Guest guest Posted May 17, 2001 Report Share Posted May 17, 2001 [i know this is a bit old, but the info still stands, and is a good source to share with others.] Feeling More Pain.(fibromyalgia) --- It is easy to mistakenly think of fibromyalgia as a muscle disease. That is what is suggested by the name, the symptoms of widespread muscle pain, and a diagnosis based partly on people having painful tender points. But researchers say it is actually a disorder of pain perception, caused not by diseased muscles or even nerves in the muscles but changes in the central nervous system itself that lead to heightened, switched on pain. Dozens of experiments involving everything from hypnosis to ibuprofen have been done, but no single, sure-fire treatment has been found. Recently published overviews say the best treatment is a combination of medication, exercise, and cognitive-behavioral treatment counseling people on how to change their thought patterns about the condition. --- Diagnosis and causes --- Fibromyalgia (pronounced fie-bro-my-al-ja) has a long history under different names, but in 1990 the American College of Rheumatology came up with set criteria for classifying it: widespread pain and tenderness in 11 of 18 spots, or tender points, in the muscles of the neck, arm, back, hip, leg, and foot. Although this definition is widely cited and used, it was written principally for research purposes, not to diagnose individual patients. A history of chronic pain, fatigue, symptoms associated with sleep disturbance, and headaches can all add up to a diagnosis of fibromyalgia; the tender points help doctors validate a diagnosis based on these factors. Fibromyalgia is also a diagnosis by exclusion: it is not osteoarthritis (which affects joints), rheumatoid arthritis, or any other inflammatory disease. --- About 2% of the population have fibromyalgia, and it keeps rheumatologists busy: it is the second most common diagnosis in rheumatology clinics. Women are seven times more likely to have fibromyalgia than men, and older women are especially at risk: about 7% of women age 6079 are affected. Some researchers have shown that 10%12% of the general population have some sort of chronic pain. --- Fibromyalgia may be just the extreme end of a continuous spectrum of the chronic pain conditions that people endure. --- No one has found a discrete cause for fibromyalgia, though it has not been for want of trying. Muddying the cause-and-effect waters is the fact that fibromyalgia coincides with so many other conditions: 10%40% of people with lupus and 10%30% of people with rheumatoid arthritis have fibromyalgia. Lyme disease can be a trigger; fibromyalgia develops in 10%25% of Lyme disease patients even after the tick-borne bacterial infection has been treated with antibiotics. Major depression seems to be associated with fibromyalgia. A lifetime history of depression has been reported in 50%70% of people with fibromyalgia. Some of the symptoms are the same: the fatigue and sleep disturbances that afflict fibromyalgia patients are also experienced by many patients with depression. Yet several studies have shown that people with fibromyalgia are no more likely to have major depression than are people with rheumatoid arthritis, or healthy controls. Also, 50%70% of patients with fibromyalgia have a current or past diagnosis of chronic fatigue syndrome, irritable bowel syndrome, or migraine headaches. These syndromes overlap so extensively that it may be concluded that each represents different presentations of the same general condition, wrote Dr. Don L. Goldenberg, a researcher and clinician, in a review published in the April 26, 1999, Archives of Internal Medicine. --- All of these associations have spurred investigations into the shared root causes at the level of hormones, brain functioning, and neurotransmitters, the molecules that allow nerve and brain cells to communicate with one another. It has been shown, for example, that people with fibromyalgia have abnormal levels of various hormones, including low levels of human growth hormone. Because the pituitary glands production of human growth hormone peaks during deep sleep, the theory is that the sleep disturbances that plague patients may explain the hormone shortage. Sleep problems may also explain why they have low levels of serotonin, which is also produced during deep sleep. Low serotonin levels have been linked to depression as well as pain perception, through interactions in the spinal cord with a neurotransmitter called substance P. Recent studies have shown that people with fibromyalgia have three times as much substance P in the dorsal horn, the part of the spinal cord where the nerves that send pain signals