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Fibromyalgia

Fibromyalgia is a neurologic chronic health condition that causes pain all over the body and other symptoms. Other symptoms of fibromyalgia that patients most often have are:

  • Tenderness to touch or pressure affecting muscles and sometimes joints or even the skin
  • Severe fatigue
  • Sleep problems (waking up unrefreshed) 
  • Problems with memory or thinking clearly

Some patients also may have: 

  • Depression or anxiety
  • Migraine or tension headaches
  • Digestive problems: irritable bowel syndrome (commonly called IBS) or gastroesophageal reflux disease (often referred to as GERD) 
  • Irritable or overactive bladder
  • Pelvic pain
  • Temporomandibular disorder - often called TMJ (a set of symptoms including face or jaw pain, jaw clicking, and ringing in the ears)

Cause

The causes of fibromyalgia are unclear. They may be different in different people. Current research suggests involvement of the nervous system, particularly the central nervous system (brain and spinal cord). Fibromyalgia is not from an autoimmune, inflammation, joint, or muscle disorder. Fibromyalgia may run in families. There likely are certain genes that can make people more prone to getting fibromyalgia and the other health problems that can occur with it. Genes alone, though, do not cause fibromyalgia. 

There is most often some triggering factor that sets off fibromyalgia. It may be spine problems, arthritis, injury, or other type of physical stress. Emotional stress also may trigger this illness. The result is a change in the way the body “talks” with the spinal cord and brain. Levels of brain chemicals and proteins may change. More recently, Fibromyalgia has been described as Central Pain Amplification disorder, meaning the volume of pain sensation in the brain is turned up too high. 

Although Fibromyalgia can affect quality of life, it is still considered medically benign. It does not cause any heart attacks, stroke, cancer, physical deformities, or loss of life.

Diagnosis

A doctor will suspect fibromyalgia based on your symptoms. Doctors may require that you have tenderness to pressure or tender points at a specific number of certain spots before saying you have fibromyalgia, but they are not required to make the diagnosis. A physical exam can be helpful to detect tenderness and to exclude other causes of muscle pain. There are no diagnostic tests (such as X-rays or blood tests) for this problem. Yet, you may need tests to rule out another health problem that can be confused with fibromyalgia. 

Because widespread body pain is the main feature of fibromyalgia, health care providers will ask you to describe your pain. This may help tell the difference between fibromyalgia and other diseases with similar symptoms. Other conditions such as hypothyroidism (underactive thyroid gland) and polymyalgia rheumatica sometimes mimic fibromyalgia. Blood tests can tell if you have either of these problems. Sometimes, fibromyalgia is confused with rheumatoid arthritis or lupus. But, again, there is a difference in the symptoms, physical findings and blood tests that will help your health care provider detect these health problems. Unlike fibromyalgia, these rheumatic diseases cause inflammation in the joints and tissues.

Treatment plan

There is no cure for fibromyalgia. However, symptoms can be treated with both non-drug and medication based treatments. Many times the best outcomes are achieved by using multiple types of treatments. 

Non-Drug Therapies: People with fibromyalgia should use non-drug treatments as well as any medicines their doctors suggest. Research shows that the most effective treatment for fibromyalgia is physical exercise. Physical exercise should be used in addition to any drug
treatment. Patients benefit most from regular aerobic exercises. Other body-based therapies,including Tai Chi and yoga, can ease  fibromyalgia symptoms. Although you may be in pain, low impact physical exercise will not be harmful. 
Cognitive behavioral therapy is a type of therapy focused on understanding how thoughts and behaviors affect pain and other symptoms. CBT and related treatments, such as mindfulness, can help patients learn symptom reduction skills that lessen pain. Mindfulness is a non-spiritual meditation practice that cultivates present moment awareness. Mindfulness based stress reduction has been shown to significantly improve symptoms of fibromyalgia. 
Other complementary and alternative therapies (sometimes called CAM or integrative medicine), such as acupuncture, chiropractic and massage therapy, can be useful to manage fibromyalgia symptoms. Many of these treatments, though, have not been well tested in patients with fibromyalgia. 
It is important to address risk factors and triggers for fibromyalgia including sleep disorders, such as sleep apnea, and mood problems such as stress, anxiety, panic disorder, and depression. This may require involvement of other specialists such as a Sleep Medicine doctor, Psychiatrist, and therapist. 

Medications: The U.S. Food and Drug Administration has approved three drugs for the treatment of fibromyalgia. They include two drugs that change some of the brain chemicals (serotonin and norepinephrine) that help control pain levels: duloxetine and milnacipran. Older
drugs that affect these same brain chemicals also may be used to treat fibromyalgia. These include amitriptyline and cyclobenzaprine. Other antidepressant drugs can be helpful in some patients. Side effects vary by the drug. Ask your doctor about the risks and benefits of your medicine. 
The other drug approved for fibromyalgia is pregabalin. Pregabalin and another drug, gabapentin, work by blocking the over activity of nerve cells involved in pain transmission. These medicines may cause dizziness, sleepiness, swelling and weight gain. 
It is strongly recommended to avoid opioid narcotic medications for treating fibromyalgia. The reason for this is that research evidence shows these drugs are not of helpful to most people with fibromyalgia, and will cause greater pain sensitivity or make pain persist. Tramadol may be used to treat fibromyalgia pain if short-term use of an opioid narcotic is needed. Over-the-counter medicines such as acetaminophen or nonsteroidal anti-inflammatory drugs (commonly called NSAIDs) like ibuprofen or naproxen are not effective for fibromyalgia pain. Yet, these drugs may be useful to treat the pain triggers of fibromyalgia. Thus, they are most useful in people who have other causes for pain such as arthritis in addition to fibromyalgia. 
For sleep problems, some of the medicines that treat pain also improve sleep. These include cyclobenzaprine, amitriptyline, gabapentin or pregabalin. It is not recommended that patients with fibromyalgia take sleeping medicines like zolpidem or benzodiazepine medications.

Living with fibromyalgia

Even with the many treatment options, patient self-care is vital to improving symptoms and daily function. In concert with medical treatment, healthy lifestyle behaviors can reduce pain, increase sleep quality, lessen fatigue and help you cope better with fibromyalgia. With proper treatment and self-care, you can get better and live a more normal life. Here are some self-care tips for living with fibromyalgia: 

  • Make time to relax each day. Deep-breathing exercises and meditation will help reduce the stress that can bring on symptoms. 
  • Set a regular sleep pattern. Go to bed and wake up at the same time each day. Getting enough sleep lets your body repair itself, physically and mentally. Also, avoid daytime napping and limit caffeine intake, which can disrupt sleep. Nicotine is a stimulant, so those fibromyalgia patients with sleep problems should stop smoking. 
  • Exercise often. This is a very important part of fibromyalgia treatment. While difficult at first, regular exercise often reduces pain symptoms and fatigue. Patients should follow the saying, “Start low, go slow.” Slowly add daily fitness into your routine. For instance, take the stairs instead of the elevator, or park further away from the store. As your symptoms decrease with drug treatments, start increasing your activity. Add in some walking, swimming, water aerobics and/or stretching exercises, and begin to do things that you stopped doing because of your pain and other symptoms. It takes time to create a comfortable routine. Just get moving, stay active and don't give up! 
  • Educate yourself. Nationally recognized organizations like the Arthritis Foundation and the National Fibromyalgia Association are great resources for information. Share this information with family, friends and co-workers. 
  • Look forward, not backward. Focus on what you need to do to get better, not what caused your illness.

 

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