Guest guest Posted February 19, 2010 Report Share Posted February 19, 2010 Fibromyalgia and HCV ? Affecting millions of Americans, fibromyalgia is a chronic condition causing fatigue, stiffness, and tenderness of the muscles, tendons, and joints. .. .. Also See : Video Feb 04 2010/ FibromyalgiaWhat is fibromyalgia?Fibromyalgia (formerly fibrositis) is a syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. It is also characterized by restless sleep, awakening tired, fatigue, anxiety, depression, and disturbances in bowel function. The condition is non-life-threatening and does not cause body damage or deformity. It affects an estimated 3-6 million Americans. .. .. What does the name fibromyalgia mean?The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek terms for muscle (myo) and pain (algia). Is fibromyalgia a form of arthritis?Fibromyalgia is considered a muscle condition. It is not a form of arthritis (a disease of the joints) because it does not cause inflammation in the joints. But fibromyalgia can (like arthritis) cause significant pain and fatigue, and it can similarly interfere with a person's ability to carry on daily activities.Who is affected by fibromyalgia?Fibromyalgia predominantly affects women (more than 80%) between the ages of 35 and 55. Less commonly, fibromyalgia affects men, children, and the elderly. It can occur independently or can be associated with another rheumatic disease, such as systemic lupus or rheumatoid arthritis. . What causes fibromyalgia?While there is no known cause for fibromyalgia, recent research has revealed new facts about the disease. Fibromyalgia patients have elevated levels of the nerve chemical signal substance P and nerve growth factor in their spinal fluid. They tend to have low levels of the brain nerve chemical serotonin and impaired non-rapid eye movement (non-REM) sleep phase (which likely explains the common feature of awakening fatigued and unrefreshed).What are symptoms of fibromyalgia?Fibromyalgia is not always easy to diagnose because symptoms vary from person to person. Many of the symptoms mimic those of other disorders and there are no visible signs of the disorder. There is also no definitive laboratory test for fibromyalgia. . .. .. The universal symptom of fibromyalgia is pain.As mentioned earlier, the pain in fibromyalgia is not caused by tissue inflammation. Instead, patients seem to have an increased sensitivity to many different sensory stimuli. The result is an unusually low pain threshold. The pain is generally widespread, involving both sides of the body and commonly affecting the neck, buttocks, shoulders, arms, the upper back, and the chest.Additional factors can increase fibromyalgia pain.The pain of fibromyalgia can sometimes be further aggravated by sensory stressors such as noise, weather change, bright lights, and emotional stress.Fatigue occurs in approximately 90% of fibromyalgia patients.Normally, there are several levels of sleep depth. Getting enough of the deeper levels of sleep can be more important in refreshing a person than the total number of hours of sleep. Patients with fibromyalgia lack the deep, restorative level of sleep, called 'non-rapid eye movement' (non-REM) sleep. Consequently, patients often awaken in the morning without feeling fully rested. Some patients awaken with muscle aches or a sensation of muscle fatigue as if they had been 'working out' all night!More than half of fibromyalgia patients experience mental and/or emotional disturbances.These include poor concentration, forgetfulness, mood changes, irritability, depression, and anxiety. Because a firm diagnosis of fibromyalgia is difficult and no confirmatory laboratory tests are available, patients with fibromyalgia are often misdiagnosed as having depression as their primary problem.What are additional symptoms of fibromyalgia?Other symptoms include migraine and tension headaches, numbness or tingling of different body parts, abdominal pain related to irritable bowel syndrome (IBS), and irritable bladder, causing painful and frequent urination. .. .. How is fibromyalgia diagnosed?There is no specific test to determine whether someone has fibromyalgia. Therefore, the diagnosis of fibromyalgia is made on clinical grounds based on the doctor's history and physical examination. When it comes to pain, diagnosis can be made by identifying sensitive pain 'tender points' or 'trigger points' on the body. Pain is often present for longer than three months, and there are frequently 'tender points' as shown above. .. .. Additional exams and tests.Many medical conditions can cause pain in different areas of the body, mimicking fibromyalgia. Therefore, doctors may perform blood tests and X-rays to rule out other diseases and conditions.What is the treatment for fibromyalgia?Although there is no cure for fibromyalgia, treatment can relieve the symptoms. Because symptoms vary among patients, treatment programs must be individualized for each patient. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Ultimately, the physician, the physical therapist, and the patient may all play an active role in the management of fibromyalgia.Patient education.Patient education is an important first step in understanding and coping with the diverse symptoms of fibromyalgia. Community hospital support groups and the local chapters of the Arthritis Foundation have become important educational resources for patients.Stress reduction.The effects of stress vary from person to person. Therefore, stress reduction in the treatment of fibromyalgia must be individualized. This might include simple stress modification at home or work, biofeedback, relaxation tapes, psychological counseling, and/or support among family members, friends, and doctors. Sometimes, changes in environmental factors (such as noise, temperature, and weather exposure) can be helpful.Exercise.For muscle pain, it can be helpful to regularly perform low-impact exercise. Keeping muscles conditioned and healthy by exercising three times a week decreases the amount of discomfort. It is important to try low-stress exercises such as walking, swimming, water aerobics, and biking. Besides helping with tenderness, regular exercises can also boost energy levels and help with sleep.Medications.Today, Lyrica (pregabalin), Cymbalta (duloxetine), and Savella (milnacipran hydrochloride) are the only three drugs approved by the U.S. FDA for the treatment of fibromyalgia. Lyrica is an antiseizure medication, while Cymbalta and Savella are antidepressants. All three have been shown to reduce the pain of fibromyalgia.Traditionally, the treatment of fibromyalgia have been the tricyclic antidepressants such as amitriptyline (Elavil) and doxepin (Sinequan). Typically used in treating depression, they appear to reduce fatigue, relieve muscle pain, and promote deep, restorative sleep. Studies also show that adding fluoxetine (Prozac) further reduces pain, anxiety, and depression. Over-the-counter pain medications such as acetaminophen (Tylenol), aspirin, ibuprofen (Advil), and naproxen (Aleve) can also be helpful. .. .. Other medications.Local injections of analgesics and/or cortisone medication into the trigger-point areas can also be helpful in relieving painful soft tissues, while breaking cycles of pain and muscle spasm. Narcotic pain relievers are typically avoided in fibromyalgia patients because they have not been shown to be beneficial and have potential adverse side effects, including dependency, when used long term. .. .. Alternative treatmentsOther treatments and therapies used in helping patients cope with fibromyalgia include massage, acupuncture, acupressure, chiropractic care, diet and nutritional supplements, herbal remedies, and mind-body therapies (meditation, guided imagery, hypnosis). http://www.medicinenet.com/fibromyalgia_pictures_slideshow/article.htm ___________________________________ Hepatitis C and Fibromyalgia: The Possible Link Learn about the potential connection between Hepatitis C and fibromyalgia, and find out why it is possible that Hepatitis C infection may act as a trigger for fibromyalgia syndrome. If you suspect having both conditions, awareness of this link can lead you to seek the expert evaluation and care that may help reduce your symptoms of pain and fatigue. by Cutler, L.Ac. Due to overwhelming empirical evidence, some medical circles believe that the symptoms and presenting patterns shared between Hepatitis C and fibromyalgia are beyond coincidental. While Hepatitis C is known to be transmitted through infected blood, authorities are still debating how fibromyalgia is acquired. Due to similarities in manifestation and physiology, there is a possibility that Hepatitis C infection may be one of fibromyalgia syndrome’s triggers. If you suspect having both conditions, awareness of this link can lead you to seek the specialized evaluation and care that may improve your most frustrating symptoms. PrevalenceEstimates of disease prevalence in the United States approximate the number of people living with fibromyalgia to be around 6 million people, while the number of people known to be living with Hepatitis C hovers just above 4 million. While accurate statistics of the number of people affected by both diagnoses are not currently available, a surprising number of people dually diagnosed with Hepatitis C and fibromyalgia are emerging. However, one study did find the prevalence of fibromyalgia in