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« on: February 09, 2006, 07:13:53 pm »

« Last Edit: November 24, 2006, 10:51:16 am by Kathy » Logged


I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
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« Reply #1 on: June 15, 2006, 10:05:22 am »

Fibromyalgia: Chronic Pain, Tender Points, No Known Cause
The syndrome known as fibromyalgia can have a devastating impact, as people with it suffer from chronic pain in multiple parts of the body and "tender points" that hurt in response to even slight pressure. Because fibromyalgia has no single known cause and there's no specific laboratory test to detect it, it remains difficult to diagnose and treat.

For example, a patient might be treated for years for chronic hip pain with no relief, only to learn later that they have fibromyalgia. As opposed to a disease, a syndrome involves medical problems, symptoms and signs tending to occur together but not related to a single identifiable cause. Fibromyalgia patients have pain and fatigue, and also may experience sleep disturbances, morning stiffness, numbness or tingling of the extremities, headaches, restless leg syndrome, painful menstrual periods, memory and cognitive problems, or one or more of a variety of other symptoms.

"Fibromyalgia affects a substantial number of individuals, anywhere from two to four percent of the population in the US; I'd say about 6 million people at an absolute minimum," said Nanjappareddy (Muni) Reddy, MD, Medical College of Wisconsin Associate Professor of Physical Medicine and Rehabilitation. Dr. Reddy is Medical Director of Outpatient Physical Medicine and Rehabilitation at the Froedtert & The Medical College of Wisconsin Clinics. He is also the Medical Director of Curative Care Network in Milwaukee, and one of the relatively few Medical College faculty physicians with major interest and experience in evaluating and treating fibromyalgia patients.

"Fibromyalgia is a condition with chronic pain associated with multiple areas of the body, typically with what we call 'tender points' distributed quite frequently in the neck, lower back, and a number of joints, generally speaking in muscle, ligament and tendon areas," said Dr. Reddy. "That's a common presentation. People with fibromyalgia are also commonly experiencing problems with their sleep pattern, have a lot of fatigue, and often uncertainty as to what is causing the problem.

"Fibromyalgia is an easily missed diagnosis because many times people will develop symptoms gradually, and often they present with a localized area of pain. Routine treatment may have failed to give relief. However, on close scrutiny, one might determine that it's not just in one area that they have problems, but they have a number of systemic type complaints and problems. Often signs and symptoms are referred to multiple systems and locations."

The Central Sensitivity Theory
About 80% of those diagnosed with fibromyalgia are women of childbearing age, for reasons that remain unclear, although it also strikes younger and older women, men, and children. Causes being studied by researchers trying to tie the syndrome together include problems with how the central nervous system processes pain, physical or emotional trauma, hereditary factors, underlying diseases, and others.

"The diagnosis for fibromyalgia is substantially clinically-based," said Dr. Reddy, "the reason being that there's no single test that can say 'this is it'. No absolute specific answer can be given to the question of 'what is happening in the body?' in fibromyalgia. We have found that there are a number of things that may be going on. It appears to be some sort of central process of desensitization. In other words, something is going on in the brain or below the brain level, and these changes seem to be such that the person perceives pain to a heightened level. Some research experiments support that 'central sensitivity' theory.

Dr. Reddy stressed that fibromyalgia is not a psychosomatic condition (something the brain says exists but really doesn't, or solely caused by psychological factors or stress). "Many people may think of it that way but it's not. There are physical problems, and there are also some emotional and related issues. But there is more and more suggestion that central sensitivity, altered sensitivity issues, are major factors. That's where a substantial focus is these days."

The American College of Rheumatology (ACR) has established two criteria for fibromyalgia diagnosis: a patient history of widespread pain lasting more than 3 months and the presence of tender points. Pain is considered to be widespread when it affects all quadrants of the body (both right and left sides as well as above and below the waist). The ACR also has designated 18 sites on the body as possible locations for tender points. For a fibromyalgia diagnosis, a person must have at least 11 tender points.

A proper diagnosis can lead to numerous treatment options, important because of the severity of the syndrome. "Fibromyalgia can cause severe impairment in some individuals that inhibits them from doing a number of routine day-to-day activities," said Dr. Reddy. "But a significant proportion of individuals are perfectly functional and active in life despite a diagnosis of fibromyalgia."

Associations Abound
"At least from what we know, there may be a substantial amount of emotional stress associated with fibromyalgia," said Dr. Reddy. "We know that the altered sleep pattern, in some cases, does not allow adequate recovery of the muscular and ligament structures and patients often feel a lot of fatigue because of that. And they feel pain that is very bothersome and frustrating.

"Also, a number of other associations have been found. Some individuals seem to have had no prior physical trauma that can be explained. Many, though, may have had some sort of disease process or trauma (such as a bad accident) predisposing them to fibromyalgia. Examples of conditions associated with fibromyalgia include rheumatoid arthritis, lupus, AIDS, or chronic fatigue syndrome.

"And there is some suggestion that people who have had cervical injuries, as in an automobile or other accident, can develop features of fibromyalgia over time. There appears to be a reduced level of growth hormone secretion in these individuals. But again, it's not everyone. And there appears to be some neurochemical changes, such as altered levels of noradrenalin and serotonin."

The societal cost of fibromyalgia is huge, Dr. Reddy said, both in lost productivity and in care costs. "It's a pretty expensive condition nationally," he said. "People lose a lot of workdays. And there is a lot of cost involved in the medical care, the reason being they are looking for clarity, a clear diagnosis, and solutions. So it is quite common for individuals to go through a variety of tests, sometimes finding nothing wrong that is specific. A variety of numbers have been thrown around; I've seen some estimates that are quite staggering, putting the health care costs alone at about $80 billion a year.

"The complexity of fibromyalgia makes treatment difficult. Many times it is very hard to deal with all their complaints and concerns in a typical short primary care clinic visit. We generally end up seeing fibromyalgia patients in specialty clinics such as Physical Medicine and Rehabilitation, rheumatology, and quite often in pain clinics. Patients need a fairly comprehensive initial visit and a physician who understands this condition well. There are still skeptics about this diagnosis, but it's a well-described condition accepted in the medical world. There's a tendency ignore the condition. Clinics can be overwhelmed and send the patient on to somebody else."

Treatment and More Research

Patients he has initially diagnosed with fibromyalgia first get a comprehensive specialty medical assessment, Dr. Reddy said. "I also want to be sure there's nothing else that is an underlying condition that's significant enough that it should be treated first. When I'm reasonably certain that the diagnosis is clear, I identify the problem areas, such as the areas of pain, and offer local and systemic approaches of care.

"These can include physical exercise programs; modalities such as heat, cold, and electrical stimulation; medical management including medications to help with pain control and sleep problems; and also management for stress and other psychologic difficulties. Often I refer individuals not only to a physical therapist but also to a psychologist for specific treatment as well as to learn cognitive coping techniques for chronic pain."

Some medications developed for other purposes are now more accepted for treating fibromyalgia, Dr. Reddy said, for example anti-seizure medications and newer antidepressant drugs seem to hold promise.

Dr. Reddy is in the very early stages of developing a research project or projects (along with a professor at Marquette University) to look at the practice of medicine in an academic setting as it relates to fibromyalgia. "There are clinicians who don't want to touch it," he said. "There are others who want to do a lot. But the majority don't seem to have a level of comfort to work with these people. We'd like to determine what the factors are that influence how we handle them and how we work with these individuals, and maybe another project directed at improving outcomes.

"When someone comes in with elbow pain, the doctor treats the elbow pain. That's not wrong, but not enough attention may have been paid to other questions that weren't asked and other issues to look into. I've had many individuals who were treated for many years for a localized (e.g., elbow or back pain) problem, even had exploratory surgery without finding anything, and the patient wasn't getting any better.

"One of the reasons that people may not be responding is that one area is being treated but the whole picture that may indicate fibromyalgia is being ignored. That's not an uncommon problem. My experience with these people for many years has been that if you properly manage them, the majority of them can make significant progress in coping with their pain more effectively, functioning more effectively, minimizing the disabling type of conditions, and carry on with a good quality of life."

« Last Edit: June 15, 2006, 10:26:44 pm by Kathy » Logged


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« Reply #2 on: August 10, 2006, 01:22:44 pm »

Fibromyalgia
Introduction
You hurt all over, and you frequently feel exhausted. Even after numerous tests, your doctor can't seem to find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia.

Fibromyalgia is a chronic condition characterized by fatigue, widespread pain in your muscles, ligaments and tendons, and multiple tender points — places on your body where slight pressure causes pain. Fibromyalgia is more common in women than in men. Previously, the condition was known by other names such as fibrositis, chronic muscle pain syndrome, psychogenic rheumatism and tension myalgias.

Although the intensity of your symptoms may vary, they'll probably never disappear completely. It may be reassuring to know, however, that fibromyalgia isn't progressive, crippling or life-threatening. Treatments and self-care steps can improve symptoms and your general health.

Signs and symptoms
Signs and symptoms of fibromyalgia can vary, depending on the weather, stress, physical activity or even the time of day. Common signs and symptoms include:

Widespread pain. Fibromyalgia is characterized by pain in specific areas of your body when pressure is applied, including the back of your head, upper back and neck, upper chest, elbows, hips and knees. The pain generally persists for months at a time and is often accompanied by stiffness.
Fatigue and sleep disturbances. People with fibromyalgia often wake up tired and unrefreshed even though they seem to get plenty of sleep. Some studies suggest that this sleep problem is the result of a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. So people with fibromyalgia miss the deep restorative stage of sleep. Nighttime muscle spasms in your legs and restless legs syndrome also may be associated with fibromyalgia.

Irritable bowel syndrome (IBS). The constipation, diarrhea, abdominal pain and bloating associated with IBS are common in people with fibromyalgia.
Headaches and facial pain. Many people who have fibromyalgia also have headaches and facial pain that may be related to tenderness or stiffness in their neck and shoulders.

Temporomandibular joint (TMJ) dysfunction, which affects the jaw joints and surrounding muscles, is also common in people with fibromyalgia.
Heightened sensitivity. It's common for people with fibromyalgia to report being sensitive to odors, noises, bright lights and touch.
Other common signs and symptoms include:

Depression
Numbness or tingling sensations in the hands and feet (paresthesia)
Difficulty concentrating
Mood changes
Chest pain
Irritable bladder
Dry eyes, skin and mouth
Painful menstrual periods
Dizziness
Anxiety
Causes
The specific cause of fibromyalgia is unknown. However, doctors believe a number of factors may contribute. These factors may include:

Chemical changes in the brain. Some people with fibromyalgia appear to have alterations in the regulation of certain brain chemicals called neurotransmitters. This may be particularly true of serotonin — which is linked to depression, migraines and gastrointestinal distress — and substance P, a brain chemical associated with pain, stress and anxiety, as well as depression.

Sleep disturbances. Some researchers theorize that disturbed sleep patterns may be a cause rather than just a symptom of fibromyalgia.
Injury. An injury or trauma, particularly in the upper spinal region, may trigger the development of fibromyalgia in some people. An injury may affect your central nervous system, which may trigger fibromyalgia.
Infection. Some researchers believe that a viral or bacterial infection may trigger fibromyalgia.

Abnormalities of the autonomic (sympathetic) nervous system. Your autonomic nervous system is divided into the sympathetic and parasympathetic systems. Your sympathetic nervous system releases norepinephrine and influences the release of epinephrine from the adrenal gland. The sympathetic nervous system also controls bodily functions that you don't consciously control, such as heart rate, blood vessel contraction, sweating, salivary flow and intestinal movements.

Changes in muscle metabolism. For example, deconditioning and decreased blood flow may contribute to decreased strength and fatigue. Differences in metabolism and abnormalities in the hormonal substance that influences the activity of nerves (neuroendocrine) may play a role.
Psychological stress and hormonal changes also may be possible causes of fibromyalgia.


Risk factors for fibromyalgia include:

Sex. Fibromyalgia occurs more often in women than in men.
Age. Fibromyalgia tends to develop during early and middle adulthood. But it can also occur in children and elderly adults.

Disturbed sleep patterns. It's unclear whether sleeping difficulties are a cause or a result of fibromyalgia — people with sleep disorders, such as nighttime muscle spasms in the legs, restless legs syndrome or sleep apnea, can also develop fibromyalgia.

Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.

Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis, lupus or ankylosing spondylitis, you may be more likely to have fibromyalgia.

When to seek medical advice
See your doctor if you experience general aching or widespread pain that lasts several months and is accompanied by fatigue. Many of the symptoms of fibromyalgia mimic those of other diseases, such as low thyroid hormone production (hypothyroidism), polymyalgia rheumatica, neuropathies, lupus, multiple sclerosis and rheumatoid arthritis. Your doctor can help determine if one of these other conditions may be causing your symptoms.

Screening and diagnosis

Diagnosing fibromyalgia is difficult because there isn't a single, specific diagnostic laboratory test. In fact, before receiving a diagnosis of fibromyalgia, you may go through several medical tests, such as blood tests and X-rays, only to have the results come back normal. Although these tests may rule out other conditions, such as rheumatoid arthritis, lupus and multiple sclerosis, they can't confirm fibromyalgia.

The American College of Rheumatology has established general classification guidelines for fibromyalgia, to help in the assessment and study of the condition. According to these guidelines, to be diagnosed with fibromyalgia you must have experienced widespread aching pain for at least three months and have a minimum of 11 locations on your body that are abnormally tender under relatively mild, firm pressure.
In addition to taking your medical history, a doctor checking for fibromyalgia will press firmly on specific points on your head, upper body and certain joints so that you can confirm which cause pain.

Not all doctors agree with these guidelines. Some believe that the criteria are too rigid and that you can have fibromyalgia even if you don't meet the required number of tender points. Others question how reliable and valid tender points are as a diagnostic tool.

Complications
Fibromyalgia isn't progressive and generally doesn't lead to other conditions or diseases. It can, however, cause pain, depression and lack of sleep. These problems can then interfere with your ability to work at home or on the job, or maintain close family or personal relationships. The frustration of dealing with an often-misunderstood condition also can be a complication of the condition.

Treatment
In general, treatment for fibromyalgia is with a combination of medication and self-care. The emphasis is on minimizing symptoms and improving general health.

Medications
Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Anaprox, Aleve) — in conjunction with other medications, but NSAIDs haven't proven to be effective in managing the pain in fibromyalgia when taken by themselves.

Antidepressants. Your doctor may prescribe antidepressant medications, such as amitriptyline (Elavil), nortriptyline (Aventyl, Pamelor) or doxepin (Sinequan) to help promote sleep. Fluoxetine (Prozac) in combination with amitriptyline has also been found effective. Sertraline (Zoloft) and paroxetine (Paxil) can help if you're experiencing depression.

Muscle relaxants. Taking the medication cyclobenzaprine (Flexeril) at bedtime may help treat muscle pain and spasms. Muscle relaxants are generally limited to short-term use.

Prescription sleeping pills, such as zolpidem (Ambien), may provide short-term benefits for some people with fibromyalgia, but doctors usually advise against long-term use of these drugs. These medications tend to work for only a short time, after which your body becomes resistant to their effects. Ultimately, using sleeping pills tends to create even more sleeping problems in many people.

Benzodiazepines may help relax muscles and promote sleep, but doctors often avoid these drugs in treating fibromyalgia. Benzodiazepines can become habit-forming, and they haven't been shown to provide long-term benefits.

Doctors don't usually recommend narcotics for treating fibromyalgia because of the potential for dependence and addiction. Corticosteroids, such as prednisone, haven't been shown to be effective in treating fibromyalgia.

Cognitive-behavioral therapy
Cognitive-behavioral therapy seeks to increase your belief in your own abilities and teaches you methods for dealing with stressful situations. Therapy can be provided via individual counseling, audiotapes or classes, and may help you manage your fibromyalgia.