from the body connect with the nerves that go to the brain. A brain imaging study of a small group of female patients showed lower than normal blood flows to the thalamus and the caudate nucleus, parts of the brain involved in processing pain signals. That processing involves inhibiting as well as receiving pain signals, so the lower blood flows may indicate that the brains of patients dont filter out pain as well as the brains of unaffected people. --- The central sensitization theory of chronic pain may also help explain fibromyalgia. The theory is that a powerful nerve impulse (particularly a pain impulse) from the body or impulses sent over and over again physically change the central nervous system, especially the nerves and nerve connections in the dorsal horn of the spinal cord. Levels of neurotransmitters like substance P rise. Nerve cells get physically altered so they are more easily excited by pain signals, or process normal touching sensations as if they were pain impulses. Whats particularly relevant to fibromyalgia is that animal studies have shown that pain impulses from muscles, as opposed to the skin, seem to be potent in causing these changes in the dorsal horn. A recent Israeli study of car accident victims documented that 22% of people who suffered whiplash had fibromyalgia a year later, compared to just 1% for those with a leg fracture. Pain impulses from neck muscles may be especially potent inducers of central sensitization. --- Treatment --- Doctors have found that effective treatment starts with giving people with fibromyalgia a firm diagnosis, but also making sure they stay active and follow as normal a routine as possible. Prolonged inactivity and disability just seem to worsen the prognosis. --- The search for helpful drugs has been frustrating. The tricyclic antidepressants, particularly Elavil (amitriptyline), have been studied extensively. They do seem to work for some patients, but their effectiveness also may wear off. Prozac (fluoxetine) and other drugs in the selective serotonin reuptake inhibitor (SSRI) family have not worked as well, though a study led by Goldenberg showed that taking fluoxetine in the morning and amitriptyline in the evening was moderately effective. Although pain relievers ease discomfort, clinical trials of the nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and aspirin have not shown them to be all that effective. --- Exercise, especially when it gets the heart working harder, seems to help patients more than simple stretching and relaxation. Unless they have a medical condition that keeps them from exercising, Dr. S. Wilke at the Cleveland Clinic recommends an exercise regime for fibromyalgia patients that includes three 20- to 30-minute sessions a week that will produce shortness of breath and perspiration. --- Helping patients cope with their condition and change their pessimistic thought patterns is the goal of cognitive-behavioral treatment and stress-reduction programs. Research into their effectiveness has produced mixed results. For example, a Dutch study published in the July 1996 Journal of Rheumatology showed no advantage to adding a structured cognitive component to a group education program. Yet research has shown that cognitive-behavioral therapy works for patients with other conditions that involve chronic pain. Besides being painful, fibromyalgia is a frustrating condition because it is so amorphous. The prognosis of fibromyalgia and related chronic pain conditions is often adversely affected by a patients understandably poor outlook on life. Hopelessness can set in. Cognitive-behavior therapy is one way to work on changing such beliefs. Doctors with expertise in treating fibromyalgia tend to recommend an all-fronts approach that includes medication, exercise, and some kind of cognitive-behavioral treatment. --- Fibromyalgia Overlaps with Other Conditions and Diseases* Primary Condition # of Patients with Percent Fibromyalgia/ # in the Study Lyme disease 22/278 8 Osteoarthritis 8/20 40 Repetitive strain 65/103 63 syndrome Rheumatoid arthritis 38/280 13.5 Systemic lupus 25/119 21 erythematosus Sjogrens syndrome 14/30 47 * Adapted from Ang and Wilke, Diagnosis, Etiology and Therapy of Fibromyalgia, Comprehensive Therapy April 1999; 25(4):221227. ---------------------------------------------- COPYRIGHT 1999 Harvard Health Publications Group in association with The Gale Group and LookSmart. COPYRIGHT 2000 Gale Group ---------------------------------------------- in Indy ''We are each of us Angels with only one wing and can only fly embracing each other.'' Quote Link to comment Share on other sites More sharing options...
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