Fibromyalgia

September 11, 2011

Fibromyalgia syndrome (FMS) is a real illness with multiple symptoms that each need to be dealt with in order to achieve recovery. To treat FMS, one must understand what it is.

Most people with Fibromyalgia syndrome report at least several, if not all, of the following symptoms:

  1. Muscle and joint pain that can be severe at times and then let up
  2. Decreased energy or feeling exhausted at times, and at other times feeling driven, which can lead to a vicious cycle of ups and downs
  3. Tender points that are painful when pressed on, and generalized body aches
  4. Mood problems, mostly depression, but also during pain-free times feeling pressured to make up for lost time
  5. Insomnia or unrefreshing sleep: feeling unrested and fatigued on awakening
  6. Mental cloudiness and confusion often referred to as “fibro fog,” along with an excess of mental “noise”

The cause of these symptoms is uncertain. Normally, the brain filters out the “noise” of minor stresses such as the occasional body pains we all have. After undergoing a higher level of stress, the body seems to become hypersensitive to unpleasant sensations. A person with Fibromyalgia syndrome then feels bombarded and overwhelmed.

Autoimmune dysfunction is often blamed because many people with Fibromyalgia syndrome have abnormal rheumatological blood tests. Neurochemical abnormalities may play a role since depression is often a major part of the syndrome. Fibromyalgia syndrome may be related to previous trauma such as a car accident or prior abuse. Probably, multiple causes combine to give rise to Fibromyalgia syndrome. For example, a person may be genetically predisposed to Fibromyalgia syndrome, but an event such as trauma or a viral illness may set off the cascade of symptoms.

Fibromyalgia syndrome is a diagnosis of exclusion: that is, other causes must be ruled out before blaming Fibromyalgia syndrome. The hallmark of Fibromyalgia syndrome is pain and tenderness to touch in at least 11 of the 18 characteristic tender points. The tender points are best tested on a bad day, as the tenderness can come and go. Depending on the results of the medical history and physical examination, tests may be done to rule out autoimmune disorders, vitamin deficiencies (B12, folic acid, or minerals), infections (such as Lyme disease or hepatitis C), or disease of various internal organs.

The cornerstone of Fibromyalgia syndrome treatment includes moderate exercise and stretching. Overly vigorous exercise can make symptoms worse. Good dietary and sleep habits are important, as is minimizing physical and psychological stress.

Medications have a central role in treating symptoms but cannot cure Fibromyalgia syndrome. Finding the right medication is often a matter of trial and error. For pain, over-thecounter and prescription nonsteroidal anti-inflammatory pain relievers are helpful. As with other chronic pain conditions, narcotics should be avoided. Antiseizure medications (including Neurontin, Tegretol, and Depakote) also help relieve pain, as well as stabilizing mood and helping the brain filter out pain “noise.” Many people with Fibromyalgia syndrome find antidepressants to be very helpful, both for pain and for mood symptoms. The serotonin reuptake inhibitors (SSRIs like Prozac, Paxil, Zoloft, and Celexa), tricyclic antidepressants, and others (such as Effexor, Remeron, or Wellbutrin) can help the brain deal with physical and psychological stress. Fibromyalgia syndrome patients often use muscle relaxants (such as Flexeril, Zanaflex, Soma, Skelaxin, and Norflex), usually along with anti-inflammatory medications, to treat muscle tightness and inflammation. Muscle relaxants are sedating, which can help Fibromyalgia syndrome patients fall asleep. For initiating sleep, nonaddicting sleep medications (such as Ambien or Sonata) can be helpful. Tricyclic antidepressants (including amitriptyline, doxepin, or nortriptyline) can help bring about deep restorative sleep. Other medications used for sleep include Remeron or atypical agents such as Seroquel or Zyprexa.

Some clinicians recommend using a combination of medications from each category. Medications tend to help more than one symptom and different medications can have additive effects for the same symptom. It can take time to find the right mix, but eventually relief is possible.

SEE ALSO: Arthritis, Autoimmune disorders, Depression, Sleep disorders

Suggested Reading

Fransen, J., & Russell, I. J. (1996). The fibromyalgia help book. St. Paul, MN: Smith House Press.

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