Treatment programs
Interdisciplinary treatment programs may be effective in improving your symptoms, including relieving pain. These programs can combine a variety of treatments, such as relaxation techniques, biofeedback and receiving information about chronic pain. There isn't one combination that works best for everybody. Your doctor can create a program based on what works best for you.

Self-care
Self-care is critical in the management of fibromyalgia.

Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.

Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
Exercise regularly. At first, exercise may increase your pain. But doing it regularly often decreases symptoms.

Appropriate exercises often include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days.

Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.
Coping skills
Besides dealing with the pain and fatigue of fibromyalgia, you may also have to deal with the frustration of having a condition that's often misunderstood. In addition to educating yourself about fibromyalgia, you may find it helpful to provide your family, friends and co-workers with information.

It's also helpful to know that you're not alone. Organizations such as the Arthritis Foundation and the American Chronic Pain Association provide educational classes and support groups. These groups can often provide a level of help and advice that you might not find anywhere else. They can also help put you in touch with others who have had similar experiences and can understand what you're going through.


Complementary and alternative therapies for pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia.

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven't been adequately studied. Some of the more common complementary and alternative treatments promoted for pain management include:

Chiropractic care. This treatment is based on the philosophy that restricted movement in the spine may lead to pain and reduced function. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility.
The goal is to restore spinal movement and, as a result, improve function and decrease pain. Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn't need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm.
 Because manipulation has risks, always go to properly trained and licensed practitioners.

Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. The therapy aims to improve circulation in the muscle, increasing the flow of nutrients and eliminating waste products. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety. Although massage is almost always safe, avoid it if you have open sores, acute inflammation or circulatory problems.

Osteopathy. Doctors of osteopathy go through rigorous and lengthy training in academic and clinical settings, equivalent to medical doctors. They're licensed to perform many of the same therapies and procedures as conventional doctors. One area where osteopathy differs from conventional medicine — but is similar to chiropractic medicine — is in the use of manipulation to address joint and spinal problems.

Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. In a 2006 Mayo Clinic study, acupuncture significantly improved symptoms of fibromyalgia. Research on the benefits of acupressure — a similar practice that uses finger pressure on the skin rather than needles — is inconclusive.

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« Reply #3 on: August 11, 2006, 06:03:33 am »

« Last Edit: August 11, 2006, 07:08:25 am by Kathy » Logged


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« Reply #4 on: September 15, 2006, 08:20:54 am »

Diagnosis and Treatment of Fibromyalgia

Fibromyalgia is a poorly understood medical condition characterized by soft tissue pain, fatigue, sleep disturbance and widely distributed areas of tenderness known as tender points. It is a chronic condition with no cure that affects about 3.4% of women and 0.5 % of men.

There is no laboratory test to diagnose fibromyalgia, which previously caused some health care providers to believe the condition to be psychosomatic, or brought on by the individual’s emotions. However, recent research has shown that fibromyalgia patients typically have altered sleep patterns and brain chemistry. Many report awakening repeatedly and not being refreshed by sleep. Furthermore, sleep disturbances (as well as stress) may lead to symptoms of fibromyalgia. One-third of patients with fibromyalgia also have low insulin growth factor levels, which indicates low growth hormone secretion.

Researchers have also found that fibromyalgia patients have elevated levels of a neurotransmitter - cerebrospinal fluid substance P - which is associated with enhanced pain perception. Fibromyalgia patients also have low production of the steroid cortisol in contrast to higher-than-normal levels found in depression patients. These disturbances in the nervous and endocrine systems may cause fibromyalgia. In essence, pain is not caused by inflammation or damage, but is instead associated with a central defect in pain processing. Some speculate that physical or psychological trauma may cause such changes in the central nervous system, leading to fibromyalgia.

Diagnosis
Diagnosis of fibromyalgia is based on symptoms described by the patient, a physical examination and sometimes, observation over time. The American College of Rheumatology established diagnostic criteria, which include unexplained pain or tender points. These are typically located at 11 or more of 18 specific sites on the body, such as the neck, shoulders, lower back, buttocks, hips, elbows and knees. The location of the pain may shift over time and a person may have fibromyalgia even if they don’t meet all the criteria.

Because hypothyroidism can mimic fibromyalgia symptoms, the thyroid-stimulating hormone level should be checked routinely. Another condition, myofascial pain syndrome, may also be confused with fibromyalgia. However, fibromyalgia pain is widespread and changes locations. Myofascial pain is one of the conditions that often accompanies fibromyalgia, along with migraine headaches, irritable bowel syndrome, depression and temporomandibular joint syndrome.

Treatment
Each fibromyalgia patient is different and may require individualized treatment. An active exercise program, low-dose anti-depressants, acupuncture, psychotherapy, behavior modification therapy, chiropractic care, massage and physical therapy, used alone or in conjunction with one another, may provide some relief of symptoms.

In various studies, one-third to one-half of study participants responded to pharmacologic treatment of fibromyalgia. However, in some patients, symptoms may get worse. One study showed that the combination of a tricyclic antidepressant, 25 mg of amitriptyline (Elavil), with a selective serotonin reuptake inhibitor, 20 mg of fluoxetine (Prozac), was twice as effective as either one taken alone.

In patients with fibromyalgia, aerobic exercise and strength-training activities have been associated with significant improvement in pain, tender point counts and disturbed sleep. Maintaining an exercise regimen is often difficult; patients may want to utilize a workout partner or other strategy to stay motivated.

Acupuncture may be an extremely useful addition to fibromyalgia treatment efforts. The frequency of acupuncture sessions ranges widely from patient to patient, but appears to improve quality of life. For patients who have more severe pain and for whom other therapies are ineffective or cannot be utilized, chronic opioid analgesic therapy, involving oral painkillers, may be an option. Nonsteroidal anti-inflammatory agents, such as aspirin and ibuprofen, have not been proven effective, however.

Behavior modification training, including coping skills, relaxation exercises and self-hypnosis may provide relief for some patients. Pain perception is a very complicated phenomenon that may be modified by experience. Finally, growth hormone therapy, though prohibitively expensive for most patients, was shown in one study to reduce symptoms and improve quality of life without significant side effects.
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« Reply #5 on: September 15, 2006, 12:52:51 pm »

Non-Drug Therapies for Fibromyalgia

A combination of non-drug therapies work just as well as medication when it comes to relieving the pain, depression, and disability associated with fibromyalgia. Researchers reporting in the Clinical Journal of Pain compared a program of exercise sessions, stress management, massage, and diet education with standard medication therapy. They concluded that patients can feel better by using several non-drug therapies.

Acupuncture

Some studies have suggested that acupuncture can significantly reduce pain in people with fibromyalgia. However, a large, controlled study published in the July 2005 Annals of Internal Medicine found that inserting needles at fibromyalgia-related pressure points is no better than randomly inserting needles ("sham acupuncture")  at relieving pain for fibromyalgia.

Drug Research News

Pramipexole, a drug used to treat Parkinson’s disease and restless legs syndrome, may cut fibromyalgia-related pain symptoms in half, according to a study published in the journal Arthritis and Rheumatism.

A small study performed in Spain in 2005 suggests that the antipsychotic drug olanzapine (Zyprexa) reduces pain in people with fibromyalgia. Previous research has shown that olanzapine is effective for chronic pain conditions. However, the drug can cause unpleasant side effects. Nearly half of those in the 2005 study dropped out because of severe weight gain.
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« Reply #6 on: September 23, 2006, 10:30:31 am »

Lupus and Fibromyalgia




Fibromyalgia is a disorder that can occur alone or secondary to connective tissue disorders such as lupus. Studies suggest that about 25% of people who have lupus also have fibromyalgia. It's important for people who have lupus to know about fibromyalgia for several reasons.

Many of the symptoms are the same. For example, fatigue, joint and muscle pain, morning stiffness, hand symptoms without observed swelling, Raynaud's phenomenon (painful hands or feet in response to cold), numbness, and headaches can be seen in both of these disorders.

The treatments for lupus and fibromyalgia are very different, but fibromyalgia can get in the way of judging the lupus activity. If you are being treated with immunosuppressive drugs for your lupus but have continued pain and fatigue, those symptoms may be considered evidence of continuing lupus activity, when they might be fibromyalgia. So there is the theoretical risk that you might be treated with higher doses of immunosuppressants and be at risk for their side effects, when such drugs don't help fibromyalgia and may not be needed at that time for your lupus.

For example, among people with lupus, the occurrence of fatigue correlates more strongly with the presence of fibromyalgia than with their degree of lupus disease activity or damage.
The proper diagnosis can alleviate anxiety. For example, if you have numbness and it can be determined that the cause is fibromyalgia, that can be reassuring because you know it won't progress and cause more serious outcomes, as might occur in numbness due to lupus.

Because fibromyalgia doesn't have the same internal organ manifestations and potential for damage that lupus-mediated problems have, symptoms may have a better prognosis (outlook) if they are caused by fibromyalgia.
Discerning the difference is also important for research. Fibromyalgia seems to affect the validity of some of the measurements of lupus activity. Whether a new drug works for lupus or not can be hard to figure out if 25% of the participants also have fibromyalgia and are having symptoms for that are erroneously labeled as lupus activity

Understanding Fibromyalgia

Fibromyalgia is not a disease but a syndrome (a cluster of symptoms and signs of disordered function) that causes chronic, widespread musculoskeletal pain. The pain typically includes particular areas of increased sensitivity called tender points - spots where application of mild finger pressure causes pain without spreading beyond that site. Fibromyalgia is often associated with one or more other symptoms, such as: sleep problems, fatigue, stiffness, skin tenderness, pain after exertion such as exercise, lightheadedness, fluid retention, paresthesias (sensations of numbness, tingling, or other heightened sensitivity), or cognitive problems (including difficulty with memory and vocabulary).

Diagnosing fibromyalgia can be difficult because there are no tests to confirm the diagnosis and because the symptoms can be similar to so many other disorders. Thus, it is a clinical diagnosis made by the physician after ruling out other possible causes of the symptoms, including lupus, rheumatoid arthritis, other connective tissue diseases, and underactive thyroid.

People with fibromyalgia have ups and downs, just as people with lupus do. They don't hurt all the time. Similarly, stress, anxiety, and other emotional or physical stresses may make symptoms worse. However, in long-term studies of people with fibromyalgia, most still have the illness 10 to 15 years later, although two-thirds are somewhat better.

What Causes Fibromyalgia?

Although it is considered a rheumatologic disorder, no evidence suggests that fibromyalgia is an autoimmune disorder, as lupus is. Further, although muscle pain is one of the hallmarks of fibromyalgia, there does not seem to be anything wrong with the muscle itself - there is no muscle inflammation and biopsies of muscle tender points don't show any consistent abnormalities.

The most widely accepted theory to date of the cause of fibromyalgia is called central sensitization - in which your central nervous system becomes hyper-sensitive to sensations. Different nerves carry different kinds of messages to the brain. Some carry pain messages, and some carry other messages, such as sensations of simple pressure.

 We believe that in patients with fibromyalgia, something has upped the sensitivity, so that the brain starts seeing a wide range of input messages as all representing pain. So, for example, you may have allodynia - in which when your skin is merely touched, it feels like pain because the message is getting shunted to the wrong kind of sensation.

What sets off that higher sensitivity could be a pre-existing disorder with pain, such as lupus, or an accident, or other kinds of trauma. Some research suggests that a history of childhood abuse, which could heighten the responses of the central nervous system, also may predispose to the supersensitive responses of fibromyalgia later in life. However, it's not at all clear or even likely that every patient has a triggering event.

Studies have shown differences in blood flow in the parts of the brain involved with processing pain in people with fibromyalgia. While we don't yet understand how that information will be useful in treating people, it's a start - and it also adds some objective data to support the central nervous system hypothesis as the underlying cause.

Research has also shown that abnormal patterns occur when brain waves are measured during sleep in people with fibromyalgia. That probably reflects the disrupted sleep seen, which in turn probably contributes to the pain. Even in healthy people, if you interfere with sleep for a period of weeks, muscle tenderness develops. This is probably one part of the cause of muscle tenderness in fibromyalgia, and it may relate to a deficiency of serotonin in the brain.

Researchers have also looked at the connection between the brain and the adrenal glands, where we make cortisone, and abnormalities have been found. So perhaps the normal response to stress is exaggerated.

Many other areas have been examined: decreased growth hormone, increased substance P, and increased activity of a certain kind of receptor in the nervous system associated with chronic pain (called the NMDA receptor).

Psychological factors have been a big issue because a lot of people with fibromyalgia are depressed. Because depression itself can cause symptoms that could mimic those of fibromyalgia, again, the two can be difficult to sort out.
However, people with fibromyalgia who are seen in hospital practices seem to have more severe symptoms and a higher incidence of depression than that seen in the general population. This is likely due to a referral bias - that hospital practices attract people with more severe forms of fibromyalgia and such people are more likely to be depressed.

Nonetheless, depression itself may affect how people respond to pain and how they will get better and, therefore, it is a separate factor that needs to be addressed by further research.

Fibromyalgia Treatment

A very wide range of medications has been tried for fibromyalgia, but relatively few have been shown to be useful in controlled clinical trial.

Amitriptyline (brand named Elavil) seems to offer the most benefits. It was originally developed as an antidepressant, but it is also prescribed for certain types of pain relief. However, it has potential side effects (such as sleepiness and dry eyes) that make it difficult for some people to use. Gabapentin (Neurontin) does not work as well as amitriptyline but has almost no side effects (other than some minimal sleepiness). It was originally developed as an anti-seizure drug. In general, the anti-depressant and anti-seizure medications are not addictive, although you can't stop them suddenly because this can cause a rebound effect. So they need to be tapered off slowly.

Researchers are also exploring other drugs that affect the neurophysiology of the brain in a different way, such as fluoxetine (Prozac) and other antidepressants in its class (selective serotonin reuptake inhibitors or SSRIs). Although these don't seem to work as well as amitriptyline, they are usually easier for patients to tolerate. Newer antidepressants are also being studied in ongoing research trials.

The use of any of these drugs for fibromyalgia is called "off-label" because, although the drugs are FDA-approved for other disorders, they have not been FDA-approved for fibromyalgia. (It should also be noted that people who are hypersensitized, such as those with fibromyalgia, may develop drug side effects - even on very low doses of some drugs - that are out of proportion compared to other patients taking those drugs.)

What does not work should also be noted. Corticosteroids, such as prednisone and methylprednisolone (Medrol) do not help. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin), may help some patients due to pain-relief action only, but not due to anti-inflammatory action.
Narcotic pain relievers such as morphine, meperidine (Demerol), and hydromorphone hydrochloride (Dilaudid) are not recommended. Although narcotics are valuable for acute pain, such as after surgery, the chronic pain pathway of fibromyalgia is different from the acute pain pathway. (Pain experts now understand that acute and chronic pain are different and mediated by different pathways in the nervous system.) Further, narcotics can cause physiological addiction.

A number of non-medical approaches have been shown useful for fibromyalgia: two that show particularly strong results are aerobic exercise and cognitive behavioral therapy.

Aerobic exercise, such as brisk walking, low-impact aerobics, and swimming (but not stretching and yoga, which are not aerobic) decrease pain and the tender point count over time. Patients often have a lot of trouble sticking with their exercise program because they have post-exertional pain and don't want to go back. So it's a challenge. You have to start very slowly, perhaps just five minutes of aerobics daily, in order to build tolerance and avoid becoming discouraged.

Cognitive behavioral therapy (CBT) should not be confused with psychological counseling. They are not the same thing. CBT is a directed kind of behavioral modification that involves education and can help you change your thinking about how to approach and deal with your pain. It also includes the concept of pacing, which is important in fibromyalgia - learning to recognize when you need to rest and integrating rest into your schedule.