people with Hepatitis C (15 to 19 percent) to be much higher than the occurrence of fibromyalgia in the general American population (2 percent). FibromyalgiaFibromyalgia is a syndrome causing widespread muscle pain, extreme fatigue and multiple tender points in specific parts of the body. With pain characterized as aching, burning, stabbing and throbbing, its severity can vary widely. While fibromyalgia is a chronic condition, it is not a progressive disease. However, this condition can greatly reduce the quality of life of those affected. Experts do not agree on what causes fibromyalgia. When trying to determine the etiology of this complex syndrome, it is challenging to discern between cause and effect. The endless cycle of pain, inactivity, insomnia, fatigue and depression typical of fibromyalgia complicates the isolation needed to trace this syndrome’s origins. Although researchers have identified several possible reasons for fibromyalgia, it remains unclear if they are a cause, or part of the problem. Some of the leading contenders for what triggers fibromyalgia include: · Hormone Imbalance· Infectious Disease· Immune System Malfunction· Sleep Disorder· Traumatic Event· Muscle Abnormality The Hepatitis C ConnectionAlthough not yet confirmed, many experts believe that Hepatitis C may act as a trigger to the onset of fibromyalgia. .. The documented links between the two conditions include: · Symptom Specificity – Fibromyalgia and chronic Hepatitis C infection share many clinical features including musculoskeletal pain and fatigue. While the two conditions do not always accompany each other, some symptoms may be unique when a person has both fibromyalgia and Hepatitis C. One study found that people dually diagnosed with fibromyalgia and Hepatitis C exhibit symptoms such as inflammation around a joint, bursa and/or tendon, and vasculitis (blood or lymph vessel inflammation) that are not seen in Hepatitis C negative people with fibromyalgia. · Immune Proteins – Cytokines are proteins that regulate immune response. Interleukins are a specific type of cytokine that cause a person to feel pain. Several interleukins have been found to be dramatically elevated in fibromyalgia patients. Harvard researchers found those same interleukins increased in production when exposed to the Hepatitis C virus. · Hepatitis C and Pain – Many people infected with Hepatitis C virus infection complain of myalgias, arthritis and widespread pain. When compared to other liver diseases, the frequency of musculoskeletal pain clearly favors Hepatitis C. The frequencies of musculoskeletal pain for the following isolated conditions are as follows: Alcoholic liver disease = 48 percent, Hepatitis B = 59 percent and Hepatitis C = 91 percent. As fibromyalgia’s most prominent symptom, it is not surprising that musculoskeletal pain may represent the link to Hepatitis C. Infectious CauseCertain infections, notably viruses, often occur in the histories of people with fibromyalgia. As these infectious organisms invade the body, scientists think they may cause damage at a cellular level. While fibromyalgia is considered to be non-contagious, it is possible that it may be a manifestation of a viral disease such as Hepatitis C, which is contagious. While many infectious microorganisms have been tied to fibromyalgia, the link with Hepatitis C is becoming increasingly suspect. At this point, there is sufficient evidence linking infectious diseases and fibromyalgia together, but it is unknown if any of these microorganisms are fibromyalgia’s origin, a simultaneous condition or a result. Why it Is ImportantA high prevalence of fibromyalgia has been found in patients infected with Hepatitis C, especially women. According to Israeli researchers, recognizing fibromyalgia in people with Hepatitis C will prevent misinterpretation of fibromyalgia symptoms as part of the liver disease and enable physicians to correctly focus on alleviating these symptoms.A doctor well versed in fibromyalgia should be consulted if this syndrome is suspected. Because its diagnosis is not simple and symptoms often overlap with other conditions, a proper evaluation will test for fibromyalgia while ruling out other diseases. Doctors who are familiar with fibromyalgia typically make a diagnosis based on criteria established by the American College of Rheumatology (ACR). .. Those criteria are: 1. Widespread pain (right and left side body pain, above and below the waist) that lasts for more than 3 months. 2. Eleven or more tender points present at 18 specific sites on the body.Whenever there is a profound crossover in a disease’s symptoms, we can learn from their parallels. Although many questions shroud the connection between fibromyalgia and Hepatitis C, their relationship exists in many people with either condition. With their comparable symptoms, similar immune biochemistry and irrefutable statistics of simultaneous presentation, exposure to the Hepatitis C virus may be one of fibromyalgia’s triggers. Understanding this connection may prompt a person with fibromyalgia to get tested for Hepatitis C or it may help a person with Hepatitis C seek evaluation for fibromyalgia. If you think you might be burdened with both conditions, discuss your thoughts with your primary healthcare provider. By taking this proactive stance, you may open yourself up to new ways of reducing Hepatitis C’s challenging symptoms of pain and fatigue http://www.hepatitis-central.com/mt/archives/2009/01/hepatitis_c_and_12.html .. .. ___________________________________ .. The Mysterious Condition of FibromyalgiaDescription: It sneaks in unannounced and makes itself completely at home. It affects every aspect of life, turning days into challenges. This unwelcome arrival frequently manages to hide so it is almost invisible, yet it shows little sign of leaving. This is fibromyalgia (FM), often referred to as “fibro,†and it affects millions of Americans every year. The vast majority of those afflicted, an estimated 95 percent, are women. Ask some physicians to explain fibromyalgia, and they will tell you it is a condition that exists in the minds of hysterical females; others will claim it is an unidentified health problem that requires additional sleep and an occasional pain reliever. A growing number of medical professionals, however, will tell you what the American College of Rheumatology (ACR) determined in 1990. They would confirm it is an actual medical syndrome that affects all four body quadrants, causes widespread pain for at least three months, and involves at least 11 “tender points†among 18 sites on the body. The sites are overly sensitive to stimuli that typically would not cause pain. Fibromyalgia is a real condition creating real problems for people of all ages and ethnic backgrounds and can be experienced concurrently with hepatitis B and C. Viral infections often appear in the medical backgrounds of those suffering from fibromyalgia. It is not known how the occurrence of a viral disease, such as hepatitis, is specifically linked to the condition. Studies have explored various potential triggers of the syndrome, including trauma, stress and hepatitis infections. For example, research findings published in a 2005 study suggested having chronic hepatitis B appeared to increase the risk of FM and its associated symptoms.According to the ACR, the American Medical Association, the National Institutes of Health, the Food and Drug Administration (FDA), and the American Pain Society, this condition is real. So why does it take an average of five years for a patient to get an accurate diagnosis? .. Unfortunately, as powerful as fibromyalgia can be, it is just as elusive. It does not show up on a blood test or X-ray. It doesn’t have a defining hallmark of symptoms but has generalized ones that can fit the parameters of other conditions. “Fibromyalgia has no specific physical abnormalities to see, just elevated tenderness,†explains Dr. Philip Mease, director of Rheumatology Research at the Swedish Medical Center in Seattle, Washington.Dr. Teitelbaum, medical director of Fibromyalgia and Fatigue Centers and author of “From Fatigued to Fantastic,†adds that there is no fancy test for the condition. “Doctors will say it doesn’t exist,†he notes. “If your physician tells you this, just say ‘goodbye,’ and walk out the door. You don’t want a doctor you have to educate.â€Head to ToeThe name fibromyalgia means pain in the muscle fibers. .. From mild annoyances to completely debilitating, the pain element only paints a limited picture of this pervasive condition. There are numerous other common complaints associated with fibro. (See Common Complaints.)A thorough medical history is the best way to discover most of these issues, although some doctors will order thyroid panels and complete blood counts to look for abnormal numbers. Dr. Braverman, director of the Place for Achieving Total Health, has been working with fibro patients for more than 20 years. .. “Technology has come a long way, so we have more effective ways of finding and treating fibro,†he says. “There have been more cases of fibromyalgia in recent years because of lack of health care in the U.S. Many people are finding they can’t visit their doctors as often so it goes untreated.