Fw: Fibromyalgia: A Multi Disciplinary Approach and Drugs for Treatment

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From: " Ilena Rose " <ilena@...>

Sent: Thursday, September 06, 2001 1:07 AM

Subject: Fibromyalgia: A Multi Disciplinary Approach and Drugs for Treatment

> http://www.immunesupport.com/library/showarticle.cfm?ID=3089

>

> Fibromyalgia: A Multi Disciplinary Approach and Drugs for Treatment

>

>

> ImmuneSupport.com

> 09-05-2001 Stuart L. Silverman MD FACP FACR,

> Clinical Prof Med Rheum UCLA/Cedars Sinai

>

> These two articles appeared in the syllabus of the FAME 2001 Conference

> and are used with permission of the conference organizers.

>

> General measures for all patients with fibromyalgia include education as

> to the nature of the disorder and what to expect from treatment,

> instruction in stress management, coping skills, development of an

> individual program for flare management, development of a regular exercise

> program and a daily stretching program. Aquatic therapy if available may

> be preferred by many patients to land therapy.

>

> Social support is also needed. Patient support groups in the community may

> be helpful for some individuals. Patients wit fibromyalgia often state

> that their friends or family do not believe their diagnosis. Not all

> physicians may be supportive of patients with a diagnosis of fibromyalgia.

>

>

> When available, a team approach is suggested for patients with difficult

> symptoms, fibromyalgia of long duration, cognitive dysfunction,

> significant anxiety or depression, significant functional loss or narcotic

> dependency. Our core fibromyalgia team at Cedars Sinai Medical Center,

> which has been in existence for over 8 years consists of an occupational

> therapist who also teaches sleep hygiene, a physical therapist, a

> psychologist trained in cognitive behavioral therapy, EMG/Biofeedback

> specialist and a rheumatologist.

>

> We also use at times a nutritionist, a complementary medicine physician,

> social worker, vocational rehab specialist and a neuropsychologist. A

> physician can create his or her own team, using health care providers in

> the community who have been educated in the specific needs of the

> fibromyalgia patient (physical therapy for a patient with FM is often at a

> slower pace than cardiac rehab).

>

> The Pharmacologic Approach to Fibromyalgia: Using drugs effectively in the

> treatment of fibromyalgia

>

> Pain, fatigue, sleep disorders, irritable bowel, cognitive dysfunction and

> associated anxiety and depression are among the symptoms of fibromyalgia

> that may be responsive to drug therapy.

>

> Peripherally acting analgesics such as COX2, NSAIDs, centrally acting

> analgesics such as tramadol, antidepressants, anticonvulsants such as

> gabapentin, and muscle relaxants e.g. tizanidine may help relieve pain.

> Opioid analgesics may be helpful in a small number of patients but are

> usually best avoided.

>

> Local barriers may need to be treated with selective trigger point

> injection. Sleep disorders may respond to improved sleep hygiene, herbal

> sleep aids, low dose antidepressants, gabapentin, nonbenzodiazepine

> hypnotics such as zolpidem, or assessed for bacterial overgrowth and given

> appropriate antibiotic treatment.

>

> Cognitive dysfunction will often respond to improved sleep and treatment

> of depression. However a few patients may benefit from nimodipine.

> Depression and anxiety can be managed with antidepressants and anxiolytic

> therapy. All patients should also be treated with general measures of

> education, stress management, daily stretching and regular exercise. Other

> concomitant problems that may respond to appropriate medications include

> migraine and urethral syndrome.

>

> Since patients with fibromyalgia have multiple symptoms, polypharmacy is

> common. Low doses are preferred as patients with fibromyalgia may be very

> sensitive to medication. Medications may lose effectiveness with time.

> There are potential problems with medications including interactions and

> side effects. Herbal medications may be helpful in some patients for some

> symptoms.

>

>

>