Some non-conventional therapies seem to be helpful, although studies evaluating them have been very short-term - three months or less. Acupuncture, hypnosis, and massage all have their proponents, but no one seems overwhelmingly helpful.

Probably the best approach is to have medication, aerobic exercise and psychological support rolled into one, integrated program. Some studies looking at such programs are promising for decreasing pain and increasing functional status.

Getting the Right Diagnosis

Because fibromyalgia can cause so many different types of symptoms, patients may go to a wide variety of specialists - a gastrointestinal specialist for irritable bowel symptoms, a neurologist for dizziness or numbness, a rheumatologist for muscle and joint pain, etc. - and that may contribute to difficulty with diagnosis as well as differentiating whether it's your fibromyalgia or your lupus causing a particular symptom. Your doctors need to communicate in order to pull a unifying diagnosis together.

How can fibromyalgia be differentiated from renewed lupus activity? That can be difficult.

Generally, in patients with fibromyalgia and no other underlying disease, the sedimentation rate is normal and there is no positive ANA. So if a patient with lupus is very symptomatic and in the past has had a lot of changes in labs to go along with such symptoms - but this time the lab work does not show any changes, that can be a hint the symptoms may not be due to lupus.
If the patient is placed on corticosteroids and it doesn't help the symptoms, that suggests the symptoms are not due to an inflammatory cause such as lupus - and fibromyalgia might be considered.

If you are having a major lupus flare, then you will hurt all over and other signs and symptoms occur that usually make it obvious to you and your physician. But when patients come in looking pretty good and the only complaint is "I hurt all over," and then the doctor touches them and they jump, that's suggestive of fibromyalgia coming into the picture.
The bottom line is that you need to keep track of all of your symptoms to help your doctor discern any new patterns that might merit a different diagnosis - and different treatment.

www.LupusMCTD.com
« Last Edit: September 23, 2006, 11:14:27 am by Kathy » Logged


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« Reply #7 on: October 05, 2006, 01:39:13 pm »

Fibromyalgia Diagnosis Is Difficult

Research shows that people with fibromyalgia typically see many doctors before receiving the diagnosis. One reason for this may be that pain and fatigue, the main symptoms of fibromyalgia, overlap with many other conditions.



Doctors often have to rule out other potential causes of these symptoms before making a diagnosis of fibromyalgia.




No Diagnostic Laboratory Tests For Fibromyalgia

Another reason fibromyalgia diagnosis remains difficult is that there are currently no diagnostic laboratory tests for fibromyalgia; standard laboratory tests fail to reveal a physiologic reason for pain.



Because there is no generally accepted, objective test for fibromyalgia, some doctors unfortunately may conclude a patient's pain is not real, or they may tell the patient there is little they can do.




Diagnostic Criteria For Fibromyalgia

A doctor familiar with fibromyalgia, however, can make a diagnosis based on two criteria established by the American College of Rheumatology:


a history of widespread pain lasting more than 3 months
the presence of tender points

Pain is considered to be widespread when it affects all four quadrants of the body; that is, you must have pain in both your right and left sides as well as above and below the waist to be diagnosed with fibromyalgA rheumatologist is a medical doctor who specializes in arthritis and related diseases.



Fibromyalgia Tender Points

The American College of Rheumatology also has designated 18 sites on the body as possible tender points. For a fibromyalgia diagnosis, a person must have 11 or more tender points.



Tender points of fibromyalgia exist at these nine bilateral muscle locations:



Low Cervical Region: (front neck area) at anterior aspect of the interspaces between the transverse processes of C5-C7.
Second Rib: (front chest area) at second costochondral junctions.
Occiput: (back of the neck) at suboccipital muscle insertions.
Trapezius Muscle: (back shoulder area) at midpoint of the upper border.
Supraspinatus Muscle: (shoulder blade area) above the medial border of the scapular spine.
Lateral Epicondyle: (elbow area) 2 cm distal to the lateral epicondyle.
Gluteal: (rear end) at upper outer quadrant of the buttocks.
Greater Trochanter: (rear hip) posterior to the greater trochanteric prominence.
Knee: (knee area) at the medial fat pad proximal to the joint line.

www.LupusMCTD.com

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I look normal, as I have an "Invisible Illness". You can not catch it, you can not see it. It's called Lupus.My body is attacking itself on the inside.
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« Reply #8 on: October 08, 2006, 10:43:00 am »

Lupus and Fibromyalgia

Fibromyalgia is a disorder that can occur alone or secondary to connective tissue disorders such as lupus. Studies suggest that about 25% of people who have lupus also have fibromyalgia. It's important for people who have lupus to know about fibromyalgia for several reasons.

Many of the symptoms are the same.
 For example, fatigue, joint and muscle pain, morning stiffness, hand symptoms without observed swelling, Raynaud's phenomenon (painful hands or feet in response to cold), numbness, and headaches can be seen in both of these disorders.

The treatments for lupus and fibromyalgia are very different, but fibromyalgia can get in the way of judging the lupus activity. If you are being treated with immunosuppressive drugs for your lupus but have continued pain and fatigue, those symptoms may be considered evidence of continuing lupus activity, when they might be fibromyalgia.

So there is the theoretical risk that you might be treated with higher doses of immunosuppressants and be at risk for their side effects, when such drugs don't help fibromyalgia and may not be needed at that time for your lupus. For example, among people with lupus, the occurrence of fatigue correlates more strongly with the presence of fibromyalgia than with their degree of lupus disease activity or damage.

The proper diagnosis can alleviate anxiety. For example, if you have numbness and it can be determined that the cause is fibromyalgia, that can be reassuring because you know it won't progress and cause more serious outcomes, as might occur in numbness due to lupus. Because fibromyalgia doesn't have the same internal organ manifestations and potential for damage that lupus-mediated problems have, symptoms may have a better prognosis (outlook) if they are caused by fibromyalgia.

Discerning the difference is also important for research. Fibromyalgia seems to affect the validity of some of the measurements of lupus activity. Whether a new drug works for lupus or not can be hard to figure out if 25% of the participants also have fibromyalgia and are having symptoms for that are erroneously labeled as lupus activity

  • Understanding Fibromyalgia

Fibromyalgia is not a disease but a syndrome (a cluster of symptoms and signs of disordered function) that causes chronic, widespread musculoskeletal pain.
The pain typically includes particular areas of increased sensitivity called tender points - spots where application of mild finger pressure causes pain without spreading beyond that site.

 Fibromyalgia is often associated with one or more other symptoms, such as: sleep problems, fatigue, stiffness, skin tenderness, pain after exertion such as exercise, lightheadedness, fluid retention, paresthesias (sensations of numbness, tingling, or other heightened sensitivity), or cognitive problems (including difficulty with memory and vocabulary).

Diagnosing fibromyalgia can be difficult because there are no tests to confirm the diagnosis and because the symptoms can be similar to so many other disorders. Thus, it is a clinical diagnosis made by the physician after ruling out other possible causes of the symptoms, including lupus, rheumatoid arthritis, other connective tissue diseases, and underactive thyroid.

People with fibromyalgia have ups and downs, just as people with lupus do. They don't hurt all the time. Similarly, stress, anxiety, and other emotional or physical stresses may make symptoms worse. However, in long-term studies of people with fibromyalgia, most still have the illness 10 to 15 years later, although two-thirds are somewhat better.

  • What Causes Fibromyalgia?

Although it is considered a rheumatologic disorder, no evidence suggests that fibromyalgia is an autoimmune disorder, as lupus is. Further, although muscle pain is one of the hallmarks of fibromyalgia, there does not seem to be anything wrong with the muscle itself - there is no muscle inflammation and biopsies of muscle tender points don't show any consistent abnormalities.

The most widely accepted theory to date of the cause of fibromyalgia is called central sensitization - in which your central nervous system becomes hyper-sensitive to sensations. Different nerves carry different kinds of messages to the brain. Some carry pain messages, and some carry other messages, such as sensations of simple pressure.

What sets off that higher sensitivity could be a pre-existing disorder with pain, such as lupus, or an accident, or other kinds of trauma. Some research suggests that a history of childhood abuse, which could heighten the responses of the central nervous system, also may predispose to the supersensitive responses of fibromyalgia later in life. However, it's not at all clear or even likely that every patient has a triggering event.

Studies have shown differences in blood flow in the parts of the brain involved with processing pain in people with fibromyalgia. While we don't yet understand how that information will be useful in treating people, it's a start - and it also adds some objective data to support the central nervous system hypothesis as the underlying cause.

Research has also shown that abnormal patterns occur when brain waves are measured during sleep in people with fibromyalgia. That probably reflects the disrupted sleep seen, which in turn probably contributes to the pain. Even in healthy people, if you interfere with sleep for a period of weeks, muscle tenderness develops. This is probably one part of the cause of muscle tenderness in fibromyalgia, and it may relate to a deficiency of serotonin in the brain.

Researchers have also looked at the connection between the brain and the adrenal glands, where we make cortisone, and abnormalities have been found. So perhaps the normal response to stress is exaggerated.

Many other areas have been examined: decreased growth hormone, increased substance P, and increased activity of a certain kind of receptor in the nervous system associated with chronic pain (called the NMDA receptor).

Psychological factors have been a big issue because a lot of people with fibromyalgia are depressed. Because depression itself can cause symptoms that could mimic those of fibromyalgia, again, the two can be difficult to sort out.

However, people with fibromyalgia who are seen in hospital practices seem to have more severe symptoms and a higher incidence of depression than that seen in the general population. This is likely due to a referral bias - that hospital practices attract people with more severe forms of fibromyalgia and such people are more likely to be depressed. Nonetheless, depression itself may affect how people respond to pain and how they will get better and, therefore, it is a separate factor that needs to be addressed by further research.

  • Fibromyalgia Treatment

A very wide range of medications has been tried for fibromyalgia, but relatively few have been shown to be useful in controlled clinical trial.

Amitriptyline (brand named Elavil) seems to offer the most benefits. It was originally developed as an antidepressant, but it is also prescribed for certain types of pain relief.

However, it has potential side effects (such as sleepiness and dry eyes) that make it difficult for some people to use. Gabapentin (Neurontin) does not work as well as amitriptyline but has almost no side effects (other than some minimal sleepiness). It was originally developed as an anti-seizure drug. In general, the anti-depressant and anti-seizure medications are not addictive, although you can't stop them suddenly because this can cause a rebound effect. So they need to be tapered off slowly.

Researchers are also exploring other drugs that affect the neurophysiology of the brain in a different way, such as fluoxetine (Prozac) and other antidepressants in its class (selective serotonin reuptake inhibitors or SSRIs). Although these don't seem to work as well as amitriptyline, they are usually easier for patients to tolerate. Newer antidepressants are also being studied in ongoing research trials.

The use of any of these drugs for fibromyalgia is called "off-label" because, although the drugs are FDA-approved for other disorders, they have not been FDA-approved for fibromyalgia. (It should also be noted that people who are hypersensitized, such as those with fibromyalgia, may develop drug side effects - even on very low doses of some drugs - that are out of proportion compared to other patients taking those drugs.)

What does not work should also be noted. Corticosteroids, such as prednisone and methylprednisolone (Medrol) do not help. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin), may help some patients due to pain-relief action only, but not due to anti-inflammatory action.

Narcotic pain relievers such as morphine, meperidine (Demerol), and hydromorphone hydrochloride (Dilaudid) are not recommended. Although narcotics are valuable for acute pain, such as after surgery, the chronic pain pathway of fibromyalgia is different from the acute pain pathway. (Pain experts now understand that acute and chronic pain are different and mediated by different pathways in the nervous system.) Further, narcotics can cause physiological addiction.

A number of non-medical approaches have been shown useful for fibromyalgia: two that show particularly strong results are aerobic exercise and cognitive behavioral therapy.

Aerobic exercise, such as brisk walking, low-impact aerobics, and swimming (but not stretching and yoga, which are not aerobic) decrease pain and the tender point count over time. Patients often have a lot of trouble sticking with their exercise program because they have post-exertional pain and don't want to go back. So it's a challenge. You have to start very slowly, perhaps just five minutes of aerobics daily, in order to build tolerance and avoid becoming discouraged.

Cognitive behavioral therapy (CBT) should not be confused with psychological counseling. They are not the same thing. CBT is a directed kind of behavioral modification that involves education and can help you change your thinking about how to approach and deal with your pain. It also includes the concept of pacing, which is important in fibromyalgia - learning to recognize when you need to rest and integrating rest into your schedule.

Some non-conventional therapies seem to be helpful, although studies evaluating them have been very short-term - three months or less. Acupuncture, hypnosis, and massage all have their proponents, but no one seems overwhelmingly helpful.

Probably the best approach is to have medication, aerobic exercise and psychological support rolled into one, integrated program. Some studies looking at such programs are promising for decreasing pain and increasing functional status.

  • Getting the Right Diagnosis

Because fibromyalgia can cause so many different types of symptoms, patients may go to a wide variety of specialists - a gastrointestinal specialist for irritable bowel symptoms, a neurologist for dizziness or numbness, a rheumatologist for muscle and joint pain, etc. - and that may contribute to difficulty with diagnosis as well as differentiating whether it's your fibromyalgia or your lupus causing a particular symptom. Your doctors need to communicate in order to pull a unifying diagnosis together.

How can fibromyalgia be differentiated from renewed lupus activity? That can be difficult.

Generally, in patients with fibromyalgia and no other underlying disease, the sedimentation rate is normal and there is no positive ANA. So if a patient with lupus is very symptomatic and in the past has had a lot of changes in labs to go along with such symptoms - but this time the lab work does not show any changes, that can be a hint the symptoms may not be due to lupus.

If the patient is placed on corticosteroids and it doesn't help the symptoms, that suggests the symptoms are not due to an inflammatory cause such as lupus - and fibromyalgia might be considered.
 
If you are having a major lupus flare, then you will hurt all over and other signs and symptoms occur that usually make it obvious to you and your physician. But when patients come in looking pretty good and the only complaint is "I hurt all over," and then the doctor touches them and they jump, that's suggestive of fibromyalgia coming into the picture.

The bottom line is that you need to keep track of all of your symptoms to help your doctor discern any new patterns that might merit a different diagnosis - and different treatment. [/size] www.LupusMCTD.com
« Last Edit: October 09, 2006, 08:24:42 am by ♥ Supreme Queen Goddess ♥ » Logged


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« Reply #9 on: October 09, 2006, 08:14:05 pm »

What is fibromyalgia?

Fibromyalgia is a chronic condition causing pain, stiffness, and tenderness of the muscles, tendons, and joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, fatigue, anxiety, depression, and disturbances in bowel function. Fibromyalgia was formerly known as fibrositis.

While fibromyalgia is one of the most common diseases affecting the muscles, its cause is currently unknown. The painful tissues involved are not accompanied by tissue inflammation. Therefore, despite potentially disabling body pain, patients with fibromyalgia do not develop body damage or deformity.

 Fibromyalgia also does not cause damage to internal body organs. Therefore, fibromyalgia is different from many other rheumatic conditions (such as rheumatoid arthritis, systemic lupus, and polymyositis). In those diseases, tissue inflammation is the major cause of pain, stiffness and tenderness of the joints, tendons and muscles, and it can lead to joint deformity and damage to the internal organs or muscles.

What causes fibromyalgia?

The cause of fibromyalgia is not known. Patients experience pain in response to stimuli that are normally not perceived as painful. Researchers have found elevated levels of a nerve chemical signal, called substance P, and nerve growth factor in the spinal fluid of fibromyalgia patients. The brain nerve chemical serotonin is also relatively low in patients with fibromyalgia. Studies of pain in fibromyalgia have suggested that the central nervous system (brain) may be somehow supersensitive. Scientists note that there seems to be a diffuse disturbance of pain perception in patients with fibromyalgia.