â€Any combination of these symptoms can play havoc with a person’s life, not only physically, but also emotionally, socially and mentally. As Teitelbaum describes it, “Imagine you’re a busy mother of several children and suddenly you experience brain fog, so people see you as dumb. .. You gain the typical 32.5 pounds, your libido drops the typical 73 percent, you have no energy and you feel like you have a toothache throughout your entire body. Your medical tests come back normal—so now your friends, family and doctors think you’re crazy.â€Braverman agrees. “Physically, the pain can be excruciating and force a person to the confinement of their beds. Mentally, fibro has been proven to cause depression due to the pain and anguish that people experience. Socially, it definitely has an effect. Many people find that they cannot go out as much as before, to run errands, go to dinner, or attend social gatherings. It is an all-encompassing disease.â€Searching for an Answer, a former education student and now author of a children’s book called “ny the Phoenix†knows this feeling. He was diagnosed with the condition in 2006, after searching for an answer for two years. .. Constant headaches had resulted in four sinus surgeries and a battery of neurological tests. Nothing helped. Then a friend handed him a book about fibromyalgia. After a sleep study that showed apnea, he went to a new doctor and was diagnosed immediately. A husband and father, ’s days often depend on the weather. “I find that barometric pressure has a large impact, as well as extreme heat and cold,†he says. “I get as much sleep as possible, usually over nine hours. I look ahead to what needs to be done, and I try to use no more than 90 percent of the energy that I have available. .. It is a very frustrating disease, because there is no way to plan for good or bad days.â€Today, is on disability because it is impossible for him to work. “If you find that you have severe fibro as I do, fight for your disability,†he advises. “Sit down and take stock of what you have left. .. For me, it is my ability to tell stories, so I write. Just because you have fibromyalgia doesn’t mean that your life has ended. It simply means you need to go to your back-up abilities.â€To Make Matters WorseJust as the condition does not have a definitive test, it does not have a distinct cause or treatment either. Over 150 clinical trials are being conducted at any one time trying to determine the answers. So far, researchers have proposed that fibromyalgia may be an abnormality in brain chemicals. An imbalance in neurotransmitters, such as norepinephrine, serotonin and dopamine, directly affects how pain is experienced and how it is blocked.“A person with fibro is like a house with a thermostat that is off kilter,†explains Mease. .. “There is an alteration in sensory processing in the individual. There is an excess of sensory input and a deficiency in the body’s ability to inhibit or block it. Too much comes in and not enough protects it.â€Teitelbaum compares it to an energy crisis. “With fibro, the body blows a fuse,†he explains. “And that fuse is the hypothalamus.†Other theories are that fibro is a genetic condition (it tends to run in families) or that it comes along as a “fellow traveler†as Mease calls it, with other infectious or autoimmune diseases, such as hepatitis.Regardless of the cause, what many patients want most, once they have their diagnosis, is help. Unfortunately, treatment is as complex an issue as the condition itself. .. Patients may take a variety of medications designed to battle specific symptoms, including pills to combat pain, diarrhea, and depression. They may need pills to increase energy or sleep at night. Prescription costs easily run into the hundreds or even thousands of dollars. The FDA has approved several drugs for the condition including milnacipran (Savella®), duloxetine (Cymbalta®) and pregabalin (Lyrica®). As with most medications, however, there are side effects to consider. Other possible treatments include massage, acupuncture, chiropractic care and heat applications. Some fibro patients also have had trigger point (spots that are tender to palpation) injections in which an anesthetic is injected into the muscle, which is then gently stretched. .. The problem with this method is that the injections are usually quite painful, and it can take days for the patient to feel relief.Teitelbaum recommends treatment through what he calls the SHINE Protocol. “Ninety-one percent of fibro patients show improvement after following these steps,†he says.In the protocol, “S†stands for sleep. “It’s essential that the body gets at least eight hours of sleep, even if it means helping it by using herbs, medication or other techniques,†explains Teitelbaum.“H†stands for hormonal support, as in taking supplements to support the thyroid and adrenal glands. “I†stands for infection because fibro patients often deal with a variety of infections. “N†stands for nutritional support, indicating the importance of a healthy diet, and “E†stands for exercising as able. While exercise typically helps, it is hard to do when dealing with intense exhaustion and muscles that are already complaining. Cutting off SleevesLee’s life hasn’t been easy for some time. After a full life as an educator and syndicated newspaper columnist, he began to experience health problems. In 1990, he was diagnosed with multiple sclerosis. Later, he developed several types of arthritis. Everything got worse in 1995 when a speeding semi-truck loaded with a payload of stone broadsided him, burying him under 75 tons of rubble. .. “The police thought I was dead,†he admits. He almost was. It took six hours to extricate him. He spent a month in intensive care and six months in the hospital. When he appeared in the courtroom, he was still in a wheelchair and hooked up to an IV. “I was so out of it, I had no idea what was even going on. I got absolutely nothing.â€It wasn’t until 2004 that Lee was diagnosed with fibro. Amazingly, after all his health problems, it is fibro that has had the most profound effect on his life. “This pain supersedes everything else,†he states. “There are spots on my arms that hurt so much I have had to cut off all the sleeves on my shirts. I can’t stand the touch of the fabric.â€Not much makes Lee feel better. He uses a massage pad in his chair but says he has to put several towels or blankets between the rollers and his skin or he can’t stand the pressure. .. Each month Lee’s medications cost $3,000. After being unemployed for more than 14 years, this is money he simply does not have so he stopped taking most of the medication.“Each night I plan to do things the next day, but then it gets here, and I just can’t shake the exhaustion,†he explains. “I try to go out, but I can’t . . . often for days or even weeks on end. Fibromyalgia saps all my energy.â€Lee lives alone and depends on his friends and daughter to stop by and help with chores. He spends a great deal of time in bed. .. “Mentally, there is so much I want to do,†he says, “but physically, it isn’t possible.â€Fibromyalgia is an unwelcome visitor that creeps in the body. It brings pain, fatigue, fog, and insomnia. Noticing it doesn’t take long; identifying it can take what seems like forever. Treatment is often a hit and miss process. Eviction is rarely possible, but sometimes, with a skillful doctor and appropriate treatments, a truce can reached.. .. http://www.liverhealthtoday.org/ ___________________________________ AAPM: Help for Pain and Mood in Fibromyalgia Feb 7 2010SAN ANTONIO -- Patients with fibromyalgia and comorbid depression had significant improvement in both conditions when treated with duloxetine (Cymbalta), according to pooled data from four clinical trials presented here at the American Academy of Pain Medicine meeting.The magnitude of improvement in pain was consistent across all severity levels of depression. Conversely, patient mood improved to a similar extent across the range of pain severity.Analysis of treatment effect showed that 60% to 70% of the benefit for pain and mood resulted from a direct effect of the drug. The remaining 30% to 40% of improvement arose from an indirect effect."Improvement in pain and improvement in major depressive disorder are positively correlated," B. Marangell, MD, of Eli Lilly & Co. in Indianapolis, and colleagues reported in a poster presentation."Improvement in pain reflected greater direct treatment effect with an indirect effect of improved mood, indicating that the improvement seen with duloxetine in fibromyalgia is not solely a mood effect. Improvement in mood was found to reflect a greater direct treatment effect, with an indirect effect of pain improvement.""These data support the independent analgesic properties of duloxetine in the treatment of fibromyalgia."As many as a third of patients with fibromyalgia have comorbid major depression, and as many as 70% have a history of major depression. Sorting out the association between the two conditions is complicated by the fact that the pain can obscure the depression and lead to underdiagnosis and undertreatment, the researchers wrote.On the other hand, major depression can intensify as pain interferes with daily activities, and comorbid depression can lead to increased pain complaints, intensity, and duration among patients with fibromyalgia, they noted.In an effort to clarify the clinical course of patients with both conditions, Marangell and colleagues analyzed data from four placebo-controlled clinical trials of duloxetine in patients with fibromyalgia. They limited the analysis to patients who had comorbid major depression at enrollment and who received 60 to 120 mg of duloxetine.The investigators performed two path analyses to determine the direct and indirect treatment effects on pain and on depression.The study involved 350 patients with fibromyalgia and comorbid depression, 147 randomized to placebo, and 203 to duloxetine. Baseline characteristics included a median Hamilton depression (HAMD) score of 15 and a Brief Pain Inventory (BPI) average of 6 to 7.The analysis showed that about half of the patients with a HAMD score above or below the median had ≥30% improvement in pain score.Moreover, 35% to 40% of patients treated with duloxetine had ≥50% improvement in pain score whether they had a low (HAMD <15)> Iyengar S, et al "Fibromyalgia and comorbid major depressive disorder: Assessment of mood and pain response to duloxetine hydrochloride compared to placebo" AAPM 2010; Abstract 121. http://www.medpagetoday.com/MeetingCoverage/AAPM/ http://Hepatitis Cnewdrugs.blogspot.com/2010/02/fibromyalgia-and-hcv.