Fw: Managing with Fibromyalgia

[Guest guest]

Managing with Fibromyalgia Q: I am a white female in my mid 30's. After many years of suffering from chronic muscle and joint pain, weakness and fatigue, headaches, and sleep disturbances, I have been diagnosed with fibromyalgia. My Rheumatologist suggests that this is something chronic with ups and downs and that the best thing I can do is to try to exercise, avoid stress, eat well, avoid alcohol and give into it and just do nothing when all else fails. He also suggested the possible use of anti-depressants at night to help with sleep, if this becomes a major problem. Apparently there is no known cause or cure. Can you give any suggestions on managing it and discuss this disease? A: The constellation of complaints that you describe is a near textbook definition of fibromyalgia. Absent only is the mention of areas of reproducible pain with deep pressure located near the base of the skull, elbows, knees, and buttocks called trigger points or tender points. Beyond this characteristic, there are no blood tests or X-rays or any other tests to confirm this diagnosis. As a result, physicians label this a "diagnosis of exclusion" meaning that tests for other diseases with similar symptoms have been done and are negative. To a great degree, this is good news as the diseases for which there are positive tests are often life-long and crippling. Fibromyalgia may be a chronic and persistent discussion that in some cases will improve. It can also coexist with chronic fatigue syndrome, making the combination particularly problematic. Disturbed sleep either as a result of the syndrome or as one of its characteristics may further blunt any attempt at successful management. The recommendations you have been given are standard and yet must seem confusing. You're tired and feeling weak and yet being told to exercise. Studies have been done looking for evidence for major psychological disorders in people with either chronic fatigue syndrome or fibromyalgia. No relationships have been found that would support such a link. Yet due the debilitating nature of both, it is not unusual to experience depressive symptoms. Antidepressants in low doses can be helpful to improve sleep quality and are safe for long term use. They are also helpful in reducing pain and increasing function. Beyond this, there are no other proven drug therapies. Some researchers were looking at the value of using the combination of phenteramine and fenfluramine (phen/fen) but as these drugs have been withdrawn by their manufacturers. What promise they may have had will never be known. There are many alternative treatments available as well but their benefits are unproven at this time. I often find that the lives of many of my own patients with either of these problems are often in varying degrees of disarray. Elements of anger or resentment towards friends or family, unresolved grief, or just disappointment with life in general seem to be recurrent themes. One could argue that these syndromes are the cause but, as a last resort, I would suggest you take an inventory of your life. What are your goals and objectives and if written, have you met them? What are the relationships of significance in your life and are they healthy and affirming? How much of your peace and contentment is generated from within and how much do rely on others for your own happiness? The answers to these questions may be revealing and open the door to the kind of healing that to date has been unattainable.