Also, patients with fibromyalgia have impaired non-Rapid-Eye-Movement, or non-REM, sleep phase (which likely explains the common feature of waking up fatigued and unrefreshed in these patients). The onset of fibromyalgia has been associated with psychological distress, trauma, and infection.

Who does fibromyalgia affect?

Fibromyalgia affects predominantly women (over 80 percent) between the ages of 35 and 55. Rarely, fibromyalgia can also affect men, children, and the elderly. It can occur independently, or can be associated with another disease, such as systemic lupus or rheumatoid arthritis. The prevalence of fibromyalgia varies in different countries. In Sweden and Britain, 1 percent of the population is affected by fibromyalgia. In the United States, approximately 2 percent of the population have fibromyalgia.

What are symptoms of fibromyalgia?

The universal symptom of fibromyalgia is pain. As mentioned earlier, the pain in fibromyalgia is not caused by tissue inflammation. Instead, these patients seem to have an increased sensitivity to many different sensory stimuli, and an unusually low pain threshold. Minor sensory stimuli that ordinarily would not cause pain in individuals can cause disabling pain in patients with fibromyalgia. The body pain of fibromyalgia can be aggravated by noise, weather change, and emotional stress.

The pain of fibromyalgia is generally widespread, involving both sides of the body. Pain usually affects the neck, buttocks, shoulders, arms, the upper back, and the chest. "Tender points" are localized tender areas of the body that can bring on widespread pain and muscle spasm when touched. Tender points are commonly found around the elbows, shoulders, knees, hips, back of the head, and the sides of the breast bone.


Fatigue occurs in 90 percent of patients. Fatigue may be related to abnormal sleep patterns commonly observed in these patients. Normally, there are several levels of depth of sleep. Getting enough of the deeper levels of sleep may be more important in refreshing a person than the total number of hours of sleep. Patients with fibromyalgia lack the deep, restorative level of sleep, called "non-rapid-eye- movement" (non-REM) sleep. Consequently, patients with fibromyalgia often awaken in the morning without feeling fully rested. Some patients awaken with muscle aches or a sensation of muscle fatigue as if they had been "working out" all night!

Mental and/or emotional disturbances occur in over half of fibromyalgia patients. These symptoms include poor concentration, forgetfulness, mood changes, irritability, depression, and anxiety. Since a firm diagnosis of fibromyalgia is difficult, and no confirmatory laboratory tests are available, patients with fibromyalgia are often misdiagnosed as having depression as their primary underlying problem.

Other symptoms of fibromyalgia include migraine and tension headaches, numbness or tingling of different parts of the body, abdominal pain related to irritable bowel syndrome ("spastic colon"), and irritable bladder, causing painful and frequent urination. Like fibromyalgia, irritable bowel syndrome can cause chronic abdominal pain and other bowel disturbances without detectable inflammation of the stomach or the intestines.

Each patient with fibromyalgia is unique. Any of the above symptoms can occur intermittently and in different combinations.

How is fibromyalgia diagnosed?

There is no blood or x-ray test to help the doctor determine whether someone has fibromyalgia. Therefore, the diagnosis of fibromyalgia is made purely on clinical grounds based on the doctor's history and physical examination. In patients with widespread body pain, the diagnosis of fibromyalgia can be made by identifying point tenderness areas (typically, patients will have at least 11 of the 18 classic tender points), by finding no accompanying tissue swelling or inflammation, and by excluding other medical conditions that can mimic fibromyalgia. Many medical conditions can cause pain in different areas of the body, mimicking fibromyalgia. These conditions include:

low thyroid hormone level (hypothyroidism)
parathyroid disease (causing elevated blood calcium level)
muscle diseases causing muscle pain (such as polymyositis)
bone diseases causing bone pain (such as Paget's disease)
elevated blood calcium (hypercalcemia)
infectious diseases (such as hepatitis, Epstein Barr virus, AIDS)
cancer

Even though there is no blood test for fibromyalgia, blood tests are important to exclude other medical conditions. Therefore, thyroid hormone and calcium blood levels are obtained to exclude hypercalcemia, hyperparathyroidism and hypothyroidism. The blood alkaline phosphatase (a bone enzyme) level is often raised in patients with Paget's disease of the bone. The CPK (a muscle enzyme) level is often elevated in patients with polymyositis, a disease with diffuse muscle inflammation. Therefore, obtaining alkaline phosphatase and CPK blood levels can help the doctor decide whether Paget's disease and polymyositis are the causes of bone and muscle pains. A complete blood count (CBC), and liver tests help in the diagnosis of hepatitis and other infections.

Fibromyalgia can occur alone, or in association with other systemic rheumatic conditions. Systemic rheumatic conditions refer to diseases that can cause inflammation and damage to numerous different tissues and organs in the body. Systemic rheumatic conditions associated with fibromyalgia include systemic lupus erythematosus, rheumatoid arthritis, polymyositis, and polymyalgia rheumatica.

Blood tests which are helpful in evaluating these diseases include erythrocyte sedimentation rate (ESR), serum protein electrophoresis (SPEP), antinuclear antibody (ANA), and rheumatoid factor (RF). In patients with fibromyalgia without associated systemic illnesses, the ESR, SPEP, ANA, and RF blood tests are usually normal.

What is the treatment for fibromyalgia?

Since the symptoms of fibromyalgia are diverse and vary among patients, treatment programs must be individualized for each patient. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Recent studies have verified that the best outcome for each patient results from a combination of approaches that involves the patient in customization of the treatment plan.

Patient Education

Patient education is an important first step in helping patients understand and cope with the diverse symptoms. Unfortunately, not all physicians are intimately acquainted with the vagaries of this illness. Therefore, community hospital support groups and the local chapters of the Arthritis Foundation have become important educational resources for patients and their doctors. Arthritis Foundation is a national voluntary health organization that provides community education through their many local chapters. Community hospital support groups also provide an arena for patients to share their experiences and treatment successes and failures.

Stress Reduction

It is extremely difficult to measure stress levels in different patients. For some people, spilling milk on the table can represent a significant tragedy. For others, a tank rolling into the living room might represent "just another day!" Therefore, stress reduction in the treatment of fibromyalgia must be individualized. Stress reduction might include simple stress modification at home or work, biofeedback, relaxation tapes, psychological counseling, and/or support among family members, friends, and doctors. Sometimes, changes in environmental factors (such as noise, temperature, and weather exposure) can exacerbate the symptoms of fibromyalgia, and these factors need to be modified.

Exercise

Low-impact aerobic exercises, such as swimming, cycling, walking and stationary cross-country ski machines can be effective treatments for fibromyalgia. Exercise regimens are most beneficial when performed on an every-other-day basis, in the morning. How exercise benefits fibromyalgia is unknown. Exercise may exert its beneficial effect by promoting a deep level of sleep (non-REM sleep). Similarly, avoiding alcohol and caffeine before bedtime can also help promote a more restful sleep.

Medications

The most effective medications in the treatment of fibromyalgia are the tricyclic antidepressants, medications traditionally used in treating depression. In treating fibromyalgia, tricyclic antidepressants are taken at bedtime in doses that are a fraction of those used for treating depression. Tricyclic antidepressants appear to reduce fatigue, relieve muscle pain and spasm, and promote deep restorative sleep in patients with fibromyalgia. Scientists believe that tricyclics work by interfering with a nerve transmitter chemical in the brain called "serotonin." Examples of tricyclic antidepressants commonly used in treating fibromyalgia include amitriptyline (Elavil) and doxepin (Sinequan).

Studies have shown that adding fluoxetine (Prozac), or related medications, to low dose amitriptyline (Elavil) further reduces muscle pain, anxiety, and depression in patients with fibromyalgia. The combination is also more effective in promoting restful sleep, and improving an overall sense of well-being. These two medications also tend to cancel out certain side effects each can have. Tricyclic medications can cause tiredness and fatigue while fluoxetine can make patients more cheerful and awake. Even more recently, study of patients with resistant fibromyalgia found that lorazepam (Ativan) was helpful in relieving symptoms. Fluoxetine (Prozac) has also been shown to be effective when used alone for some patients with fibromyalgia.

Other Treatments

Local injections of analgesics and/or cortisone medication into the trigger point areas can also be helpful in relieving painful soft tissues, while breaking cycles of pain and muscle spasm. Some studies indicate that the pain-reliever tramadol (Ultram) and tramadol/acetaminophen (Ultracet) may be helpful for the treatment of fibromyalgia pains. The muscle relaxant cyclobenzaprine (Flexeril) has been helpful for reducing pain symptoms and improving sleep.

The nonsteroidal antiinflammatory drugs (NSAIDs), while very helpful in treating other rheumatic conditions, have only a limited value in treating fibromyalgia pain. Narcotic pain relievers and cortisone medications have not been shown to be beneficial in this condition. Narcotics and cortisone medications are avoided because they have not been shown to be beneficial and they have potential adverse side effects, including dependency, when used long-term.

Both biofeedback and electroacupuncture have been used for relief of symptoms with some success. Standard acupuncture was recently reported to be effective in treating some patients with fibromyalgia.

What is in the future for fibromyalgia therapy?

The key to unlocking the mystery of fibromyalgia has yet to be found. Research scientists have been studying numerous viruses as potential causes for fibromyalgia. Identification of an infectious agent or toxin which causes the disease may one day lead to a laboratory test which can help doctors diagnose fibromyalgia. Until further research uncovers the exact cause of the disease, specific treatment aimed at a cure remains unattainable.

New drugs may be developed that block substance P or nerve growth factor to relieve pain of fibromyalgia. Many fibromyalgia patients can be helped by improved patient education, proper exercise, and medications. With ongoing research, the future will certainly improve for those affected by fibromyalgia.

Recent research has suggested that drugs that block more than one brain nerve transmitter, such as duloxetine (Cymbalta), can be effective in treating fibromyalgia. Duloxetine has been effective in treating depression and relieving pain in persons with depression. Additional research suggests that the drug pregabalin may be helpful by blocking nerve pain in patients with fibromyalgia. More research is underway to evaluate the potential of these new treatments.

Fibromyalgia At A Glance
Fibromyalgia causes pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation.
Fibromyalgia does not cause body damage or deformity.
Fatigue occurs in 90% of patients with fibromyalgia.
Irritable bowel syndrome can occur with fibromyalgia.
Sleep disorder is common in patients with fibromyalgia.
There is no test for the diagnosis of fibromyalgia.
Fibromyalgia can be associated with other rheumatic conditions.
Treatment of fibromyalgia is most effective with combinations of education, stress reduction, exercise, and medications.

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« Reply #10 on: November 25, 2006, 10:42:34 am »

The Scientific Basis for Understanding Pain in Fibromyalgia

Robert Bennett MD



Fibromyalgia is a clinical construct that has been developed, for the most part, by rheumatologists. It is a direct descendent of "fibrositis", a common misnomer that was first coined in 1904  There are always problems inherent in defining a disorder in purely descriptive terms. Nevertheless the publication of the American College of Rheumatology's 1990 Classification Criteria for fibromyalgi has been coincident with an impressive resurgence of research in this area. This article attempts to synthesize contemporary research findings. 

~Diagnosis

The 1990 American College of Rheumatology's guidelines for making a diagnosis of fibromyalgia are the most widely used criteria in current use . They comprise the historical feature is widespread pain of 3 months or more and the physical finding of 11 or more out of 18 specified tender point sites on digital palpation with an approximate force of 4 kg.

 The 1990 criteria suggested abolishing the distinction between primary and secondary FM. This concept is important as some FM patients get extensive workups to exclude another diagnosis. The number of tender points of 11or more was originally derived from a receiver-operating curve and relates to the number giving the best sensitivity and specificity. In clinical practice, the diagnosis of FM can be entertained when less than 11 tender points are present.

~Clinical Features 

Pain


The core symptom of the FM syndrome is chronic widespread pain. The pain is usually perceived as arising from muscle, however many fibromyalgia patients also report joint pain (4) . Stiffness, worse in the early morning, along with the perception of articular pain this may reinforce the impression of an arthritic condition. Fibromyalgia pain and stiffness typically have a diurnal variation, with a nadir during the hours of about 11.00 am to 3.00 pm.

Symptoms also wax and wane in intensity over days and weeks; with flares occurring with increased exertion, systemic infections, soft tissue injuries, lack of sleep, cold exposure, and psychological stressors. 

Fatigue

Easy fatigability from physical exertion, mental exertion and psychological stressors are typical of fibromyalgia. The etiology of fatigue in fibromyalgia is multifaceted and is thought to include non-restorative sleep, deconditioning, depression, poor coping mechanisms and secondary endocrine dysfunction involving the hypothalamic pituitary adrenal axis and growth hormone deficiency. Patients with the chronic fatigue syndrome (CFS) have many similarities with FM patients.

 Characteristically, patients with CFS have an acute onset of symptoms after an infectious type illness, with subsequent persistence of debilitating fatigue and post-exertional malaise. About 75% of patients meeting the diagnostic criteria of CFS also meet the criteria for diagnosis of FM .

Disordered sleep

Fibromyalgia patients invariably report disturbed sleep... Even if they report 8 to 10 hours of continuous sleep they wake up feeling tired. Most relate to being light sleepers, being easily aroused by low-level noises or intrusive thoughts. Many exhibit an alpha-delta EEG pattern  but this is not an invariable in fibromyalgia and nor is it specific  .
The experimental induction of alpha-delta sleep in healthy individuals has been reported to induce musculoskeletal aching and/or stiffness as well as increased muscle tenderness (16) .   

Associated disorders

It is not unusual for fibromyalgia patients to have an array of somatic complaints other than musculoskeletal pain  It is now thought that these symptoms are in part a result of the abnormal sensory processing – as described elsewhere.   

Restless leg syndrome
This refers to daytime (usually maximal in the evening) symptoms of  unusual sensations in the lower limbs (but can occur in arms or even scalp) that are often described as paresthesia (numbness, tingling, itching, muscle crawling) and a restlessness, in that stretching or walking eases the sensory symptoms.  This symptomatology is nearly always accompanied by a sleep disorder - now referred to as periodic limb movement disorder (formerly nocturnal myoclonus)  Restless leg syndrome has been reported in 31% of fibromyalgia patients compared to 2% of controls .

Irritable bowel syndrome

This common syndrome of GI distress that occurs in about 20% of the general population is found in about 60% of fibromyalgia patients .  The symptoms are those of abdominal pain, distension with an altered bowel habit (constipation, diarrhea or an alternating disturbance).  Typically the abdominal discomfort is improved by bowel evacuation.

Irritable bladder syndrome
This is found in 40-60% of fibromyalgia patients .  The initial incorrect diagnoses are usually recurrent urinary tract infections, interstitial cystitis or a gynecological condition.  Once these possibilities have been ruled out a diagnosis of irritable bladder syndrome (also called female urethal syndrome) should be considered.  The typical symptoms are those of suprapubic discomfort with an urgency to void, often accompanied by frequency and dysuria.

Cognitive dysfunction
This is a common problem for many fibromyalgia patients . It adversely affects the ability to be competitively employed and may cause concern as to an early presentation of a neurodegenerative disease. The cause of cognitive dysfunction is in part related to the distracting effects of chronic pain, mental fatigue and psychological distress . 

Cold intolerance
About 30% of fibromyalgia patients complain of cold intolerance. Some patients develop a true primary Raynaud’s phenomenon, which may lead to misdiagnoses such as SLE or scleroderma .