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 8, 2010 Report Share Posted April 8, 2010 I was just formally diagnosed with this not 30 minutes ago. New doctor.... fresh set of eyes looking at some old problems. He told me that Hep C causes Fibromyalgia a great deal of the time. I have a new Doc and will be adding to my list of new docs as we are replacing everybody but my liver doctor.TeriFrom: Christ <ludichrist2000@...>009 - VCHepC <VCHepC >; Hepatitis C <Hepatitis C >; WebWarriors grp < >Sent: Thu, April 8, 2010 5:06:57 PMSubject: [ ] Fibromyalgia and HCV ? Fibromyalgia and HCV ? Affecting millions of Americans, fibromyalgia is a chronic condition causing fatigue, stiffness, and tenderness of the muscles, tendons, and joints. .. .. Also See : Video Feb 04 2010/ FibromyalgiaWhat is fibromyalgia?Fibromyalgia (formerly fibrositis) is a syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. It is also characterized by restless sleep, awakening tired, fatigue, anxiety, depression, and disturbances in bowel function. The condition is non-life-threatenin g and does not cause body damage or deformity. It affects an estimated 3-6 million Americans. .. .. What does the name fibromyalgia mean?The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek terms for muscle (myo) and pain (algia). Is fibromyalgia a form of arthritis?Fibromyalgia is considered a muscle condition. It is not a form of arthritis (a disease of the joints) because it does not cause inflammation in the joints. But fibromyalgia can (like arthritis) cause significant pain and fatigue, and it can similarly interfere with a person's ability to carry on daily activities.Who is affected by fibromyalgia?Fibromyalgia predominantly affects women (more than 80%) between the ages of 35 and 55. Less commonly, fibromyalgia affects men, children, and the elderly. It can occur independently or can be associated with another rheumatic disease, such as systemic lupus or rheumatoid arthritis. . What causes fibromyalgia?While there is no known cause for fibromyalgia, recent research has revealed new facts about the disease. Fibromyalgia patients have elevated levels of the nerve chemical signal substance P and nerve growth factor in their spinal fluid. They tend to have low levels of the brain nerve chemical serotonin and impaired non-rapid eye movement (non-REM) sleep phase (which likely explains the common feature of awakening fatigued and unrefreshed) .What are symptoms of fibromyalgia?Fibromyalgia is not always easy to diagnose because symptoms vary from person to person. Many of the symptoms mimic those of other disorders and there are no visible signs of the disorder. There is also no definitive laboratory test for fibromyalgia. . .. .. The universal symptom of fibromyalgia is pain.As mentioned earlier, the pain in fibromyalgia is not caused by tissue inflammation. Instead, patients seem to have an increased sensitivity to many different sensory stimuli. The result is an unusually low pain threshold. The pain is generally widespread, involving both sides of the body and commonly affecting the neck, buttocks, shoulders, arms, the upper back, and the chest.Additional factors can increase fibromyalgia pain.The pain of fibromyalgia can sometimes be further aggravated by sensory stressors such as noise, weather change, bright lights, and emotional stress.Fatigue occurs in approximately 90% of fibromyalgia patients.Normally, there are several levels of sleep depth. Getting enough of the deeper levels of sleep can be more important in refreshing a person than the total number of hours of sleep. Patients with fibromyalgia lack the deep, restorative level of sleep, called 'non-rapid eye movement' (non-REM) sleep. Consequently, patients often awaken in the morning without feeling fully rested. Some patients awaken with muscle aches or a sensation of muscle fatigue as if they had been 'working out' all night!More than half of fibromyalgia patients experience mental and/or emotional disturbances.These include poor concentration, forgetfulness, mood changes, irritability, depression, and anxiety. Because a firm diagnosis of fibromyalgia is difficult and no confirmatory laboratory tests are available, patients with fibromyalgia are often misdiagnosed as having depression as their primary problem.What are additional symptoms of fibromyalgia?Other symptoms include migraine and tension headaches, numbness or tingling of different body parts, abdominal pain related to irritable bowel syndrome (IBS), and irritable bladder, causing painful and frequent urination. .. .. How is fibromyalgia diagnosed?There is no specific test to determine whether someone has fibromyalgia. Therefore, the diagnosis of fibromyalgia is made on clinical grounds based on the doctor's history and physical examination. When it comes to pain, diagnosis can be made by identifying sensitive pain 'tender points' or 'trigger points' on the body. Pain is often present for longer than three months, and there are frequently 'tender points' as shown above. .. .. Additional exams and tests.Many medical conditions can cause pain in different areas of the body, mimicking fibromyalgia. Therefore, doctors may perform blood tests and X-rays to rule out other diseases and conditions.What is the treatment for fibromyalgia?Although there is no cure for fibromyalgia, treatment can relieve the symptoms. Because symptoms vary among patients, treatment programs must be individualized for each patient. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Ultimately, the physician, the physical therapist, and the patient may all play an active role in the management of fibromyalgia.Patient education.Patient education is an important first step in understanding and coping with the diverse symptoms of fibromyalgia. Community hospital support groups and the local chapters of the Arthritis Foundation have become important educational resources for patients.Stress reduction.The effects of stress vary from person to person. Therefore, stress reduction in the treatment of fibromyalgia must be individualized. This might include simple stress modification at home or work, biofeedback, relaxation tapes, psychological counseling, and/or support among family members, friends, and doctors. Sometimes, changes in environmental factors (such as noise, temperature, and weather exposure) can be helpful.Exercise.For muscle pain, it can be helpful to regularly perform low-impact exercise. Keeping muscles conditioned and healthy by exercising three times a week decreases the amount of discomfort. It is important to try low-stress exercises such as walking, swimming, water aerobics, and biking. Besides helping with tenderness, regular exercises can also boost energy levels and help with sleep.Medications.Today, Lyrica (pregabalin) , Cymbalta (duloxetine) , and Savella (milnacipran hydrochloride) are the only three drugs approved by the U.S. FDA for the treatment of fibromyalgia. Lyrica is an antiseizure medication, while Cymbalta and Savella are antidepressants. All three have been shown to reduce the pain of fibromyalgia.Traditionally, the treatment of fibromyalgia have been the tricyclic antidepressants such as amitriptyline (Elavil) and doxepin (Sinequan). Typically used in treating depression, they appear to reduce fatigue, relieve muscle pain, and promote deep, restorative sleep. Studies also show that adding fluoxetine (Prozac) further reduces pain, anxiety, and depression. Over-the-counter pain medications such as acetaminophen (Tylenol), aspirin, ibuprofen (Advil), and naproxen (Aleve) can also be helpful. .. .. Other medications.Local injections of analgesics and/or cortisone medication into the trigger-point areas can also be helpful in relieving painful soft tissues, while breaking cycles of pain and muscle spasm. Narcotic pain relievers are typically avoided in fibromyalgia patients because they have not been shown to be beneficial and have potential adverse side effects, including dependency, when used long term. .. .. Alternative treatmentsOther treatments and therapies used in helping patients cope with fibromyalgia include massage, acupuncture, acupressure, chiropractic care, diet and nutritional supplements, herbal remedies, and mind-body therapies (meditation, guided imagery, hypnosis). http://www.medicine net.com/fibromya lgia_pictures_ slideshow/ article.htm ____________ _________ _________ _____ Hepatitis