Paging Dr. Frischer - Fibromyalgia

There are diseases that many doctors just love to avoid: they do not lend themselves to easy diagnosis. Neither blood tests, nor x-rays, nor special exams will help to identify them. For these types of illnesses, the doctor will ask a series of questions over time, and arrive at the diagnosis through a process of elimination. Even once the diagnosis is made, it is difficult to determine whether the patient is getting better or worse, since there is no objective way to measure such change! It is not a precise process; welcome to the "art of medicine." Here, then, is one such disease…fibromyalgia.Everyone seems to know someone who believes that they have fibromyalgia, and it may even be you. Fibromyalgia is a Greek word that literally means "pain in the muscles and fibers." It is a medical disorder characterized by chronic widespread pain with tender points in joints, muscles or tendons, and is especially unusual in that there may be exaggerated pain from normal touch. Fibromyalgia may mimic the pain of arthritic-type diseases, but these patients don't display the swelling, redness, joint destruction, or deformity of joints found with arthritis. They do describe a soft-tissue pain that is radiating, gnawing, shooting or burning, and ranges from mild to severe. Sufferers tend to wake up with body aches and stiffness. The tender points in fibromyalgia occur without even touching them, with pain radiating in all directions. For some, the pain tends to improve during the day and then increase at night. The pain can be continuous and unrelenting, and can get worse with activity, cold or damp weather, anxiety, and stress. Patients report: •bodyaches •chronic facial pain or aching •fatigue •irritable bowel syndrome •memory difficulties and cognitive problems •multiple tender areas (muscle and joint pain) on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, and knees •numbness and tingling •palpitations •reduced exercise tolerance •sleep disturbances •tension or migraine-type headaches There is a high likelihood of also having psychiatric conditions such as depression and anxiety, and stress-related disorders such as post-traumatic stress syndrome. Fibromyalgia may develop along with other musculoskeletal conditions like rheumatoid arthritis or lupus. It's possible that 2-4% of the population has it, with women outnumbering men 9:1. The formal diagnosis of fibromyalgia requires a history of at least three months of widespread pain, and pain with tenderness in at least 11 of 18 specific sites. These sites include fibrous tissue or muscles of the arms, elbows, buttocks, chest, knees, lower back, neck, rib cage, shoulders, and thighs. It is clearly a controversial disease, badly lacking in scientific consensus. The absence of physical or objective laboratory findings causes many physicians to not even believe it exists, or to chalk it up entirely to psychiatric problems. While the cause of fibromyalgia is unknown, physical and emotional trauma may play a role in its development. Some have theorized that the sleep disturbances so common in this disorder may actually be the cause. Another theory purports that the disorder may be associated with abnormal muscle metabolism caused by decreased blood flow, which then leads to chronic fatigue and weakness. Some propose that the disease is inherited. Others suggest an infectious cause, possibly from a virus. When little is known, theories appear. Treatment varies, depending on the severity of the symptoms. For mild symptoms, the pain may go away when stressors diminish or lifestyle changes are made. Further treatment involves medications, education, physical therapy, counseling, and support groups. Currently there are a few drugs approved for the treatment of fibromyalgia, including Lyrica, Cymbalta, and Savella. Anti-inflammatory medications, such as ibuprofen, naproxen, and a host of others, can help with pain, as does Neurontin, or even narcotics for severe pain. Antidepressants in low doses have been shown to decrease depression, decrease pain, improve sleep, and release pain-relieving endorphins. Fish oil, magnesium with malic acid, and vitamins have been beneficial. General good health measures including diet, stress reduction, and exercise are highly recommended. The course of the disease varies. It is common and it is chronic. Symptoms can improve, or may worsen and continue for months or years. In fact, the only comforting news is that there is no proof that fibromyalgia actually kills anyone. If you feel you may have symptoms suggestive of fibromyalgia, see your doctor. Good health to you all!

********** Published: May 14, 2010 - Volume 9 - Issue 4