Multiple sensitivities
One result of disordered sensory processing is that many sensations are amplified in fibromyalgia patients. Thus patients with fibromyalgia are more likely to receive other diagnoses such as multiple chemical sensitivity (MCS), sick building syndrome and drug intolerance.  One report cites a prevalence of 52% of MCS in fibromyalgia  . Buchwald found a large overlap between fibromyalgia, chronic fatigue syndrome and  .

Dizziness
This is a common complaint of fibromyalgia . In many cases no obvious cause is found, despite sophisticated testing.  Treatable causes related to fibromyalgia include: proprioceptive dysfunction secondary to muscle deconditioning, proprioceptive dysfunction secondary to myofascial trigger points in the sterno-cleido-mastoids and other neck muscles, neurally mediated hypotension and medication side effects.

Neurally mediated hypotension (NLM)
This syndrome is a lesser variant of “neurocardiogenic syncope”. Its prevalence in one report was 60% . NLM results from a paradoxical reflex when venous pooling reduces filling of the heart (right ventricle). In predisposed patients, this causes an inappropriately high secretion of catecholamines. This in turn leads to a vigorous contraction of the volume depleted ventricle – leading to an over-stimulation of ventricular mechanoreceptors which signal the midbrain to reduce sympathetic tone and increase vagal tone, with resulting syncope or presyncope. In fibromyalgia patients this may be manifest by severe fatigue after exercise, on prolonged standing or in response to stressful situations.

Initiation and maintenance of fibromyalgia

Most fibromyalgia patients causally relate an acute injury, repetitive work related pain, athletic injuries or another pain state to the onset of their problems. Others attribute stress, infections and toxins to its onset. Fibromyalgia is commonly found as an accompaniment of rheumatoid arthritis , systemic lupus erythematosus (SLE) ,  low back pain  , Sjogren's   and osteoarthritis.

One recent study from Israel documented a 22% prevalence of fibromyalgia, one year after automobile accidents causing whiplash; this compares to a 1% prevalence after accidents involving leg fractures . However most injured subjects do not develop fibromyalgia, and only 20–35% of patients with rheumatoid arthritis or SLE have a concomitant fibromyalgia syndrome. Buskila has reported a strong familial prevalence of fibromyalgia  .

 This suggests that subjects destined to develop fibromyalgia are either genetically predisposed (nature), or have past life events or experiences that favor its later development (nurture). Chronic pain states may also develop during or after some infections . A series of elegant experiments in rats has described a complex neural pathway whereby pro-inflammatory cytokines can cause a hyperalgesic state .

 This pathway involves pro-inflammatory cytokines (IL1, IL-6, and TNF) that activate cytokine binding sites on vagal paraganglia with afferent impulses travelling to the nucleus of the tractus solitarus. Subsequent cross-stimulation of the nucleus raphe magnus activates descending spinal tracts which sensitize second order dorsal horn neurons via an NMDA / substance P / nitric oxide cascade. Thus one can hypothesize that several discrete stimuli may initiate fibromyalgia via a common final pathway that involves the generation of a central pain state through the sensitization of second order spinal neurons.   

Prognosis and Impact

Kennedy and Felson reported on follow up of 39 patients, mean age 55, who had experienced fibromyalgia symptoms for 15 years. All of them still had fibromyalgia. Moderate to severe pain or stiffness was present in 55% of patients; significant sleep difficulties were reported in 48%; and notable levels of fatigue were present in 59%. Despite continuing symptoms, 66% of patients reported that FMS symptoms were somewhat improved compared to when first diagnosed.  Wolfe et al analyzed 1604 fibromyalgia patients followed for 7 years in academic rheumatology centers. Symptoms of pain, fatigue, sleep disturbance, functional status, anxiety, depression, and health status were abnormal at initiation and were the same after 7 years of follow up.

Fifty nine percent of the patients rated their health as only fair or poor. There is some evidence that fibromyalgia patients seen in the community, rather than tertiary care centers, have a better prognosis. Granges et al reported a 24% remission rate after 2 years of patients seen in an ambulatory care setting  . The consequences of pain and fatigability influence motor performance.  Henriksson, et al, have noted that every-day activities take longer in fibromyalgia patients, they need more time to get started in the morning and often require extra rest periods during the day . 

They have difficulty with repetitive sustained motor tasks, unless frequent time-outs are taken.  Tasks may be well tolerated for short periods of time, but when carried out for prolonged periods become aggravating factors .  Prolonged muscular activity, especially under stress or in uncomfortable climatic conditions, was reported to aggravate the symptoms of fibromyalgia .  The adaptations that fibromyalgia patients have to make in order to minimize their pain experience, has a negative impact on both vocational and avocational activities. 

Disability
Despite the superficial appearance of normality many fibromyalgia patients have difficulty with remaining competitive in the work force  . Most FM patients report that chronic pain and fatigue adversely affect the quality of their life and negatively impact their ability to be competitively employed  .  The extent of reported disability in FM varies greatly from country to country – probably reflecting differences in political philosophies and socio-economic realities. 

A survey of fibromyalgia patients seen in 6 US centers reported that 42% were employed and 28% were homemakers. Seventy percent perceived themselves as being disabled.  Twenty six percent were receiving at least one form of disability payment (44) . Sixteen percent were receiving Social Security benefits (SSD); this compares to 2.2% in the overall US population.

Pathogenesis 

Fibromyalgia articles commonly begin with the admonition that "the cause of fibromyalgia is not known". This assertion is no longer justified. Impressive advances have been made in understanding the neurobiology of chronic pain. As fibromyalgia is now considered part of the spectrum of chronic pain, these advances are relevant to understanding pain in fibromyalgia patients.

 

Epidemiology

Non-malignant persistent pain is common. Wolf found that the prevalence of chronic widespread musculoskeletal pain was more common in women and increased progressively from ages 18 to 70 -- with 23 % prevalence in the seventh decade.

The American College of Rheumatology has defined fibromyalgia in terms of chronic widespread pain involving 3 or more segments of the body plus the finding of at least 11 out of 18 designated tender point.  When Wolfe's patients were examined, 25.2% of females and 6.8% of men had 11 or more tender points.  The overall (M+F) prevalence of fibromyalgia was 2%, with a prevalence of 3.4% in women and 0.5% in men. Croft reported prevalence rates of 11.2% for chronic widespread pain, 43% for regional pain and 44% for no pain  . 

When subjects with widespread pain were examined, 21.5% had 11 or more tender points, 63.8% had between 1 and 10 tender points and 14.7% had no tender points . Interestingly the tender point count did not correlate with widespread pain, but it did correlate with depression, fatigue, and poor sleep. The results of these 2 studies indicate that a history of chronic widespread pain is more prevalent than the strictly defined diagnosis of fibromyalgia. Thus the concept is emerging that fibromyalgia is towards one end of a continuous spectrum of chronic pain.

 

Central Pain Mechanisms


There are several lines of evidence to suggest that the pain experience of fibromyalgia patients is in part the result of disordered sensory processing at a central level.   

Qualitative differences in pain

A study using an electronic dolorimeter recorded the subject’s assessment of pain intensity on a 0 to 10-cm visual analogue scale (VAS) at varying levels of applied force  . Distinctly different response curves were obtained for controls and fibromyalgia patients.  It was found that in pain free controls exhibited a logarithmic type of increase in pain intensity whereas fibromyalgia subjects showed a linear increase. Similar abnormalities of pain processing in fibromyalgia patients have also been reported for heat and cold .

 

Deficient pain modulation in response to repeated thermal stimuli

Down-regulation of pain threshold can be demonstrated in normal individuals by subjecting them to repeated skin stimulation. This effect, known as diffuse noxious inhibitory control (DNIC), was investigated in female fibromyalgia patients and compared to age-matched healthy women . Tonic thermal stimuli at painful and non-painful intensities were used to induce pain inhibition. Concurrent tonic thermal stimuli, at both painful and non-painful levels, significantly increased the electrical pain threshold in the healthy subjects but not in the fibromyalgia patients.   

Hyper-responsive somatosensory induced potentials

Gibson et al reported an increased late nociceptive (CO2-laser stimulation of skin) evoked somatosensory response in 10 FM patients compared to 10 matched controls  .  Lorenz et al  have recently reported increased amplitude of the N170 and P390 brain somatosensory potentials in fibromyalgia compared to controls evoked by laser stimulation of the skin. Furthermore they observed a response in both hemispheres – in controls the somatosensory potential was strictly localized to one side of the brain. These 2 studies provide direct objective evidence of altered processing of nociceptive stimuli in fibromyalgia patients.   

Secondary hyperalgesia on electrocutaneous stimulation

Secondary hyperalgesia refers to pain elicited from uninjured tissues . Arroyo and Cohen, while attempting to treat fibromyalgia patients with electrical nerve stimulation, noted that the pain was made worse and often caused dysthetic sensations  .  Compared to controls fibromyalgia patients had a reduced pain tolerance and 2 unexpected phenomena: (i) a spread of dysthesia (mainly tingling and burning) that was felt both distally and proximally to the stimulator, and (ii) a persistence of dysthesia around the stimulated locus that lasted for 12 to 20 minutes after the stimulation was terminated.   Therefore electrical stimulation of the skin in fibromyalgia patients resulted in several features that are characteristic of secondary hyperalgesia. 

Abnormalities on SPECT imaging

Functional CNS changes can be demonstrated by several different imaging techniques. It is interesting that chronic pain states have been associated with reduced thalamic blood flow, whereas acute pain increases thalamic blood flow.  The reason for this difference is postulated to be a disinhibition of the medial thalamus which results in activation of a limbic network. Mountz et al reported that fibromyalgia patients had a decreased thalamic and caudate blood flow compared to healthy controls on SPECT (single-photon-emission-computed tomography) imaging  . A similar finding has been reported in-patients with unilateral chronic neuropathic pain, using O-15 positron emission tomography . Thus functional imaging studies are supportive of an altered processing of sensory input in fibromyalgia patients.

 

Elevated levels of substance P in the CSF

Substance P lowers the threshold of synaptic excitability, permitting the unmasking of normally silent interspinal synapses and the sensitization of second order spinal neurons (66) . An increased production of neurotransmitters within the spinal cord may be detected as increased levels in cerebrospinal fluid (CSF)  . Animal models of hyperalgesia and hypoalgesia, have implicated substance P as a major etiological factor in central sensitization. There are 2 definitive studies that have shown a 3 fold increase of substance P in the CSF of fibromyalgia patients compared to controls .

Beneficial response to an NMDA receptor antagonist

There is persuasive evidence that glutamine reacting with NMDA (N-Methyl-D-Aspartic acid) receptors plays a central role in the generation of non-nociceptive pain. Two studies from Sweden reported that intravenous ketamine (an NMDA receptor antagonist) attenuates pain and increases pain threshold, as well as improving muscle endurance in FM patients (70,71) . In some patients a single intravenous infusion over a course of 10 minutes (0.3 mg/kg) resulted in a significant reduction in pain that persisted for up to 7 days. This therapeutic pain analysis supports the notion that activation of NMDA receptors is relevant to disordered sensory processing in fibromyalgia patients.

Experimentally induced central hyperexcitability

Sorensen et al injected hypertonic saline (2 ml of 5.7% saline over 8 mins.) into the asymptomatic anterior tibial muscle of fibromyalgia patients and healthy controls . Compared to controls fibromyalgia patients experienced a longer duration of pain and a larger area of referral. The same subjects were also compared as to pressure pain threshold over the anterior tibial muscle, and pain threshold to both single and repetitive electrical stimulation of the overlying skin and electrical intramuscular stimulation. Pressure pain and the intramuscular summation pain threshold was significantly lower in fibromyalgia patients. These results further support a state of disordered sensory processing in fibromyalgia.     

Psychological considerations

As in many chronic conditions there is an increased prevalence of psychological diagnoses in fibromyalgia patients; however the converse is not true. For instance, fibromyalgia is not common in patients with major depression; even depressed individuals who complain of pain did not have multiple tender points in one studies . Psychological distress in fibromyalgia may in part determine who becomes a patient .

The psychiatric diagnoses that are often considered in the differential diagnosis of fibromyalgia are the somatoform disorders, especially somatization disorder and pain disorder - as defined DSM-IV (76) .

From a management aspect it is seldom useful to characterize fibromyalgia as being solely a psychological problem or solely as an organic problem. Considering the preponderance of studies pointing to a dysfunction of sensory processing in fibromyalgia, one would expect these patients to have an amplification of bodily sensations resulting in a wide range of somatic symptoms.

 A diagnosis of a somatoform disorder will become a non-psychiatric diagnosis once the symptomatology is adequately explained by disordered physiology  . There is now good evidence that links pain to "emotional neuro-circuits". Different cortical and sub-cortical structures are involved in different aspects of the pain experience.

For instance removal of the somatosensory cortex does not abolish chronic pain, but excision or lesions of the anterior cingulate cortex reduces the unpleasantness . The anterior cingulate cortex is involved in the integration of affect, cognition and motor response aspects of pain  and exhibits increased activity on PET studies of pain patients .

Other structures involved in cortical pain processing include the prefrontal cortex (activation of avoidance strategies, diversion of attention and motor inhibition), the amygdala (emotional significance and activation of hypervigilance) and the locus ceruleus (activation of the “fight or flight” response)  . 

All these structures are linked to the medial thalamus, whereas the lateral thalamus is linked to the somatosensory cortex (pain localization).  A recent experiment convincingly showed how the prevailing mental attitude of an individual can influence the unpleasantness of a standardized pain stimulus and how this correlated to blood flow changes in the anterior cingulate gyrus. Thus prefrontal cortical activity (i.e. positive or negative thoughts) can influence the perception of pain. Is this the neural basis of somatization and cognitive-behavioral therapy? 

Management 


The current treatment modalities for fibromyalgia seldom lead to long term relief. Basically the current management philosophy is to help the patient constructively adapt to an existence plagued by pain, fatigue and other symptoms. The resistance of fibromyalgia symptoms to contemporary treatments was recently highlighted .

 In a follow up of 530 fibromyalgia patients followed in 6 US tertiary referral centers over 7 years, there was no significant improvement in pain, functional disability, fatigue, sleep disturbance, or psychological status. Half the patients were dissatisfied with their health, and 59% rated their health as fair or poor. Fibromyalgia patients used an average of 2.7 fibromyalgia-related drugs in every 6-month period. The mean yearly per-patient cost in 1996 dollars was $2,274.   

Despite this gloomy picture there is some evidence that fibromyalgia patients can be helped, but not cured, by a multi-disciplinary approach that emphasizes education, cognitive behavioral therapy, therapeutic treatment of pain, participation in a stretching and aerobic exercise program, prompt treatment of psychological problems and attention to associated syndromes .

The fibromyalgia treatment group at Oregon Health Sciences University has employed a multi-disciplinary treatment using a team of interested health professionals (nurse practitioners, clinical psychologists, exercise physiologists, mental health care workers, and social workers)  .

  In this way groups of 10-30 patients can be seen in designated sessions several times a month.  Patients are usually appreciative of meeting others who share similar problems and the dynamics of group therapy is often a powerful aid to cognitive-behavioral modifications. 

Such groups can be encouraged to develop a sense of camaraderie in solving mutual problems.  This form of therapy has proved beneficial in one 6 month program, with continuing improvement out to 2 years after leaving the program  . Turk's group has recently published similar encouraging results .
« Last Edit: November 25, 2006, 05:55:33 pm by Kathy » Logged


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« Reply #11 on: July 09, 2007, 06:17:54 pm »


~Understanding Fibromyalgia
Fibromyalgia is a real condition with real symptoms. Chronic pain all over the body. Flu-like aching. Severe tenderness. Sleep issues. Fatigue. It all adds up to one of the most common widespread types of chronic pain. In fact, it affects more than 6 million people in the U.S.