C and Fibromyalgia: The Possible Link Learn about the potential connection between Hepatitis C and fibromyalgia, and find out why it is possible that Hepatitis C infection may act as a trigger for fibromyalgia syndrome. If you suspect having both conditions, awareness of this link can lead you to seek the expert evaluation and care that may help reduce your symptoms of pain and fatigue. by Cutler, L.Ac. Due to overwhelming empirical evidence, some medical circles believe that the symptoms and presenting patterns shared between Hepatitis C and fibromyalgia are beyond coincidental. While Hepatitis C is known to be transmitted through infected blood, authorities are still debating how fibromyalgia is acquired. Due to similarities in manifestation and physiology, there is a possibility that Hepatitis C infection may be one of fibromyalgia syndrome’s triggers. If you suspect having both conditions, awareness of this link can lead you to seek the specialized evaluation and care that may improve your most frustrating symptoms. PrevalenceEstimates of disease prevalence in the United States approximate the number of people living with fibromyalgia to be around 6 million people, while the number of people known to be living with Hepatitis C hovers just above 4 million. While accurate statistics of the number of people affected by both diagnoses are not currently available, a surprising number of people dually diagnosed with Hepatitis C and fibromyalgia are emerging. However, one study did find the prevalence of fibromyalgia in people with Hepatitis C (15 to 19 percent) to be much higher than the occurrence of fibromyalgia in the general American population (2 percent). FibromyalgiaFibromy algia is a syndrome causing widespread muscle pain, extreme fatigue and multiple tender points in specific parts of the body. With pain characterized as aching, burning, stabbing and throbbing, its severity can vary widely. While fibromyalgia is a chronic condition, it is not a progressive disease. However, this condition can greatly reduce the quality of life of those affected. Experts do not agree on what causes fibromyalgia. When trying to determine the etiology of this complex syndrome, it is challenging to discern between cause and effect. The endless cycle of pain, inactivity, insomnia, fatigue and depression typical of fibromyalgia complicates the isolation needed to trace this syndrome’s origins. Although researchers have identified several possible reasons for fibromyalgia, it remains unclear if they are a cause, or part of the problem. Some of the leading contenders for what triggers fibromyalgia include: · Hormone Imbalance· Infectious Disease· Immune System Malfunction· Sleep Disorder· Traumatic Event· Muscle Abnormality The Hepatitis C ConnectionAlthough not yet confirmed, many experts believe that Hepatitis C may act as a trigger to the onset of fibromyalgia. .. The documented links between the two conditions include: · Symptom Specificity – Fibromyalgia and chronic Hepatitis C infection share many clinical features including musculoskeletal pain and fatigue. While the two conditions do not always accompany each other, some symptoms may be unique when a person has both fibromyalgia and Hepatitis C. One study found that people dually diagnosed with fibromyalgia and Hepatitis C exhibit symptoms such as inflammation around a joint, bursa and/or tendon, and vasculitis (blood or lymph vessel inflammation) that are not seen in Hepatitis C negative people with fibromyalgia. · Immune Proteins – Cytokines are proteins that regulate immune response. Interleukins are a specific type of cytokine that cause a person to feel pain. Several interleukins have been found to be dramatically elevated in fibromyalgia patients. Harvard researchers found those same interleukins increased in production when exposed to the Hepatitis C virus. · Hepatitis C and Pain – Many people infected with Hepatitis C virus infection complain of myalgias, arthritis and widespread pain. When compared to other liver diseases, the frequency of musculoskeletal pain clearly favors Hepatitis C. The frequencies of musculoskeletal pain for the following isolated conditions are as follows: Alcoholic liver disease = 48 percent, Hepatitis B = 59 percent and Hepatitis C = 91 percent. As fibromyalgia’s most prominent symptom, it is not surprising that musculoskeletal pain may represent the link to Hepatitis C. Infectious CauseCertain infections, notably viruses, often occur in the histories of people with fibromyalgia. As these infectious organisms invade the body, scientists think they may cause damage at a cellular level. While fibromyalgia is considered to be non-contagious, it is possible that it may be a manifestation of a viral disease such as Hepatitis C, which is contagious. While many infectious microorganisms have been tied to fibromyalgia, the link with Hepatitis C is becoming increasingly suspect. At this point, there is sufficient evidence linking infectious diseases and fibromyalgia together, but it is unknown if any of these microorganisms are fibromyalgia’s origin, a simultaneous condition or a result. Why it Is ImportantA high prevalence of fibromyalgia has been found in patients infected with Hepatitis C, especially women. According to Israeli researchers, recognizing fibromyalgia in people with Hepatitis C will prevent misinterpretation of fibromyalgia symptoms as part of the liver disease and enable physicians to correctly focus on alleviating these symptoms.A doctor well versed in fibromyalgia should be consulted if this syndrome is suspected. Because its diagnosis is not simple and symptoms often overlap with other conditions, a proper evaluation will test for fibromyalgia while ruling out other diseases. Doctors who are familiar with fibromyalgia typically make a diagnosis based on criteria established by the American College of Rheumatology (ACR). .. Those criteria are: 1. Widespread pain (right and left side body pain, above and below the waist) that lasts for more than 3 months. 2. Eleven or more tender points present at 18 specific sites on the body.Whenever there is a profound crossover in a disease’s symptoms, we can learn from their parallels. Although many questions shroud the connection between fibromyalgia and Hepatitis C, their relationship exists in many people with either condition. With their comparable symptoms, similar immune biochemistry and irrefutable statistics of simultaneous presentation, exposure to the Hepatitis C virus may be one of fibromyalgia’s triggers. Understanding this connection may prompt a person with fibromyalgia to get tested for Hepatitis C or it may help a person with Hepatitis C seek evaluation for fibromyalgia. If you think you might be burdened with both conditions, discuss your thoughts with your primary healthcare provider. By taking this proactive stance, you may open yourself up to new ways of reducing Hepatitis C’s challenging symptoms of pain and fatigue http://www.hepatiti s-central. com/mt/archives/ 2009/01/hepatiti s_c_and_12. html .. .. ____________ _________ _________ _____ .. The Mysterious Condition of FibromyalgiaDescrip tion: It sneaks in unannounced and makes itself completely at home. It affects every aspect of life, turning days into challenges. This unwelcome arrival frequently manages to hide so it is almost invisible, yet it shows little sign of leaving. This is fibromyalgia (FM), often referred to as “fibro,†and it affects millions of Americans every year. The vast majority of those afflicted, an estimated 95 percent, are women. Ask some physicians to explain fibromyalgia, and they will tell you it is a condition that exists in the minds of hysterical females; others will claim it is an unidentified health problem that requires additional sleep and an occasional pain reliever. A growing number of medical professionals, however, will tell you what the American College of Rheumatology (ACR) determined in 1990. They would confirm it is an actual medical syndrome that affects all four body quadrants, causes widespread pain for at least three months, and involves at least 11 “tender points†among 18 sites on the body. The sites are overly sensitive to stimuli that typically would not cause pain. Fibromyalgia is a real condition creating real problems for people of all ages and ethnic backgrounds and can be experienced concurrently with hepatitis B and C. Viral infections often appear in the medical backgrounds of those suffering from fibromyalgia. It is not known how the occurrence of a viral disease, such as hepatitis, is specifically linked to the condition. Studies have explored various potential triggers of the syndrome, including trauma, stress and hepatitis infections. For example, research findings published in a 2005 study suggested having chronic hepatitis B appeared to increase the risk of FM and its associated symptoms.According to the ACR, the American Medical Association, the National Institutes of Health, the Food and Drug Administration (FDA), and the American Pain Society, this condition is real. So why does it take an average of five years for a patient to get an accurate diagnosis? .. Unfortunately, as powerful as fibromyalgia can be, it is just as elusive. It does not show up on a blood test or X-ray. It doesn’t have a defining hallmark of symptoms but has generalized ones that can fit the parameters of other conditions. “Fibromyalgia has no specific physical abnormalities to see, just elevated tenderness,†explains Dr. Philip Mease, director of Rheumatology Research at the Swedish Medical Center in Seattle, Washington.Dr. Teitelbaum, medical director of Fibromyalgia and Fatigue Centers and author of “From Fatigued to Fantastic,†adds that there is no fancy test for the condition. “Doctors will say it doesn’t exist,†he notes. “If your physician tells you this, just say ‘goodbye,’ and walk out the door. You don’t want a doctor you have to educate.