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Fibromyalgia

What is Fibromyalgia?

Fibromyalgia is a chronic condition that typically causes widespread muscle pain and significant tenderness in multiple areas of the body. While the specific cause of fibromyalgia is not yet clear, it is known to be closely associated with fatigue, sleep disturbances, headaches, depression and anxiety and may be related to autoimmune conditions.

 

How common is Fibromyalgia?

Fibromyalgia is more common in women than men. In the United States fibromyalgia is the most common cause of generalized musculoskeletal pain in women between 20 and 55 years of age. Additionally it affects about 2 percent of people by age 20 and 8 percent of people by age 70, although the majority of people initially develop symptoms between the ages of 30 and 55.

 

Is there a cause for Fibromyalgia?

There is usually not a specific triggering factor that causes fibromyalgia. However typically patients may report chronic pain conditions, arthritis, acute injuries, or other types of physical or emotional stress.

 

How is Fibromyalgia diagnosed?

A doctor will suspect fibromyalgia based on your symptoms. However, there are no specific laboratory or imaging tests used to diagnose fibromyalgia. Thus, the diagnosis is typically based upon a thorough patient history, a complete physical examination, and blood tests, which are used to exclude conditions with similar symptoms such as rheumatoid artrhitis, thyroid disease and lupus.

 

Notwithstanding according to the American College of Rheumatology there are criteria traditionally needed for the diagnosis of Fibromyalgia; these include:

Pain and symptoms over the past week

A minimum of 11 painful areas out of 19 specific areas of your body in conjunction with the level of severity of these and associated symptoms such as:

Fatigue

Waking unrefreshed

Cognitive (memory or thought) problems

Symptoms lasting at least three months at a similar level

No other health conditions that would explain the pain and other symptoms

 

Image from Medscape showing typical Tender Points:

http://www.medscape.org/viewarticle/767044_transcript

 

For more information please visit:

http://www.medscape.com/resource/fibromyalgia

 

Is there a blood test to diagnose Fibromyalgia?

Currently there are no widely available diagnostic tests (such as X-rays or blood tests) to diagnose this condition. EpicGenetics of Santa Monica, California, developed a test, called the FM/a test which has shown some promising results but at this time is still considered experimental and is not covered by most insurances.

 

For more information please visit:

http://epicgenetics.com

 

How is Fibromyalgia treated?

Currently there is no cure for fibromyalgia, however research shows that the most effective treatment is physical exercise. Fibromyalgia patients benefit most from aerobic exercises or other physical therapies including yoga and aquatic therapy. Cognitive behavioral therapy is also a well-established type of therapy which focuses on understanding how thoughts and behaviors affect pain and helps patients develop coping skills to lessen their symptoms. Other complementary and alternative therapies include acupuncture, chiropractic and massage therapy, which may be helpful in managing fibromyalgia symptoms.

 

For refractory fibromyalgia symptoms patients can also be treated with medications. The U.S. Food and Drug Administration has approved three drugs for the treatment of fibromyalgia. They include duloxetine (Cymbalta) and milnacipran (Savella), which act by altering the levels of serotonin and norepinephrine and indirectly help control pain. The other drug approved for the treatment of fibromyalgia is pregabalin (Lyrica). Pregabalin and gabapentin (Neurontin) both work by blocking the over activity of nerve cells involved in pain transmission. In addition some older antidepressants may also be used to treat fibromyalgia such as amitriptyline (Elavil). Other treatment options may include muscle relaxants and non-steroidal anti-inflammatories.

 

If your doctor deems it necessary to supplement your regimen with opioids, short term use is recommended. Side effects vary with each medication and as always you should ask your doctor about the risks and benefits prior to starting any medications. Again current research suggests that medications are not of great benefit in the long term for most people with fibromyalgia. In fact, long term opioid use may cause greater pain sensitivity leading to a syndrome called opioid induced hyperalgesia. Generally, the best outcomes are achieved by using multiple types of treatment modalities.

 

For more information please visit American College of Rheumatology at:

http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia

 

Is there treatment for my insomnia?

Yes, sleep dysfunction is commonly associated with fibromyalgia. The first line of therapy should be to improve your sleep hygiene. According to the national sleep foundation these include the following:

Avoid napping during the day, which can disturb the normal pattern of sleep and wakefulness.

Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime. While alcohol is well known to speed the onset of sleep, as the body begins to metabolize the alcohol it actually disrupts sleep, causing arousal.

Exercise can promote good sleep. Vigorous exercise should be done in the early morning or by late afternoon. A more relaxing exercise, like yoga, can be done before bed to help initiate a restful night's sleep.

Food can be disruptive right before sleep. Stay away from large or spicy meals close to bedtime. And, remember, chocolate has caffeine.

Ensure adequate exposure to natural light. Light exposure helps maintain a healthy sleep-wake cycle.

Establish a regular relaxing bedtime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don't dwell on, or bring your problems to bed.

Associate your bed with sleep. It's not a good idea to use your bed to watch TV, listen to the radio, or read.

Make sure that the sleep environment is pleasant and relaxing. The bed should be comfortable, the room should not be too hot or cold, or too bright.

 

For more information please visit the National Sleep Foundation at:

https://sleepfoundation.org/ask-the-expert/sleep-hygiene/page/0/1

 

It is not recommended that patients with fibromyalgia take sleeping medicines like zolpidem (Ambien), Lunesta or benzodiazepine medications (Temazepam).

 

Are there Fibromyalgia support groups?

Yes, although many are available to choose from you may find information with the National Fibromyalgia and Chronic Pain Association:

https://www.fmcpaware.org/

 

At El Paso Pain Center our team of board-certified pain physicians can help diagnose and treat patients with Fibromyalgia. Please call to make your appointment today (915) 598-7246.

 

Sources:

http://www.uptodate.com/contents/fibromyalgia-beyond-the-basics

http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia

http://www.medscape.com/resource/fibromyalgia

ABOUT AUTHOR

by Dr.Eduardo G. Vazquez

Dr. Vazquez specializes in chronic pain management, interventional pain management, and cancer pain treatment. Dr. Vazquez is also fluent in English and Spanish and is board certified by the American Board of Anesthesiology in Anesthesiology and Pain Management.

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