Fibromyalgia is a disorder that is complex and often misunderstood. This section will provide you with a quick and easy way to start yourself on the path to better understanding fibromyalgia.

~What is Fibromyalgia
Fibromyalgia (pronounced fie-bro-my-AL-juh) is one of the most common chronic widespread types of pain in the U.S. In fact, it affects more than 6 million people. And its causes are still not fully known. Recent data suggest that changes in the central nervous system may contribute to the chronic pain of this condition.





~The science of fibromyalgia.
Nerve and brain cells can become extra sensitive under certain conditions. This may lead to extra signals being sent to the brain, and an increase in the pain that a person feels. A person whose central nervous system has become extra sensitive may feel a type of chronic widespread pain that is typical of fibromyalgia.

The pain may occur as a result of a number of things. For example, viral infections, trauma, or injury. Even exposure to chronic stress. The sleep problems that go along with fibromyalgia may make the condition worse. And that could lead to even more pain and disturbed sleep.

Right now, there is no blood test or X-ray that can tell someone if they have fibromyalgia. But researchers continue to focus on improved ways to diagnose and treat this condition.

~Symptoms of Fibromyalgia
The pain of fibromyalgia can make simple tasks hard. Even something like washing dishes may all of a sudden feel like too much. Sleeping is often a struggle, too.

Fibromyalgia causes physical pain. Fibromyalgia can often hamper the ability to work and engage in everyday activities, as well as compromise personal relationships, and affect a patient’s social life, too.

Getting relief from the pain of fibromyalgia isn’t easy. And support from friends, family, and the health care system is often lacking. Patients may feel like they must learn to live with the pain.

~Patients with fibromyalgia often experience:

Chronic widespread body pain in the neck, shoulders, back, arms, and legs
Muscle tenderness, soreness, and flu-like aching
Poor sleep, stiffness, and fatigue
Dull pain in muscles, tendons, and ligaments

Fibromyalgia is painful. And its causes are still not fully known. Even though fibromyalgia can’t be detected through a blood test or an X-ray, your doctor can perform a “tender point” exam to make a diagnosis. It is important to see a doctor because many of its symptoms are similar to other conditions.


~Frequently Asked Questions
What is fibromyalgia?
Fibromyalgia is one of the most common chronic widespread types of pain in the U.S. Patients with fibromyalgia often experience:

Chronic widespread body pain in the neck, shoulders, back, arms, and legs
Deep tenderness, soreness, and flu-like aching
Poor sleep, stiffness, and fatigue
Dull pain in muscles, tendons, and ligaments

~Who is affected?

It’s estimated that approximately 5% to 7% of the U.S. population have fibromyalgia
Women are more likely to have fibromyalgia
It affects all ages and races
Most people are diagnosed between the ages of 20 and 50 years old
Fibromyalgia has a serious impact on patients' families, friends, and employers.

~What are the symptoms?
Fibromyalgia is characterized by the presence of multiple tender points and a collection of symptoms.

~Pain:

Profound, widespread, and chronic
Migrating to all parts of the body and varying in intensity
Described as deep muscular aching, throbbing, twitching, stabbing, and shooting pain
Neurological complaints such as numbness, tingling, and burning are often present and add to the discomfort of the patient
The severity of the pain and stiffness is often worse in the morning
Aggravating factors that affect the pain may include: cold/humid weather, not feeling refreshed or feeling more tired after sleeping, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety, and stress

~Fatigue:

The fatigue of fibromyalgia is much more than being tired. It is an overwhelming exhaustion
It feels like every drop of energy has been drained from the body
It can leave the patient with a limited ability to function both mentally and physically

~Sleep Problems:

Many fibromyalgia patients have an associated sleep disorder
This disorder prevents them from getting deep, restful, restorative sleep
Medical researchers have documented specific differences in the stage 4 deep sleep of fibromyalgia patients
During sleep, people with fibromyalgia are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep



~Other Symptoms/Conditions:
Additional contributing symptoms/conditions may include:

Irritable bowel and bladder
Headaches and migraines
Restless legs syndrome (periodic limb movement disorder)
Impaired memory and concentration
Skin sensitivities and rashes; dry eyes and mouth
Anxiety
Depression
Ringing in the ears
Dizziness
Vision problems
Raynaud's Syndrome
Neurological symptoms
Impaired coordination



~What causes fibromyalgia?
Most experts agree that fibromyalgia is a central nervous system (CNS) disorder. Studies have found that, compared with people who do not have fibromyalgia, people with fibromyalgia may have:

Excess pain-producing chemical (substance P) in the spinal fluid and too little pain-reducing chemical
Low levels of blood flow to the thalamus region of the brain, which plays an important role in pain sensation and movement
Reduced functioning of the HPA axis hypofunction, which regulates production of certain hormones
A change in the serotonin transporter
Abnormalities in the function of cytokines (proteins that affect how cells interact and behave)

There also appears to be a fairly strong genetic component to fibromyalgia and related conditions. Like most disorders, fibromyalgia occurs in part because of the genes that individuals are born with (that make them more susceptible to an illness), and in part because of what they are subsequently exposed to over their lifetime.

For some, the onset of fibromyalgia is slow; however, in a large percentage of patients the onset is triggered by an illness or injury that causes trauma to the body. These events may act to incite an undetected physiological problem already present.

Exciting new research has also begun in the areas of brain imaging and neurosurgery. Ongoing research will test the theory that fibromyalgia is caused by a defect in the central nervous system that changes the way a person normally would respond to pain.



~How is fibromyalgia treated?
One of the most important factors in improving the symptoms of fibromyalgia may be for the patient to recognize the need for lifestyle changes.Change is often difficult because it implies adjustment, discomfort, and effort. However, in the case of fibromyalgia, certain changes may bring about a noticeable improvement in function and quality of life.

A physician who is knowledgeable about the diagnosis of fibromyalgia, and who can listen to and work with the patient is an important component in the treatment of fibromyalgia. It may be a family practitioner, an internist, or a specialist (rheumatologist or neurologist, for example). Traditional types of medical help may be only part of a potential treatment program. Alternative treatments, nutrition, relaxation techniques, and exercise can play an important role in fibromyalgia treatment as well. Each patient should, with the input of a health care professional, establish a treatment plan best suited to them




~How is Fibromyalgia Diagnosed
Although fibromyalgia can’t be detected through a blood test or X-ray, your doctor can perform a "tender point" exam as a tool for diagnosis.

Fibromyalgia is diagnosed based on whether or not the patient meets the criteria established by The American College of Rheumatology (ACR) in 1990. According to the ACR, the following criteria must be met:

History of chronic widespread pain for at least three months
Patients must exhibit pain in at least 11 of 18 tender points

To be considered widespread, the pain must meet all of the following:

Pain in both sides of the body
Pain above and below the waist
Pain in the axial skeletal area (cervical spine, anterior chest, thoracic spine, or low back)
Pain (not just tenderness) in at least 11 of 18 tender point sites (see the illustration) when the doctor applies pressure (palpation) on the site

Illustration of Tender Points



For various reasons, many people with fibromyalgia struggle with their symptoms for many years before being diagnosed. Some relief can be felt in just knowing there is a name for their pain, that fibromyalgia is not terminal, and that they can finally begin to focus on specific ways to actually begin to manage and treat their symptoms.


~10 Things You Should Know About Fibromyalgia

Fibromyalgia is one of the most common chronic widespread types of pain in the U.S. The condition affects more than 6 million people.
Fibromyalgia pain is widespread and persistent. There is often deep tenderness. Plus soreness or burning pain, which often causes a lack of sleep. Sometimes, patients also have stiffness in their muscles or flu-like aching.
Fibromyalgia is thought to result from neurological changes in how a patient perceives pain.
To be diagnosed with fibromyalgia, patients must have widespread pain lasting at least three months, plus pain in at least 11 of 18 parts of the body known as “tender points.” (According to the American College of Rheumatology.)
Women are much more likely to report having fibromyalgia than men.
The outlook for people with fibromyalgia has never been better. Exercise, diet, and rest can help manage this condition. So can counseling and drug therapy.

Several types of health care providers are available to help manage fibromyalgia. These include rheumatologists, primary care physicians, nurse practitioners, neurologists, psychiatrists, physiatrists, and pain specialists.
Fibromyalgia places large financial costs on patients and society. It may cause lost work days, as well as lost income and disability payments.

Although fibromyalgia is not a psychological condition, it can impact mood and cause distress. In that way it is similar to other chronic pain conditions. However, the majority of sufferers do not have mood-related disorders.
Do you think you may have fibromyalgia? You need to know you are not alone. Talk to your health care provider. Or contact the National Fibromyalgia Association at 714-921-0150


~Working With Your Doctor
How quickly fibromyalgia is diagnosed, and how effectively it is treated, can be greatly impacted by decisions made by the patient with regard to his or her medical care and advice. It is important for patients to select the right doctor and establish an effective partnership through open communication and understanding.

Choosing the right doctor is very important when it comes to finding relief for any condition, including fibromyalgia. Do you have a doctor you know well? If not, here are a few tips:

Ask a friend, family member, or coworker. Have someone you know and trust refer you to a doctor. It’s a great place to start.
Learn more about the doctor's fibromyalgia experience.
Many doctors have experience treating fibromyalgia. Some have more history treating it than others.

Should you see a specialist? Ask your doctor. Be sure to ask questions on your first visit. Together, you can decide whether you should see a specialist. Some doctors, like rheumatologists, pain specialists, and neurologists have devoted their careers to relieving pain.

Call your health care insurance provider. They will have a list of physicians covered under your plan. And they can also help find a location near you. They can also tell you what steps you need to take before you see a specialist.

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« Reply #12 on: September 22, 2007, 11:49:39 am »

EULAR Issues Guidelines for the Treatment of Fibromyalgia Syndrome



Release Date: September 21, 2007


 
 

 The European League Against Rheumatism (EULAR) has issued the first guidelines for the treatment of fibromyalgia syndrome (FMS) and published them in the September 17 Online First issue of the Annals of the Rheumatic Diseases.

"Although effective treatments are available no guidelines exist for management of FMS," write Serena F. Carville, from King's College London, United Kingdom, and colleagues. "The objectives were to ascertain the strength of the research evidence on effectiveness of treatment of FMS and develop recommendations for its management based on the best available evidence and expert opinion to inform healthcare professionals."

The authors of these guidelines consisted of a multidisciplinary task force from 11 European countries. This panel defined the study design a priori, using standard operating procedures published by EULAR. These included search strategy, which was a systematic review using the keywords "fibromyalgia," "treatment or management," and "trial"; "participants"; "interventions"; "outcome measures"; "data collection"; and "analytical method."

Exclusion criteria for identified studies were failure to use classification criteria from the American College of Rheumatology (ACR), studies that were not clinical trials or studies comprising inclusion of patients with chronic fatigue syndrome or myalgic encephalomyelitis. The main endpoints were change in pain measured by the visual analog scale (VAS), and the fibromyalgia impact questionnaire (FIQ).

The panel categorized the studies by quality, based on whether they were randomized, blinded, and concealed allocation, and they used only the highest-quality studies as a basis for their recommendations. The panel used a Delphi process to provide a basis for recommendation when evidence from the literature was inadequate.

Of 146 studies eligible for review, 39 pharmacologic intervention studies and 59 nonpharmacologic studies were used to create the final recommendation summary tables, after those of lower quality or with insufficient data were excluded. Identified categories of treatment were antidepressants, analgesics and "other pharmacological," and exercise, cognitive behavioral therapy, education, dietary interventions, and "other nonpharmacological interventions."

Using this systematic review process and expert consensus, the panel developed 9 recommendations for the management of FMS. However, many studies reviewed had insufficient sample size and study quality to allow the panel to issue strong recommendations. EULAR plans to update the guidelines every 5 years and incorporate findings from good-quality clinical trials that will add to currently available evidence.

"These recommendations are the first to be commissioned for FMS, although previous reviews have addressed the area," the review authors conclude. "These recommendations should assist health care providers, with a secondary intention to incorporate information into materials for patients. The 9 recommendations included 8 management categories, 3 of which had strong evidence from the current literature, and 3 were based on expert opinion."

Specific recommendations in these guidelines regarding general considerations for management of FMS are as follows:

Comprehensive evaluation of pain, function, and psychosocial context is needed to understand FMS completely, because it is a complex, heterogeneous condition involving abnormal pain processing and other secondary features (level of evidence, IV D).
Optimal treatment of FMS mandates a multidisciplinary approach, which should include a combination of nonpharmacologic and pharmacologic interventions. After discussion with the patient, treatment modalities should be specifically tailored based on pain intensity, function, and associated features such as depression, fatigue, and sleep disturbance (level of evidence, IV D).
Specific recommendations on nonpharmacologic management of FMS are as follows:

Heated pool treatment, with or without exercise, is effective (level of evidence, IIa B).
For some patients with FMS, individually tailored exercise programs can be helpful. These may include aerobic exercise and strength training (level of evidence, IIb C).
For certain patients with FMS, cognitive behavioral therapy may be beneficial (level of evidence,IV D).
Based on the specific needs of the patient, relaxation, rehabilitation, physiotherapy, psychological support, and other modalities may be indicated (level of evidence, IIb C).
Specific recommendations on pharmacologic management are as follows:

Tramadol is recommended for management of pain (level of evidence, Ib A). Although other treatment options may include simple analgesics (eg, paracetamol) and other weak opioids, corticosteroids and strong opioids are not recommended (level of evidence, IV D).
Antidepressants are recommended for the treatment of FMS because they decrease pain and often improve function (level of evidence, Ib A). Appropriate options may include amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide, and pirlindole.
Tropisetron, pramipexole, and pregabalin are recommended for the treatment of FMS because they reduce pain (level of evidence, Ib A).
Limitations of these recommendations are that some are based only on expert opinion; basis from clinical trial data limited to changes in pain measured by the VAS and function evaluated with the FIQ; failure to consider positive effects on other outcome measures of pain or on function evaluated with different instruments; and high variability in outcome measures used, results reporting, and poor methodologic quality precluding meta-analysis.

"Guidance on how to conduct good RCTs [randomized controlled trials] in FMS, including standardised outcome measures and validated, sensitive instruments is important for future research," the review authors conclude. "The assessment of strength of evidence tends to favour pharmacological studies as double blinding and placebo controls are impossible in many non-pharmacological studies. However, most non-pharmacological interventions are safe and have other health benefits."

EULAR provided financial support for creation of these guidelines. Some of the review authors have disclosed various financial relationships with Procter and Gamble, Sanofi-Aventis, Roche, Bristol Meyers Squibb, Pierre Fabre, Servier, Pfizer, Eli Lilly, Jazz Pharmaceutical, Allergan, and Wyeth.

Ann Rheum Dis. Published online September 17, 2007.

Clinical Context
The predominant rheumatologic features of FMS include chronic, widespread pain and lowered pain threshold, with hyperalgesia and allodynia. Other features often accompanying FMS include fatigue, depression, anxiety, sleep problems, headache or migraine, bowel irregularity, diffuse abdominal pain, and urinary frequency.

The most frequently used research classification criteria for FMS are those developed by the ACR. However, no previous guidelines have addressed management of FMS, despite the availability of effective treatments. EULAR sought to evaluate the strength of the research evidence on the effectiveness of FMS treatment and to develop management recommendations for healthcare professionals based on the best evidence and expert opinion.

