Fibromyalgia

General

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain and is often accompanied by fatigue, sleep, memory and mood issues. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety, depression and fibro fog.

Researchers call fibromyalgia a pain amplification syndrome where painful stimuli is magnified it its transmission to and/or reception by the brain.  Over time there seems to be an actual remodeling in the way the brain processes and perceives pain.

Focuses of irritability seem to reside in the white connective tissue that envelops muscle bundles and muscle groups. Very tender spots seem to develop in predictable locations of the body. Increases in neurotransmitters responsible for pain transmission are usually present in the brain of a fibromyalgia sufferer. An increase in Substance P, a chemical agent known to elicit pain, is seen in and around the spinal joints and tissue.

Disability claims due to fibromyalgia seem sensational, however the disability is usually not from pain, but from the loss of mental acuity - sometimes called Fibro Fog, that can accompany fibromyalgia pain. Manifestations of “Fibro Fog” include difficulty with word use and recall, short-term memory problems, directional disorientation, multitasking difficulty, confusion and trouble concentrating, and finally difficulty performing simple math.

Causes

Symptoms sometimes begin after a physical trauma (such as a motor vehicle accident), surgery, infection or significant psychological stress . In other cases, symptoms gradually accumulate over time with no single triggering event.

Risks

Women are much more likely to develop fibromyalgia than are men. In fact, the ratio is 10:1. Age does not seem to be a predictable factor. If another family member has fibromyalgia, then chances of diagnosis are increased. A person who suffers from any number of autoimmune diseases, such as Rheumatoid arthritis or Lupus, also has an increased probability of a fibromyalgia diagnosis.

Treatment

While there is no cure for fibromyalgia, a variety of medication and/or interventional treatment options can help control symptoms. Exercise, relaxation and stress-reduction measures also may help. It is often a combination of the options to follow that provide the best pain management.

Medication Management

  • Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol (Ultram, Conzip). Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time.
  • Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or fluoxetine (Prozac) to help promote sleep.
  • Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin, Gralise) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.
Interventional Treatment

  • Trigger Point Therapy. Injections of local anesthetic mixed with an anti-inflammatory drug can be helpful to dissipate the tender spots associated with fibromyalgia. Dry needling (stimulation of the tender or trigger points with the needle without injecting medicine) may be performed as well.
  • Medial Branch Blocks. A nerve block to diminish pain in the facet joints of the spine will often reduce spinal pain and tender/trigger points that are in the referral zone of that spinal level. For example, a medial branch block performed in the lower cervical spine may diminish trigger points active in the upper trapezius muscle at the top of the shoulder. It is also possible that prior chronic irritation of spinal facet joints is a factor in predisposing one to develop fibromyalgia.
Self-Help Treatment

  • Swimming. Low impact, regular exercise seems to be the key to managing fibromyalgia. Swimming is one of the best choices 3-5 days per week, working up to 30 minute sessions. Do not overdo exercise programs in the beginning stages, which is a common mistake that scares many patients away. Slowly increase duration and intensity of workouts in such a manner that the exercise does not aggravate your pain.
  • Yoga. The muscle and white connective tissue lengthening that occurs with Yoga is very beneficial for fibromyalgia symptoms. The breathing associated with Yoga helps oxygenate affected tissue and increase speed of healing and turnover time of new tissue cells.
  • Relaxation. A variety of breathing, relaxation and biofeedback techniques exist to help one cope with any type of chronic stress.
  • Massage. Gentle massage helps to sweep away toxins that build-up in irritated muscle and white connective tissue. The irritating chemicals, like lactic acid and histamines, can perpetuate inflammation and pain.

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