â€Head to ToeThe name fibromyalgia means pain in the muscle fibers. .. From mild annoyances to completely debilitating, the pain element only paints a limited picture of this pervasive condition. There are numerous other common complaints associated with fibro. (See Common Complaints.) A thorough medical history is the best way to discover most of these issues, although some doctors will order thyroid panels and complete blood counts to look for abnormal numbers. Dr. Braverman, director of the Place for Achieving Total Health, has been working with fibro patients for more than 20 years. .. “Technology has come a long way, so we have more effective ways of finding and treating fibro,†he says. “There have been more cases of fibromyalgia in recent years because of lack of health care in the U.S. Many people are finding they can’t visit their doctors as often so it goes untreated.â€Any combination of these symptoms can play havoc with a person’s life, not only physically, but also emotionally, socially and mentally. As Teitelbaum describes it, “Imagine you’re a busy mother of several children and suddenly you experience brain fog, so people see you as dumb. .. You gain the typical 32.5 pounds, your libido drops the typical 73 percent, you have no energy and you feel like you have a toothache throughout your entire body. Your medical tests come back normal—so now your friends, family and doctors think you’re crazy.â€Braverman agrees. “Physically, the pain can be excruciating and force a person to the confinement of their beds. Mentally, fibro has been proven to cause depression due to the pain and anguish that people experience. Socially, it definitely has an effect. Many people find that they cannot go out as much as before, to run errands, go to dinner, or attend social gatherings. It is an all-encompassing disease.â€Searching for an Answer, a former education student and now author of a children’s book called “ny the Phoenix†knows this feeling. He was diagnosed with the condition in 2006, after searching for an answer for two years. .. Constant headaches had resulted in four sinus surgeries and a battery of neurological tests. Nothing helped. Then a friend handed him a book about fibromyalgia. After a sleep study that showed apnea, he went to a new doctor and was diagnosed immediately. A husband and father, ’s days often depend on the weather. “I find that barometric pressure has a large impact, as well as extreme heat and cold,†he says. “I get as much sleep as possible, usually over nine hours. I look ahead to what needs to be done, and I try to use no more than 90 percent of the energy that I have available. .. It is a very frustrating disease, because there is no way to plan for good or bad days.â€Today, is on disability because it is impossible for him to work. “If you find that you have severe fibro as I do, fight for your disability,†he advises. “Sit down and take stock of what you have left. .. For me, it is my ability to tell stories, so I write. Just because you have fibromyalgia doesn’t mean that your life has ended. It simply means you need to go to your back-up abilities.â€To Make Matters WorseJust as the condition does not have a definitive test, it does not have a distinct cause or treatment either. Over 150 clinical trials are being conducted at any one time trying to determine the answers. So far, researchers have proposed that fibromyalgia may be an abnormality in brain chemicals. An imbalance in neurotransmitters, such as norepinephrine, serotonin and dopamine, directly affects how pain is experienced and how it is blocked.“A person with fibro is like a house with a thermostat that is off kilter,†explains Mease. .. “There is an alteration in sensory processing in the individual. There is an excess of sensory input and a deficiency in the body’s ability to inhibit or block it. Too much comes in and not enough protects it.â€Teitelbaum compares it to an energy crisis. “With fibro, the body blows a fuse,†he explains. “And that fuse is the hypothalamus.†Other theories are that fibro is a genetic condition (it tends to run in families) or that it comes along as a “fellow traveler†as Mease calls it, with other infectious or autoimmune diseases, such as hepatitis.Regardles s of the cause, what many patients want most, once they have their diagnosis, is help. Unfortunately, treatment is as complex an issue as the condition itself. .. Patients may take a variety of medications designed to battle specific symptoms, including pills to combat pain, diarrhea, and depression. They may need pills to increase energy or sleep at night. Prescription costs easily run into the hundreds or even thousands of dollars. The FDA has approved several drugs for the condition including milnacipran (Savella®), duloxetine (Cymbalta®) and pregabalin (Lyrica®). As with most medications, however, there are side effects to consider. Other possible treatments include massage, acupuncture, chiropractic care and heat applications. Some fibro patients also have had trigger point (spots that are tender to palpation) injections in which an anesthetic is injected into the muscle, which is then gently stretched. .. The problem with this method is that the injections are usually quite painful, and it can take days for the patient to feel relief.Teitelbaum recommends treatment through what he calls the SHINE Protocol. “Ninety-one percent of fibro patients show improvement after following these steps,†he says.In the protocol, “S†stands for sleep. “It’s essential that the body gets at least eight hours of sleep, even if it means helping it by using herbs, medication or other techniques,†explains Teitelbaum.“H†stands for hormonal support, as in taking supplements to support the thyroid and adrenal glands. “I†stands for infection because fibro patients often deal with a variety of infections. “N†stands for nutritional support, indicating the importance of a healthy diet, and “E†stands for exercising as able. While exercise typically helps, it is hard to do when dealing with intense exhaustion and muscles that are already complaining. Cutting off SleevesLee’s life hasn’t been easy for some time. After a full life as an educator and syndicated newspaper columnist, he began to experience health problems. In 1990, he was diagnosed with multiple sclerosis. Later, he developed several types of arthritis. Everything got worse in 1995 when a speeding semi-truck loaded with a payload of stone broadsided him, burying him under 75 tons of rubble. .. “The police thought I was dead,†he admits. He almost was. It took six hours to extricate him. He spent a month in intensive care and six months in the hospital. When he appeared in the courtroom, he was still in a wheelchair and hooked up to an IV. “I was so out of it, I had no idea what was even going on. I got absolutely nothing.â€It wasn’t until 2004 that Lee was diagnosed with fibro. Amazingly, after all his health problems, it is fibro that has had the most profound effect on his life. “This pain supersedes everything else,†he states. “There are spots on my arms that hurt so much I have had to cut off all the sleeves on my shirts. I can’t stand the touch of the fabric.â€Not much makes Lee feel better. He uses a massage pad in his chair but says he has to put several towels or blankets between the rollers and his skin or he can’t stand the pressure. .. Each month Lee’s medications cost $3,000. After being unemployed for more than 14 years, this is money he simply does not have so he stopped taking most of the medication.“Each night I plan to do things the next day, but then it gets here, and I just can’t shake the exhaustion,†he explains. “I try to go out, but I can’t . . . often for days or even weeks on end. Fibromyalgia saps all my energy.â€Lee lives alone and depends on his friends and daughter to stop by and help with chores. He spends a great deal of time in bed. .. “Mentally, there is so much I want to do,†he says, “but physically, it isn’t possible.