Study Highlights
A multidisciplinary task force from 11 European countries wrote these guidelines using EULAR standard operating procedures.
Studies were excluded that were not clinical trials, did not use ACR classification criteria, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis.
Main outcomes studied were change in pain on the VAS and the FIQ.
The panel based its recommendations on only the highest-quality studies. A Delphi process was used for consensus opinion when evidence from the literature was inadequate.
Of 146 eligible studies reviewed, those of lower quality or with insufficient data were excluded, and 39 pharmacologic and 59 nonpharmacologic studies were used to create the 9 final recommendations.
The 9 recommendations included 8 management categories, 3 of which had strong evidence from the current literature, and 3 that were based on expert opinion.
The 9 recommendations were as follows:

Comprehensive evaluation of pain, function, and psychosocial context are needed to understand FMS completely, because of its complex, heterogeneous nature.
Optimal treatment of FMS mandates a multidisciplinary approach, including nonpharmacologic and pharmacologic interventions. Treatments should be specifically tailored to patient reports of pain intensity, function, and associated features such as depression, fatigue, and sleep disturbance.
Heated pool treatment, with or without exercise, is effective. Individually tailored exercise programs, which may include aerobic exercise and strength training, may be helpful for some patients.
Cognitive behavioral therapy, relaxation, rehabilitation, physiotherapy, psychological support, and other modalities may be indicated for certain patients.
Tramadol is recommended for management of pain from FMS. Simple analgesics (eg, paracetamol) and other weak opioids may be considered, but corticosteroids and strong opioids are not recommended.
Antidepressants are recommended to decrease pain and improve function (eg, amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide, and pirlindole).
Tropisetron, pramipexole, and pregabalin are recommended to reduce pain of FMS.
EULAR plans to update the guidelines every 5 years and incorporate findings from good-quality clinical trials that will add to currently available evidence.

Pearls for Practice
Pharmacologic interventions recommended for FMS include tramadol for pain management, with simple analgesics and weak opioids if needed. Corticosteroids and strong opioids are not recommended. Antidepressants are recommended to decrease pain and improve function.
Nonpharmacologic interventions recommended for FMS include comprehensive evaluation; multidisciplinary, specifically tailored therapy; and heated pool treatment, with or without exercise. Individually designed exercise programs, cognitive behavioral therapy, relaxation, rehabilitation, physiotherapy, psychological support, and other modalities may be helpful for some patients.
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« Reply #13 on: November 14, 2007, 12:13:29 pm »

People suffering from chronic fatigue continue fight for recognition, treatment


Nov. 13, 2007 People who have chronic fatigue syndrome have been tireless in their quest to be acknowledged.

It has been 20 years since the first advocacy group was formed, and almost 20 years since the U.S. Centers for Disease Control and Prevention defined the diagnosis. Despite that, during the decades since people with CFS still were told their disease didn't exist or it was all in their head.

Now, although many people with the crippling condition are glad that doctors will say, "You have chronic fatigue syndrome," they are dismayed that what follows is usually, "There's nothing I can do for you."
 
 
"Ten or 15 years ago, physicians were very reluctant to even believe that chronic fatigue or fibromyalgia existed," says Pedro Escobar, a physician who has been practicing in Tucson for 25 years. "When I first saw the patients, they had symptoms for six or seven years."

~That skepticism came from the top.

"In the early days, beyond disregard for the illness, there was almost an open hostility about it," says Kimberly McCleary, president of the CFIDS Association of America (for "chronic fatigue and immune deficiency syndrome"). "They were talking about the research they were funding, but there was very little evidence that anything was occurring. Early on we felt the need to police that."

The advocacy group carefully documented the CDC's reported spending on the illness. In 1998, a whistle-blower revealed that $13 million had been diverted from CFS research into other areas. The scandal led to an overhaul of the agency's financial management and a role for the CFIDS group in influencing research expenditures.

In the years since, stepped-up research has revealed that the disease is more prevalent than believed. A CDC June report found that 2.6 percent of 19,000 people surveyed met the clinical diagnosis for chronic fatigue syndrome.

Still, recognition isn't a cure, or even a treatment.


~Pain 'all over'


Nancy Jay, 35, of Maricopa, has suffered from chronic fatigue and fibromyalgia for about half her life. She has seen many doctors and had many tests. At first, she was told her extreme tiredness, aches, pains, chronic infections and cognitive difficulties were due to depression and stress. Eventually, a doctor told her she had chronic fatigue syndrome and that there was no treatment.

"He made such light of it. He said, 'I suggest you join a support group,' which made me feel hopeless," Jay says.

CFS is frustrating for doctors, too.

"It's very difficult because there is not just one clinical manifestation," says Escobar. "These individuals have a constellation of symptoms. They have pain that can be all over, problems with sleep, with the bladder, the bowel, with headaches. You name it."

~Symptoms come and go and vary in severity.

"Therefore, you are going to have to have a lot of time to dedicate to them. It is not the regular visit that you can do in 5 or 10 minutes. Usually you need a follow-up visit of 30 minutes to see how their sleep is doing, and whether they have new symptoms."

Escobar says that in his experience, 90 percent of patients have chronic fatigue syndrome with fibromyalgia, widespread body pain. Only about 10 percent have one or the other exclusively.


~Roller coaster


The disease can occur either gradually or suddenly. For Saskia Ekstrom, it happened quite fast.

Ekstrom, 32, of Phoenix, an archaeologist and historical-preservation specialist, became ill about 18 months ago with a viral infection and missed several weeks of work. Since then it has been a roller coaster as she alternated between bouts of debilitating fatigue and periods of feeling better.

Her doctor treated her with hormones and thyroid medication, and she has had some success with herbs and acupuncture.

"I'm very thankful I have a good doctor who understands chronic fatigue and that it's so many different factors that are involved," Ekstrom says.

Last fall she became pregnant. Some women with CFS find that pregnancy "resets" their system and they feel much better; others worsen. Ekstrom felt better at first, then worse. She also couldn't take medication while she was pregnant, or while she has been breastfeeding her son, born in August.

Ekstrom may be lucky because research has shown that people who are diagnosed and treated for chronic fatigue syndrome within five years of acquiring it usually have more recovery than people who have had it for many years.

Jay believes her condition was triggered by a bout of Lyme disease. MRIs have shown lesions on her brain from the infection, which went uncontrolled for decades, she says.

"Personally, I don't know a lot of people with this who have gotten well," Jay says.


~Finding help


There is no one treatment for CFS, and most doctors will treat it symptomatically.

Jay has tried many things, without much success, although she has felt somewhat better since changing her diet within the past few years.

"I've eliminated carbohydrates, and I eat mostly lean meats and veggies, and I don't eat dairy," she says. "I have more energy, and it's helped with losing weight, too. Most CF patients are heavy."

She says that although many alternative health providers, such as naturopaths and acupuncturists, are eager to take people with chronic fatigue syndrome and fibromyalgia, patients who are not working can't afford treatment that isn't covered by health insurance.

Escobar says he starts with simple things, such as nutritional supplements.

"I then try to improve their sleep because it makes a tremendous difference when you get one of these individuals to sleep well," he says.

He'll try sleep medication such as Lunesta if the patient can tolerate it, or send them to a sleep lab.

"You need to get into deep sleep to secrete very important growth and thyroid hormones that you only secrete in deep sleep," he says.

While treatment is still difficult, Escobar says two new drugs offer some promise. Lyrica, an anti-epilepsy drug, and Cymbalta, an antidepressant, both help ease fibromyalgia pain.


~Support groups


One of the hardest aspects of CFS is the isolation and loneliness. McCleary, of the CFIDS Association of America, says about 25 percent of people with CFS become unable to work.

"This isn't an attorney who can no longer practice law. It's an attorney who can't work the cash register in a drugstore," she says.

Jay, who was a health educator, has not worked for several years. She and her husband moved here from New York a few years ago because she couldn't tolerate the cold winters.

"I used to do freelance health writing, but now I can't because of my cognitive difficulties," she says. "I'm home all day. It's hard for me to make friends because most people can't relate to someone who's ill. They say, 'Oh I'm tired too.'

"There was a need for me to meet people who could understand."

So Jay posted a notice on craigslist.com that she was thinking of starting a support group for women with chronic illnesses.

"Within a couple of months we had more than 50 members," she says.

The group, Arizona Chronic Illness Network, met monthly for lunch. Meetings declined as Jay struggled with her illness, but she hopes to resume get-togethers of the group, which now includes men as well.

Any chronic illness will strain relationships, but the unpredictable and intractable nature of CFS is especially difficult. Jay says her husband is the only breadwinner and her caregiver as well, which is stressful. She is planning a trip to Florida to visit family members but is anxious.

"I could end up on the wrong flight because I get so confused," she says.
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« Reply #14 on: November 16, 2007, 11:08:27 pm »

Fibromyalgia symptoms or not?



 ~Understand the fibromyalgia diagnosis process
If you have widespread pain, you and your doctor may wonder if you're experiencing fibromyalgia symptoms. But determining whether you do indeed have fibromyalgia symptoms isn't an easy process. It's not uncommon to spend years going from doctor to doctor and undergoing tests for conditions as varied as arthritis, depression and multiple sclerosis before reaching a fibromyalgia diagnosis.


Fibromyalgia can't be easily confirmed or ruled out through a simple laboratory test. Your doctor can't detect it in your blood or see it on an X-ray. Instead, your doctor relies on your symptoms. Unfortunately, fibromyalgia symptoms may vary widely from one person to the next.

The American College of Rheumatology (ACR) guidelines direct doctors making a fibromyalgia diagnosis to test 18 points on your body for tenderness. Your doctor puts light pressure with his or her fingers on each point to see whether you feel pain. ACR criteria state that pain at 11 of the points may indicate fibromyalgia. Even that guideline is controversial, though, and some specialists question whether it's useful because fibromyalgia symptoms may come and go. You may experience pain in one area of your body, rather than over your entire body.

To further complicate the diagnosis, you may experience signs and symptoms that are seemingly unrelated to fibromyalgia. Chronic stomachaches or headaches combined with the pain you're experiencing may lead your doctor to suspect other similar conditions first.

~Excluding other possible causes for fibromyalgia symptoms

As your doctor moves toward a fibromyalgia diagnosis, he or she may want to rule out many diseases and conditions that mimic or are related to fibromyalgia. Testing for some of these diseases and conditions may make sense to you — for instance, you may find it reasonable that your doctor wants to rule out rheumatoid arthritis, since that disease also causes pain.

But the idea of tests for other conditions may be frightening. When your doctor suggests exams and tests for conditions such as cancer, kidney problems or multiple sclerosis, you may be alarmed.

Ruling out all of these conditions may be part of your diagnosis process. Talking openly with your doctor about your fears can help you understand what he or she is looking for with each test and how each test is part of making a final diagnosis.

*Diseases and conditions similar to fibromyalgia
*Ankylosing spondylitis, Lupus, Polymyalgia rheumatica
*Carpal tunnel syndrome, Multiple sclerosis, Restless legs syndrome
*Cushing's syndrome, Myasthenia gravis ,Rheumatoid arthritis
*Depression, Myositis, Sleep apnea
*Hyperparathyroidism ,Osteoarthritis, Sjogren's syndrome
*Hypothyroidism, Peripheral neuropathy   

~What you can do
The sooner your doctor arrives at a fibromyalgia diagnosis, the sooner you can begin treatment to get your fibromyalgia symptoms under control. Here's what you can do to help yourself and your doctor during this process:

Understand what your doctor is looking for. Ask your doctor to explain each disease and condition he or she is testing for and why. Ask for reliable sources of further information. When you better understand the diagnostic process, you'll feel less frustrated. If your doctor orders a blood test to look for lupus, ask why. Does he or she think lupus is a more likely cause of your symptoms? Or does your doctor just want to rule lupus out?

If your doctor orders exams or sends you to a specialist for a condition that doesn't make sense to you, ask questions then, too. For example, if you’re referred to a neurologist, you may wonder if your doctor misunderstood your symptoms or perhaps didn't listen to you. Ask questions to clarify the reasoning.

Keep records of the tests and procedures you've undergone. Each time you see a new doctor or specialist, avoid having to start the diagnostic process all over again. Ask for records of the tests you undergo and the results. Sometimes there may be an advantage to having an exam or test repeated, but in many cases you may save time and money by showing your new doctor your records.

Many times your records will be forwarded to a new doctor or specialist. But that isn't always the case. In some instances the new doctor or specialist will receive only portions of your medical records.

Find the right doctor. Find a doctor you trust — someone who communicates well and is willing to work as a team with you. Not all doctors have a lot of knowledge about fibromyalgia, and some may even have outdated notions of the condition. If your health insurance plan allows, switch to a new doctor who is more suitable. Even if a doctor doesn't have a lot experience with fibromyalgia cases, a doctor who is interested in helping you and willing to learn more can be a good advocate for you.

If you feel that you aren't making progress toward a final diagnosis, it may be time to find a new doctor. Contact your health insurance plan to find out what doctors you're allowed to see. Ask friends and family for referrals. Contact us here at www.LupusMCTD.com. We have many members with Fibro with and without Lupus or a Mixed Conective Tissue Disorder.(MCTD)

Build a good relationship with your doctor. Whether with your current doctor or a new doctor, build a good partnership. Be open and honest with your doctor about concerns you may have about the diagnosis process. Avoid coming to appointments angry or making accusations. Tell your doctor you're frustrated and ask how you can help move things along. Ask your doctor to be open about what's frustrating or puzzling about your symptoms.

As you work with your doctor, also take steps to take care of yourself so that you can cope with the uncertainty of not having a definitive diagnosis. Reduce stress by taking time for yourself. Engage in stress-free activities, such as massage and deep breathing. Eat a healthy diet with a variety of fruit and vegetables. Tell your doctor if you're having trouble sleeping.
~Sleep is a big issue with most health problems. But when you have pain you can't sleep.




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« Reply #15 on: June 01, 2009, 01:19:46 pm »

Fibromyalgia: Patients say many doctors don't take them seriously


June 1, 2009

Asked to describe the seemingly indescribable, to make real the manifestations of a medical condition that some still doubt even exists, fibromyalgia patients often rely on similes of the most wince-inducing sort.

• "I felt like acid was going through my veins."

• "It was like a steamroller ran over me."

• "Fatigue like someone's pulled out your battery pack."

• "… as if someone pinged me with a hammer all over my body."

• "Your (brain) feels like a pinball machine. You're trying to come up with the word, and the ball bounces around until it finally falls on your tongue."

• "It feels like death, only worse."

Can there be any doubt that these people truly are suffering from diffuse, widespread chronic pain with multiple tender spots, enervating fatigue and a host of symptoms that include restless legs, impaired memory and depression?

Well, yes.

Despite being recognized as a diagnosable disease by the American College of Rheumatology, the Food and Drug Administration and most insurers, fibromyalgia has not completely shed the stigma of being dismissed as "psychosomatic" by some in the medical establishment.

Controversy swirls even as new FDA-approved medications have shown promise and recent brain imaging research has shown central nervous system changes in those afflicted. The National Fibromyalgia Association, a patient advocacy group, estimates that 10 million Americans suffer from one or more of the multifarious manifestations of the condition.

It is this array of symptoms not linked to specific cause and effect – as opposed to how rheumatoid arthritis can ravage a patient's joints – that keeps skeptics in mainstream medicine from validating fibromyalgia as a legitimate disease.

Where, exactly, is this deep muscular aching? What's the cause of that nebulous numbness and dizziness? Why won't painkillers help? Where are the lab tests that can prove it exists?

Those are the questions that still dog fibromyalgia patients.

"They make you think you're a hypochondriac or something," says Jennifer Filbeck, 36, a former restaurant manager from Fairfield who's been unable to work since 2006. "Doctors treat you like you're crazy."

Not crazy per se, critics of the existence of fibromyalgia claim. Their argument: These people suffer from psychological conditions that manifest themselves in vague and hard-to-define physical maladies.

