee, Senior Consultant Pain Specialist of Singapore Paincare Center, from her mother-in-law, who had successfully treated her knee pain with him.

At the first consultation, Dr Lee analysed Agnes’s MRI report, assessed her lifestyle, and diagnosed her chronic headaches as stemming from stress and anxiety, as well as a chronic condition known as fibromyalgia.

“Fibromyalgia is characterised by widespread musculoskeletal pain and stiffness in the muscles, ligaments, tendons, and joints. Patients who suffer from fibromyalgia usually complain of chronic discomfort in many sensitive spots throughout the body, known as trigger points. The discomfort or pain is often accompanied by other symptoms including fatigue, insomnia, migraines, and mood swings,” explains Dr Lee.

“The condition is caused by abnormal levels of neurotransmitters in the brain which disrupts the usual transmission of messages between neurons and muscles by the nervous system. This alteration in the central nervous system’s processing of pain signals amplifies pain sensations in specific areas and can cause areas which are not normally associated with pain to feel painful,” he adds.

Fibromyalgia occurs in between 2% to 5% of the Singapore population, typically affecting individuals between the ages of 20 to 50 years old.  Unfortunately, it is often misdiagnosed because its symptoms can mimic those of other conditions such as lupus, multiple sclerosis, rheumatoid arthritis, and more.

“There are no specific blood or imaging tests that can clearly identify fibromyalgia. Patients should visit a pain specialist if the pain has persisted for at least three months and other potential causes have been ruled out,” says Dr Lee.

Treating pain with medication, minimally invasive therapies and exercise

Dr Lee prescribed Agnes with a nerve stabiliser and anti-depressant known as duloxetine, which she has been on since, to stabilise the hypersensitive nerves triggering her migraines. While it worked in suppressing the migraines, Agnes’ pain eventually expanded to other trigger points including her back, leg, knee and shoulder. Dr Lee then adjusted Agnes’ dosage of duloxetine, to successfully manage the pain in the rest of her body while maintaining control over her migraines.

“I once suffered the worst ever migraine I had ever experienced when I did not take the medication for two days as I forgot to pick up my prescription,” shares Agnes.

“Although I have some concerns about the potential side-effects of long-term use, Dr Lee has advised me to stay on duloxetine until after menopause, as stopping the medication could exacerbate my pain and peri-menopausal symptoms, including mood swings, irritability, and fatigue,” she adds.

In 2021, Agnes was administered with platelet-rich plasma (PRP) therapy to alleviate pain and stiffness in her knee and shoulder, caused by fibromyalgia.

“Following the PRP procedures, I was thrilled to find myself pain-free, with no discomfort or side effects. My pain reduced by 20% to 30% almost immediately; within four weeks the pain had completely resolved,” says Agnes.

Dr Lee also advised Agnes to exercise regularly as physical activities like stretching, strength training and cardio, can help regulate neurotransmitters and boost endorphins to decrease pain and improve mood and sleep quality. Other complementary self-care practices, such as massage, meditation, and breathing exercises have also been reported to control fibromyalgia in varying degrees.

Looking forward to a pain-free future

Today, 50-year-old Agnes is happily retired and finally pain-free. She incorporates regular weight and high-intensity interval training (HIIT) into her exercise routines, as a way to strengthen her body while keeping her aches and pains under control.

She is hopeful that in time, she will be able to wean off her medication and use exercise to manage and resolve her pain, if her body is strengthened with exercise and as her stamina improves.

“Today, I’m grateful to be finally pain-free. I have learned that it is best to seek the help of a pain specialist at the earliest sign of discomfort rather than waiting for the condition to worsen, because the longer we wait the more complex and expensive it becomes to treat pain conditions,” says Agnes.

Agnes Lee photo courtesy of Agnes Lee.
Dr Bernard Lee photo courtesy of Singapore Paincare Center.