Fibromyalgia

What is it!

   Fibromyalgia syndrome (or fibromyalgia) is a chronic disorder associated
with widespread muscle and soft tissue pain, tenderness, and fatigue. A person
with fibromyalgia will experience pain when up to 18 specific areas called are
pressed. Pushing carefully on these specific trigger points during an examination
causes discomfort or sharp pain.
    The cause of fibromyalgia is not known. Fibromyalgia has been recognized
as a medical disorder only since the 1980s, although there is evidence it may
have existed for centuries.
    The pain of fibromyalgia is more than normal muscle aches common after
physical exertion. Fibromyalgia often can be severe enough to disrupt a person's
daily work and activities.

Symptoms

   Symptoms and degree of discomfort can vary in individuals with fibromyalgia. Fibromyalgia may be diagnosed if you have: Widespread pain that has been
present for at least 3 months. To be considered "widespread," the pain must be
both above and below the waist and on both sides of the body.
   Pain at 11 or more of 18 specific points when the areas are pressed. It is now recognized that some people with fibromyalgia will have less than 11 tender/trigger
points but will have most of the other known symptoms. Widespread, chronic
muscle and joint pain is the most universal symptom in the diagnosis. The pain
usually develops gradually.
   Other symptoms that commonly occur with fibromyalgia include:,
         • Problems sleeping
         • Waking up feeling tired
         • Fatigue that interferes with daily living activities.
         • Morning stiffness
         • Anxiety or depression.
   Other symptoms that can occur but are less common include:
         • Constipation or diarrhea
         • Headache
         • Difficulty concentrating
         • Tingling sensation in the hands
                  (a condition that can occur with fibromyalgia).
   Because symptoms of fibromyalgia mimic so many other disorders, these often
must be eliminated before fibromyalgia can be properly diagnosed.
   Many people with fibromyalgia report that their muscle pain is made worse
by cold or damp weather, poor sleep, fatigue, stress, overexertion, and anxiety.
The skin may also be ultrasensitive, reacting to a firm touch with tingling,
numbness or a "pins and needles" sensation.

Treatment Overview

   Currently, there is no cure for fibromyalgia. Treatment is focused on managing
pain, fatigue, depression, and other symptoms common in fibromyalgia in an
attempt to break the cycle of increased sensitivity to pain and decreased physical activity.
   While there is no one standard medical treatment for fibromyalgia, the basic
goals of treatment are to:
         • Learn about fibromyalgia  
         • Start a program of physical exercise
         • Relieve sleep problems
         • Relieve pain and stiffness
         • Reduce stress and avoid other factors that worsen symptoms.
   Treatment may include:
         • Medications to help you sleep better
         • Medications to help relieve muscle and joint pain
         • Exercise therapy to help relieve sore muscles and increase energy.
    Improving sleep may also help with muscle and joint pain. Fibromyalgia can
affect mood and lead to depression or anxiety. These problems are common in
people with this disorder and may require specific treatment.
   Many people with fibromyalgia have other joint or muscle diseases (such as
rheumatoid arthritis or lupus) that need to be treated as well.
   Traditional medications include the use of trazadone or amitriptyline at bedtime to help with sleep as well as the use of non-steroidal anti-inflammatory drugs. Fibromyalgia is
not an inflammatory disease, but the non-steroidal drugs also have anti-pain properties that can be helpful in the fibromyalgia patients. Non-narcotic pain medications such as tramadol which are prescribed under the brand names of Ultram and Ultracet are also
helpful in pain relief in fibromyalgia patients. Stress, anxiety and depression are frequently associated symptoms in fibromyalgia patients. Stress management is important as is
regular exercise, but at times the class of medicines known as the selective serotonin
reuptake inhibitors may also be helpful. These include medicines such as Prozac, Zoloft, Paxil and Effexor. Other agents in this catagory that can be helpful include Lexapro,
Remeron and Wellbutrin. Medications used for neurogenic pain such as Neurontin are
frequently helpful in fibromyalgia patients. Holistic pain management approaches as
well as accupuncture is at times helpful.
 

What to Think About

   Although exercise seems to help most people with fibromyalgia, no one
particular treatment stands out as the most effective. The kind of treatment you
need or want may be based on:
         • The severity of your symptoms
         • Whether the condition is disrupting your daily life
         • What kinds of changes in your life you are willing and able to make.
   Because the symptoms of fibromyalgia can come and go, you may find it difficult
to judge whether a particular treatment is really working. Different people may respond differently to each type of treatment.
   It may take time and you may have to try several different treatments to find an approach that works for you.

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