Dr. Frederick Wolfe, who wrote the landmark 1990 paper that first created diagnostic guidelines for fibromyalgia, recently told the New York Times that he now considers it merely a byproduct of depression, stress and social anxiety. Wolfe, head of the National Databank of Rheumatic Diseases, told the paper, "Some of us in those days thought that we had actually identified a disease, which clearly this is not. To make people ill, to give them an illness, was the wrong thing."

That view is supported by Dr. Nortin Hadler, a rheumatologist and professor at the University of North Carolina. Writing in the Journal of Rheumatology, Hadler states bluntly that fibromyalgia is all in the mind.

"I am suggesting that chronic persistent pain is an ideation, a somatization if you will, that some are inclined toward as a response to living life under a pall, and not vice versa," he writes. "I am further suggesting that these people choose to be patients because they have exhausted their wherewithal to cope."

Medical literature has been slow to publish data on fibromyalgia. Recent studies have gone a long way in disputing the claims of Wolfe and Hadler, though researchers still have yet to pinpoint a cause.

A 2008 University of Michigan study showed that fibromyalgia patients exhibited central nervous system abnormalities that resulted in elevated sensitivity to pain and stimuli. The study, however, tested only 31 subjects.

Other research using functional MRI brain scans show increased activity in pain receptors for even minor discomfort among fibromyalgia patients.

Dr. David Ferrera, medical director of the Sacramento Research Medical Group, has spent three years conducting clinical trials on a new treatment drug, Savella, which received FDA approval in January.

Ferrara acknowledges that "it is a complex disorder and there's still a lot to learn" but says fibromyalgia patients are underserved by many doctors.

"I've had women in tears in my office because they say, 'You're the first doctor who's believed me.' These people often take three or four years to get diagnosed. They are told, 'Your lab tests are normal, there's nothing wrong with you. You're just depressed. Go get a life.' They feel like second-class citizens and begin to feel it's imaginary.

"The problem is, measuring differences in fibro people isn't easily done in a doctor's office. So they are dismissed."

Another reason fibromyalgia patients often aren't taken seriously, particularly by primary-care physicians, is that seven of 10 sufferers are women, says Lynne Matallana, president of the National Fibromyalgia Association.

Matallana, who visited Sacramento earlier this month for a fibromyalgia rally at the state Capitol, need look no further than her own story for an example. A former advertising executive, Matallana started feeling full-body pain, fatigue, dizziness and anxiety shortly after an unrelated surgery in 1993.

Doctors were as skeptical as they were baffled, she says.

"I knew I wasn't crazy," she says. "But you start to think, maybe I am imagining this. You lose your self-confidence. You lose your trust in doctors. I was told I was under stress and should see a psychiatrist. I was told there was nothing wrong with me and I needed to start recognizing that. I had one doctor who looked something up in a book and said, 'chronic fatigue' and, quote, 'Your life's going to be a living hell.'

"But when I finally found a doctor who used the word 'fibromyalgia' and said, 'We're going to find things that will help you get better,' – that's when I started getting better."

That diagnosis came three years and 37 doctors after she first felt pain. An easing of her symptoms didn't come until seven years later, after experimenting with everything from acupuncture to yoga to antidepressants.

Matallana says that even today, "when there's science behind it," fibromyalgia carries a psychosomatic stigma.

It's not just doctors who doubt the condition's existence; it's family and friends.

Cynthia Mittel, a 53-year-old Vacaville woman who said she used to have a high pain threshold (she delivered her children naturally; no drugs) now sometimes has trouble walking. What really troubles her, though, is lack of acceptance even by some in her family. Her first husband, she says, "sort of believed me but wasn't supportive." Other family members told her to toughen up.

"I basically don't talk too much to my friends and family about it," Mittel says. "Frankly, they are sick to death of it. I don't care if people believe me or not."

Mittel and Filbeck, the Fairfield patient, said they have tried the antidepressant medications Lyrica and Cymbalta without success. Filbeck says the drugs put her in what she calls "The Fibro Fog," in which she is inattentive and forgetful.

"The medicines make you stupid," she says. "You walk into the house, leave the keys in the door and then can't remember where you left them. I don't like the way they make me feel."

Roseville fibromyalgia patient Ann Davis, 62, has had trouble concentrating in her job as a graphic designer.

"You get to where you know it's not going to kill you," Davis says. "It's just an inconvenient thing you've got to live with. The pain, I could live with. It was the fatigue that got me. You can't function."

Davis was so desperate in 2007 that she signed up to participate in a clinical trial for Savella, which differs from the other fibromyalgia drugs in that it blocks both serotonin (which Lyrica and Cymbalta do) and another neurotransmitter, norepinephrine (which the others do not).

She says she felt relief within a month and is back playing golf and gardening. When she was taken off the drug, symptoms resumed with a vengeance.

"I don't get the fatigue," Davis says. "That's the big thing. I mean, I'll get muscle soreness like any normal person if I overdo it. But I don't wake up thinking a steamroller has run over me."

SOURCE: Google
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« Reply #16 on: September 25, 2009, 01:00:15 pm »



Online Video Library Launched To Share Martha Beck’s Experience Living with Fibromyalgia
 September 2009

For people living with painful conditions, September is a time for their true stories of triumph to emerge. Helping to foster support and communication, National Pain Awareness Month allows people with painful conditions to educate others about their experiences, build connections and together fight their pain.

Fibromyalgia has been a commonly misunderstood chronic pain disorder that is estimated to affect approximately 5 million Americans.(1) The disorder is characterized by the presence of chronic widespread pain and tenderness for at least three months(2), and is frequently accompanied by fatigue, emotional changes and sleep problems.(2,3) Experts recommend that a combination of education, lifestyle changes and medication may be the key to helping people who have fibromyalgia feel better.(4)

Even though fibromyalgia has gained more public attention, efforts to drive awareness are still needed. That’s why best-selling author and renowned life coach Martha Beck is championing the cause through the educational initiative Know Fibro. Through video sessions that are now posted on the initiative’s Web site, www.KnowFibro.com, Martha shares details of her nearly 30-year battle with fibromyalgia, and shares tips that have helped her feel better. “I want people to know they’re not alone,” said Beck. “These videos not only provide an honest look into how the disorder has impacted every aspect of my life, but also how I’ve learned to get my fibromyalgia under control with a comprehensive care plan.”

Know Fibro, sponsored by the National Fibromyalgia Association and Eli Lilly and Company, offers a wide range of useful information including resources from leading experts, a Web site with Martha’s personal story, easy-to-use tips found in a downloadable book, and FibroGuide, a fibromyalgia self-management program.

About Martha Beck, Ph.D.
Martha Beck, Ph.D., has lived with fibromyalgia for almost 30 years and understands the challenges those with the disorder face. She has a bachelor’s, a master’s and a Ph.D. in sociology, all three from Harvard University, and has published books and articles on a variety of social science and business topics. She also is a columnist for O, the Oprah Magazine. Beck is sharing her story as the official spokesperson of Know Fibro.

About the National Fibromyalgia Association
The National Fibromyalgia Association (NFA) is a nonprofit [501(c)(3)] organization whose mission is to develop and execute programs dedicated to improving the quality of life for people with fibromyalgia. The NFA concentrates on patient support services, awareness outreach, physician education and research. The NFA produces informational materials, hosts a patient Web site (www.FMaware.org), and a health care provider Web site (www.fibromyalgiaHCP.org), and publishes the only consumer magazine, Fibromyalgia AWARE.

About Eli Lilly and Company
Lilly, a leading innovation-driven corporation, is developing a growing portfolio of pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers – through medicines and information – for some of the world’s most urgent medical needs. Additional information about Lilly is available at www.lilly.com.
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« Reply #17 on: November 10, 2009, 02:52:39 pm »

What is Fibromyalgia?

 
 
Fibromyalgia or fibromyalgia syndrome (FS, FMS) is a debilitating collection of symptoms and problems. Its foremost symptom is pain. It seems to be closely related to chronic fatigue syndrome, but with pain as its stand-out symptom instead of fatigue. It often occurs with Chronic Myofascial Pain (CMP, CMPS) , but not always. Fibromyalgia symptoms are similar enough to Multiple Sclerosis, Lupus, Neuropathy, and other disorders that most physicians want to run a battery of tests to rule out the other conditions before a diagnosis of FMS is given. Usually, it is the lack of positive testing for other conditions plus the patient's history that yields a diagnosis of fibromyalgia. The cause of fibromyalgia has not been determined by the medical community. Researchers performing tests on patients have found common deficiencies and physical problems and proposed some theories. Celiac sprue, leaky gut syndrome, estrogen dominance, genetic predisposition to move electrolytes inefficiently, thyroid problems, allergies, trauma, viral infection, exposure to toxins, relaxin hormone deficiency, and stress have all been suggested as possible causes. There is also no known cure for fibromyalgia. Yet, some people recover from fibromyalgia and CMP, so there is a possibility of recovery, and some therapies banish symptoms to the point that sufferers can lead normal lives. FMS and CMPS are not progressive. That is, they are not a death sentence. But the symptoms can become progressively worse over time. Victims must aggressively take charge of their lives with the help of family and medical experts in order to reclaim their health. The things I have done to help myself recover represent changes in hormone balancing, lifestyle, and eating habits that are myriad and take commitment. But it's worth it. Be comforted by the fact that your old habits were not just unhealthy for you, but are unhealthy for anyone. Unhealthy lifestyles are always harmful in some way or another, and there is always a payment – in health, in attitude, in money – to be made.

Fibromyalgia symptoms are many, and no one suffers from all of them. Some symptoms may be more pronounced in your case than others. Pain was my most bothersome symptom, while my friend's was irritable bowel syndrome, yet we both suffered from fibromyalgia. All victims have tender points that are very painful to the touch. The tender points feel severely bruised and may send pain radiating to other parts of the body. Eighteen of those points have been mapped and are used to diagnose fibromyalgia. Most doctors expect a newly-diagnosed patient to have suffered pain for at least three months, and to be very sensitive in 11 of the eighteen sites. These 18 sites are really 9 pairs, with matching sites on both sides of the body. This is laughable for many sufferers, for they have pain sites everywhere. Some even suffer skin pain, where even a light touch to the skin is unbearable. Still, some patients may have fewer pain sites. The sites are located in the following areas: 1) behind the ears at the base of the skull; 2) on the trapezius muscles half-way between the spine and the shoulders; 3) on the shoulder-blades; 4) in the front just above the collarbone; 5) about 2 inches below the collarbone on both sides of the breastbone; 6) on the forearms along the line of the thumbs just below the crease of the elbows; 7) above the buttocks on the outer sides; 8) on the upper thighs, on the outside just behind the hip thrusts; 9) on the insides of the knees. My most profound pain sites (to pressure or touch) were along my outer thighs from hips to knees and at the Achilles tendons.

A LIST OF FIBROMYALGIA SYMPTOMS 2

“Growing pains” in children and youth
Chronic cold symptoms, such as sore throat, stuffiness, nasal drip, swollen glands
Drooling in sleep
Difficulty swallowing
Dry cough
Aching jaws, especially when chewing gum
Dizziness when field of view moves
Stiff neck
Mold/yeast sensitivity
Headaches/migraines
Inability to enter deep sleep; unrefreshing sleep
Sweats
Morning stiffness
Fatigue
Shortness of breath; sucking air during exercise
Painful weak grip that may let go
Dropping things
Menstrual problems and/or pelvic pain
PMS (Pre-menstrual Syndrome)
Loss of libido (Loss of sex drive)
Low back pain
Nail ridges and/or nails that curve under
Difficulty speaking known words
Directional disorientation
Visual perception problems
Tearing/reddening of eye, drooping of eyelid
Loss of ability to distinguish some shades of colors
Short-term memory impairment
Weight gain or loss
Sensitivity to odors
Mitral valve prolapse
Double/blurry/changing vision
Visual and audio effects/falling sensations before sleep (called “sleep starts”) Earaches/ringing/itch
Unexplained toothaches; shooting pains in gums and teeth
Rapid/fluttery/irregular heartbeat/heart attack-like pain Bloating/nausea/abdominal cramps
Appendicitis-like pains
Carbohydrate/chocolate cravings
Sensitivity to cold/heat/humidity/pressure changes/light/wind
Abdominal cramps, colic
Panic attacks
Mottled skin
Depression
Confusional states
Thumb pain and tingling numbness
Urine retention
Tendency to cry easily
Night driving difficulty
Weak ankles
Lax, pendulous abdomen
Upper/lower leg cramps
Tight Achilles tendons
Groin pain
Irritable bowel syndrome
Sciatica
Urinary frequency
Impotence
Stress incontinence, anal/genital/perineal pain
Painful intercourse
Muscle twitching (even in large muscles or muscle groups)
Numbness and tingling
Diffuse swelling
Hypersensitive nipples/breast pain
Fibrocystic breasts
Buckling knee
Problems climbing stairs
Problems going down stairs
Free-floating anxiety
Mood swings
Unaccountable irritability
Trouble concentrating
Shin splint-type pain
Heel pain
Sensory overload
Handwriting difficulties
Sore spot on top of head
Problems holding arms up (as when folding sheets)
“Fugue”-type states (staring into space before brain can function)
Tight hamstrings
Carpal tunnel-like pain in wrist (watchband area)
Balance problems/staggering gait
Restless leg syndrome
Myoclonus (muscle movements and jerks at night)
Feeling continued movement in car after stopping
Feeling tilted when cornering in car
First steps in the morning feel as if walking on nails
Pressure of eyeglasses or headbands is painful
Thick secretions
Bruise/scar easily
Some stripes and checks cause dizziness
Bruxism (teeth grinding)
Inability to recognize familiar surroundings
Delayed reactions to “overdoing it”
Family clustering (other members of the family have FMS)
Tissue overgrowth (fibroids, ingrown hairs, heavy and splitting cuticles, adhesions)

Reading this list is both distressing and comforting for the newly-diagnosed sufferer – you realize you really are sick , but it's comforting to know that there's a reason for all these maladies, and showing the list to family members helps them to understand how complex and encompassing the syndrome is. I would add the following: when lying down to rest and relax at night, saved-up pain accumulated during the day begins to fire off, resulting in a “torture-chamber” experience of assorted types of pain – burning, shooting, electrical, pressure, pummeling, biting. Muscles roil during the night, and prevent deep, relaxing sleep, as well as the production of growth hormone and serotonin. One wakes up feeling like he/she has been run over by a Mack truck and left for dead.

Depression is common to virtually all fibro sufferers. This depression, however, might not be symptomatic, but might the kind of depression suffered by anyone who is in constant pain or who is disabled. Irritable bowel syndrome can be characterized by constipation and/or diarrhea (sometimes alternating), frequent abdominal pain, gas, and nausea. 40% to 70% of fibromyalgia sufferers experience IBS. About half of patients suffer from migraines or tension headaches. Muscles or tendons in the face can tighten and affect the jaw (TMJ). Half of fibro sufferers are very sensitive to odors, bright lights, noise, medications and/or foods. Memory can be impaired. “Fibro-fog” is the slang for foggy thinking. Most fibromyalgia sufferers are women (9 to 1). Many fibromyalgia sufferers have hypoglycemia. Fibromyalgia symptoms ebb and flow in an unpredictable cycle. When symptoms are severe, the sufferer is in a “flare.” Stress, stormy weather, diet, hormone fluctuation, or over-exertion can bring on a flare. It is more than coincidence that many of the symptoms listed are also seen in “estrogen dominance” or insulin or thyroid resistance. I will discuss these later.

2 Devin Starlanyl: ( www.sover.net ) is both a sufferer and an expert in dealing with fibromyalgia.  Devins book, Fibromyalgia and Chronic Myofascial Pain: A Survival Manual is a must-read for any sufferer (edition 2, Starlanyl and Copeland, 2001).

 
 
 
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