Fibromyalgia

Imagine a severe case of "the blahs" combined with all over achiness. It just won't go away. In fact, the aches turn into outright pains with any type of exertion. As time passes, "the blahs" get worse and turn into a mixture of depression and exhaustion. Headaches and stomachaches develop, and the patient is tempted to spend all day in bed. Their life falls apart.

Welcome to the nightmare of fibromyalgia: a disease with no definitive cause, symptoms, tests, or treatments. The condition affects 3 to 7 million Americans, most commonly in women between 20-40 years old. The symptoms often overlap with those of other conditions: migraines and other headaches, depression, arthritis, irritable bowel syndrome, chronic fatigue syndrome, and sleep disorders. It is not clear if these conditions tend to co-exist with fibromyalgia, are caused by fibromyalgia, or if fibromyalgia and these conditions appear similar.

Unknown Cause
The cause of fibromyalgia is unknown. There is evidence that the cause may be related to abnormal functioning of the endocrine (hormonal) system and the autonomic nervous system. It is also thought that genetic factors may play a role. Some researchers suspect abnormalities in muscle tissue, whereas others propose a viral cause. A variety of factors seem to trigger the illness in susceptible individuals. These triggers include viral illnesses, trauma, chronic sleep disturbance, and emotional distress.

Diagnosis
The formal criteria of the American College of Rheumatology require that tenderness be present in at least eleven of eighteen classic sites. However in our experience, atypical cases are fairly common so these criteria should be considered guidelines rather than strict criteria. The condition should be diagnosed by an experienced clinician who will look for a constellation of symptoms together with the multiple areas of muscle tenderness. There are no tests available to diagnose fibromyalgia, but a careful examination and laboratory testing can help to rule out other diseases.

Treatment
Treatment can enormously improve the patient's quality of life. Our Pain Clinic follows the strategy of using multidisciplinary interventions. Various medications have been reported to be helpful, and often it is best to use combinations of medicines. Antidepressant medications appear to help with the symptoms of pain, sleep disturbance, fatigue, and depression. Anti-inflammatory and muscle relaxant medicines may help reduce the pain and stiffness. Research results using oral interferon are encouraging. And research is being done which demonstrates the benefits of medications which block nerve receptors known as NMDA receptors. Our clinic has pioneered the use of one such medicine, Amantadine, with promising results.

Exercise appears to be a crucial, albeit difficult, part of the treatment. Patients with fibromyalgia are extremely sensitive to activity and exertion and can experience flares of pain with minimal exercise. Yet, if the patient is to resume any normal function and quality of life, it is crucial for the patient to build tolerance to activity. When done slowly and properly, exercise can have tremendous therapeutic benefit. Besides traditional physical therapy, we have found that tailored programs of pool therapy and Tai Chi exercises can be very helpful. Crucial elements for overcoming the pain, debilitation, loss, and depression that accompany fibromyalgia are the psychological therapies including biofeedback, relaxation training, stress management and cognitive-behavioral therapy. Occupational therapy can be very useful with helping a patient to learn how to pace and manage daily activities.

There is help
No single fibromyalgia treatment is curative; therefore, ineffective and even fraudulent treatments abound. Patients are also frequently told that there is no treatment; however, good treatment does exist. Skillful multidisciplinary care with medications, exercise, and stress management can help to control the symptoms and to improve the quality of life. The good news is that research is slowly improving our knowledge and understanding of fibromyalgia.

Until next time…Steven Richeimer, M.D.

Copyright © 2000, Steven Richeimer, MD.
You may reach The Richeimer Pain Institute at www.helpforpain.com