â€Fibromyalgia is an unwelcome visitor that creeps in the body. It brings pain, fatigue, fog, and insomnia. Noticing it doesn’t take long; identifying it can take what seems like forever. Treatment is often a hit and miss process. Eviction is rarely possible, but sometimes, with a skillful doctor and appropriate treatments, a truce can reached.. .. http://www.liverhea lthtoday. org/ ____________ _________ _________ _____ AAPM: Help for Pain and Mood in Fibromyalgia Feb 7 2010SAN ANTONIO -- Patients with fibromyalgia and comorbid depression had significant improvement in both conditions when treated with duloxetine (Cymbalta), according to pooled data from four clinical trials presented here at the American Academy of Pain Medicine meeting.The magnitude of improvement in pain was consistent across all severity levels of depression. Conversely, patient mood improved to a similar extent across the range of pain severity.Analysis of treatment effect showed that 60% to 70% of the benefit for pain and mood resulted from a direct effect of the drug. The remaining 30% to 40% of improvement arose from an indirect effect."Improvement in pain and improvement in major depressive disorder are positively correlated," B. Marangell, MD, of Eli Lilly & Co. in Indianapolis, and colleagues reported in a poster presentation."Improvement in pain reflected greater direct treatment effect with an indirect effect of improved mood, indicating that the improvement seen with duloxetine in fibromyalgia is not solely a mood effect. Improvement in mood was found to reflect a greater direct treatment effect, with an indirect effect of pain improvement. ""These data support the independent analgesic properties of duloxetine in the treatment of fibromyalgia. "As many as a third of patients with fibromyalgia have comorbid major depression, and as many as 70% have a history of major depression. Sorting out the association between the two conditions is complicated by the fact that the pain can obscure the depression and lead to underdiagnosis and undertreatment, the researchers wrote.On the other hand, major depression can intensify as pain interferes with daily activities, and comorbid depression can lead to increased pain complaints, intensity, and duration among patients with fibromyalgia, they noted.In an effort to clarify the clinical course of patients with both conditions, Marangell and colleagues analyzed data from four placebo-controlled clinical trials of duloxetine in patients with fibromyalgia. They limited the analysis to patients who had comorbid major depression at enrollment and who received 60 to 120 mg of duloxetine.The investigators performed two path analyses to determine the direct and indirect treatment effects on pain and on depression.The study involved 350 patients with fibromyalgia and comorbid depression, 147 randomized to placebo, and 203 to duloxetine. Baseline characteristics included a median Hamilton depression (HAMD) score of 15 and a Brief Pain Inventory (BPI) average of 6 to 7.The analysis showed that about half of the patients with a HAMD score above or below the median had ≥30% improvement in pain score.Moreover, 35% to 40% of patients treated with duloxetine had ≥50% improvement in pain score whether they had a low (HAMD <15)> Iyengar S, et al "Fibromyalgia and comorbid major depressive disorder: Assessment of mood and pain response to duloxetine hydrochloride compared to placebo" AAPM 2010; Abstract 121. http://www.medpaget oday.com/ MeetingCoverage/ AAPM/ http://Hepatitis Cne wdrugs.blogspot. com/2010/ 02/fibromyalgia- and-hcv.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 8, 2010 Report Share Posted April 8, 2010 Thats really good news Teri. I hope that from now on you can get the help you need. love don in ks From: Teri Gottlieb <theresagottlieb@...>Subject: Re: [ ] Fibromyalgia and HCV ? Date: Thursday, April 8, 2010, 5:45 PM I was just formally diagnosed with this not 30 minutes ago. New doctor.... fresh set of eyes looking at some old problems. He told me that Hep C causes Fibromyalgia a great deal of the time. I have a new Doc and will be adding to my list of new docs as we are replacing everybody but my liver doctor.Teri From: Christ <ludichrist2000@...>009 - VCHepC <VCHepC >; Hepatitis C <Hepatitis C >; WebWarriors grp < >Sent: Thu, April 8, 2010 5:06:57 PMSubject: [ ] Fibromyalgia and HCV ? Fibromyalgia and HCV ? Affecting millions of Americans, fibromyalgia is a chronic condition causing fatigue, stiffness, and tenderness of the muscles, tendons, and joints. .. .. Also See : Video Feb 04 2010/ FibromyalgiaWhat is fibromyalgia?Fibromyalgia (formerly fibrositis) is a syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. It is also characterized by restless sleep, awakening tired, fatigue, anxiety, depression, and disturbances in bowel function. The condition is non-life-threatenin g and does not cause body damage or deformity. It affects an estimated 3-6 million Americans. .. .. What does the name fibromyalgia mean?The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek terms for muscle (myo) and pain (algia). Is fibromyalgia a form of arthritis?Fibromyalgia is considered a muscle condition. It is not a form of arthritis (a disease of the joints) because it does not cause inflammation in the joints. But fibromyalgia can (like arthritis) cause significant pain and fatigue, and it can similarly interfere with a person's ability to carry on daily activities.Who is affected by fibromyalgia?Fibromyalgia predominantly affects women (more than 80%) between the ages of 35 and 55. Less commonly, fibromyalgia affects men, children, and the elderly. It can occur independently or can be associated with another rheumatic disease, such as systemic lupus or rheumatoid arthritis. .. What causes fibromyalgia?While there is no known cause for fibromyalgia, recent research has revealed new facts about the disease. Fibromyalgia patients have elevated levels of the nerve chemical signal substance P and nerve growth factor in their spinal fluid. They tend to have low levels of the brain nerve chemical serotonin and impaired non-rapid eye movement (non-REM) sleep phase (which likely explains the common feature of awakening fatigued and unrefreshed) .What are symptoms of fibromyalgia?Fibromyalgia is not always easy to diagnose because symptoms vary from person to person. Many of the symptoms mimic those of other disorders and there are no visible signs of the disorder. There is also no definitive laboratory test for fibromyalgia. . .. .. The universal symptom of fibromyalgia is pain.As mentioned earlier, the pain in fibromyalgia is not caused by tissue inflammation. Instead, patients seem to have an increased sensitivity to many different sensory stimuli. The result is an unusually low pain threshold. The pain is generally widespread, involving both sides of the body and commonly affecting the neck, buttocks, shoulders, arms, the upper back, and the chest.Additional factors can increase fibromyalgia pain.The pain of fibromyalgia can sometimes be further aggravated by sensory stressors such as noise, weather change, bright lights, and emotional stress.Fatigue occurs in approximately 90% of fibromyalgia patients.Normally, there are several levels of sleep depth. Getting enough of the deeper levels of sleep can be more important in refreshing a person than the total number of hours of sleep. Patients with fibromyalgia lack the deep, restorative level of sleep, called 'non-rapid eye movement' (non-REM) sleep. Consequently, patients often awaken in the morning without feeling fully rested. Some patients awaken with muscle aches or a sensation of muscle fatigue as if they had been 'working out' all night!More than half of fibromyalgia patients experience mental and/or emotional disturbances.These include poor concentration, forgetfulness, mood changes, irritability, depression, and anxiety. Because a firm diagnosis of fibromyalgia is difficult and no confirmatory laboratory tests are available, patients with fibromyalgia are often misdiagnosed as having depression as their primary problem.What are additional symptoms of fibromyalgia?Other symptoms include migraine and tension headaches, numbness or tingling of different body parts, abdominal pain related to irritable bowel syndrome (IBS), and irritable bladder, causing painful and frequent urination. .. .. How is fibromyalgia diagnosed?There is no specific test to determine whether someone has fibromyalgia. Therefore, the diagnosis of fibromyalgia is made on clinical grounds based on the doctor's history and physical examination. When it comes to pain, diagnosis can be made by identifying sensitive pain 'tender points' or 'trigger points' on the body. Pain is often present for longer than three months, and there are frequently 'tender points' as shown above. .. .. Additional exams and tests.Many medical conditions can cause pain in different areas of the body, mimicking fibromyalgia. Therefore, doctors may perform blood tests and X-rays to rule out other diseases and conditions.What is the treatment for fibromyalgia?Although there is no cure for fibromyalgia, treatment can relieve the symptoms. Because symptoms vary among patients, treatment programs must be individualized for each patient. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Ultimately, the physician, the physical therapist, and the patient may all play an active role in the management of fibromyalgia.Patient education.Patient education is an important first step in understanding and coping with the diverse symptoms of fibromyalgia. Community hospital support groups and the local chapters of the Arthritis Foundation have become important educational resources for patients.Stress reduction.The effects of stress vary from person to person. Therefore, stress reduction in the treatment of fibromyalgia must be individualized. This might include simple stress modification at home or work, biofeedback, relaxation tapes, psychological counseling, and/or support among family members, friends, and doctors. Sometimes, changes in environmental factors (such as noise, temperature, and weather exposure) can be helpful.Exercise.For muscle pain, it can be helpful to regularly perform low-impact exercise. Keeping muscles conditioned and healthy by exercising three times a week decreases the amount of discomfort. It is important to try low-stress exercises such as walking, swimming, water aerobics, and biking. Besides helping with tenderness, regular exercises can also boost energy levels and help with sleep.Medications.Today, Lyrica (pregabalin) , Cymbalta (duloxetine) , and Savella (milnacipran hydrochloride) are the only three drugs approved by the U.S. FDA for the treatment of fibromyalgia. Lyrica is an antiseizure medication, while Cymbalta and Savella are antidepressants. All three have been shown to reduce the pain of fibromyalgia.Traditionally, the treatment of fibromyalgia have been the tricyclic antidepressants such as amitriptyline (Elavil) and doxepin (Sinequan). Typically used in treating depression, they appear to reduce fatigue, relieve muscle pain, and promote deep, restorative sleep. Studies also show that adding fluoxetine (Prozac) further reduces pain, anxiety, and depression. Over-the-counter pain medications such as acetaminophen (Tylenol), aspirin, ibuprofen (Advil), and naproxen (Aleve) can also be helpful. .. .. Other medications.Local injections of analgesics and/or cortisone medication into the trigger-point areas can also be helpful in relieving painful soft tissues, while breaking cycles of pain and muscle spasm. Narcotic pain relievers are typically avoided in fibromyalgia patients because they have not been shown to be beneficial and have potential adverse side effects, including dependency, when used long term. .. .. Alternative treatmentsOther treatments and therapies used in helping patients cope with fibromyalgia include massage, acupuncture, acupressure, chiropractic care, diet and nutritional supplements, herbal remedies, and mind-body therapies (meditation, guided imagery, hypnosis). http://www.medicine net.com/fibromya lgia_pictures_ slideshow/ article.htm ____________ _________ _________ _____ Hepatitis C and Fibromyalgia: The Possible Link Learn about the potential connection between Hepatitis C and fibromyalgia, and find out why it is possible that Hepatitis C infection may act as a trigger for fibromyalgia syndrome. If you suspect having both conditions, awareness of this link can lead you to seek the expert evaluation and care that may help reduce your symptoms of pain and fatigue. by Cutler, L.Ac. Due to overwhelming empirical evidence, some medical circles believe that the symptoms and presenting patterns shared between Hepatitis C and fibromyalgia are beyond coincidental. While Hepatitis C is known to be transmitted through infected blood, authorities are still debating how fibromyalgia is acquired. Due to similarities in manifestation and physiology, there is a possibility that Hepatitis C infection may be one of fibromyalgia syndrome’s triggers. If you suspect having both conditions, awareness of this link can lead you to seek the specialized evaluation and care that may improve your most frustrating symptoms. PrevalenceEstimates of disease prevalence in the United States approximate the number of people living with fibromyalgia to be around 6 million people, while the number of people known to be living with Hepatitis C hovers just above 4 million. While accurate statistics of the number of people affected by both diagnoses are not currently available, a surprising number of people dually diagnosed with Hepatitis C and fibromyalgia are emerging. However, one study did find the prevalence of fibromyalgia in people with Hepatitis C (15 to 19 percent) to be much higher than the occurrence of fibromyalgia in the general American population (2 percent). FibromyalgiaFibromy algia is a syndrome causing widespread muscle pain, extreme fatigue and multiple tender points in specific parts of the body. With pain characterized as aching, burning, stabbing and throbbing, its severity can vary widely. While fibromyalgia is a chronic condition, it is not a progressive disease. However, this condition can greatly reduce the quality of life of those affected. Experts do not agree on what causes fibromyalgia. When trying to determine the etiology of this complex syndrome, it is challenging to discern between cause and effect. The endless cycle of pain, inactivity, insomnia, fatigue and depression typical of fibromyalgia complicates the isolation needed to trace this syndrome’s origins. Although researchers have identified several possible reasons for fibromyalgia, it remains unclear if they are a cause, or part of the problem. Some of the leading contenders for what triggers fibromyalgia include: · Hormone Imbalance· Infectious Disease· Immune System Malfunction· Sleep Disorder· Traumatic Event· Muscle Abnormality The Hepatitis C ConnectionAlthough not yet confirmed, many experts believe that Hepatitis C may act as a trigger to the onset of fibromyalgia. .. The documented links between the two conditions include: · Symptom Specificity – Fibromyalgia and chronic Hepatitis C infection share many clinical features including musculoskeletal pain and fatigue. While the two conditions do not always accompany each other, some symptoms may be unique when a person has both fibromyalgia and Hepatitis C. One study found that people dually diagnosed with fibromyalgia and Hepatitis C exhibit symptoms such as inflammation around a joint, bursa and/or tendon, and vasculitis (blood or lymph vessel inflammation) that are not seen in Hepatitis C negative people with fibromyalgia. · Immune Proteins – Cytokines are proteins that regulate immune response. Interleukins are a specific type of cytokine that cause a person to feel pain. Several interleukins have been found to be dramatically elevated in fibromyalgia patients. Harvard researchers found those same interleukins increased in production when exposed to the Hepatitis C virus. · Hepatitis C and Pain – Many people infected with Hepatitis C virus infection complain of myalgias, arthritis and widespread pain. When compared to other liver diseases, the frequency of musculoskeletal pain clearly favors Hepatitis C. The frequencies of musculoskeletal pain for the following isolated conditions are as follows: Alcoholic liver disease = 48 percent, Hepatitis B = 59 percent and Hepatitis C = 91 percent. As fibromyalgia’s most prominent symptom, it is not surprising that musculoskeletal pain may represent the link to Hepatitis C. Infectious CauseCertain infections, notably viruses, often occur in the histories of people with fibromyalgia. As these infectious organisms invade the body, scientists think they may cause damage at a cellular level. While fibromyalgia is considered to be non-contagious, it is possible that it may be a manifestation of a viral disease such as Hepatitis C, which is contagious. While many infectious microorganisms have been tied to fibromyalgia, the link with Hepatitis C is becoming increasingly suspect. At this point, there is sufficient evidence linking infectious diseases and fibromyalgia together, but it is unknown if any of these microorganisms are fibromyalgia’s origin, a simultaneous condition or a result. Why it Is ImportantA high prevalence of fibromyalgia has been found in patients infected with Hepatitis C, especially women. According to Israeli researchers, recognizing fibromyalgia in people with Hepatitis C will prevent misinterpretation of fibromyalgia symptoms as part of the liver disease and enable physicians to correctly focus on alleviating these symptoms.A doctor well versed in fibromyalgia should be consulted if this syndrome is suspected. Because its diagnosis is not simple and symptoms often overlap with other conditions, a proper evaluation will test for fibromyalgia while ruling out other diseases. Doctors who are familiar with fibromyalgia typically make a diagnosis based on criteria established by the American College of Rheumatology (ACR). .. Those criteria are: 1. Widespread pain (right and left side body pain, above and below the waist) that lasts for more than 3 months. 2. Eleven or more tender points present at 18 specific sites on the body.Whenever there is a profound crossover in a disease’s symptoms, we can learn from their parallels. Although many questions shroud the connection between fibromyalgia and Hepatitis C, their relationship exists in many people with either condition. With their comparable symptoms, similar immune biochemistry and irrefutable statistics of simultaneous presentation, exposure to the Hepatitis C virus may be one of fibromyalgia’s triggers. Understanding this connection may prompt a person with fibromyalgia to get tested for Hepatitis C or it may help a person with Hepatitis C seek evaluation for fibromyalgia. If you think you might be burdened with both conditions, discuss your thoughts with your primary healthcare provider. By taking this proactive stance, you may open yourself up to new ways of reducing Hepatitis C’s challenging symptoms of pain and fatigue http://www.hepatiti s-central. com/mt/archives/ 2009/01/hepatiti s_c_and_12. html .. .. ____________ _________ _________ _____ .. The Mysterious Condition of FibromyalgiaDescrip tion: It sneaks in unannounced and makes itself completely at home. It affects every aspect of life, turning days into challenges. This unwelcome arrival frequently manages to hide so it is almost invisible, yet it shows little sign of leaving. This is fibromyalgia (FM), often referred to as “fibro,†and it affects millions of Americans every year. The vast majority of those afflicted, an estimated 95 percent, are women. Ask some physicians to explain fibromyalgia, and they will tell you it is a condition that exists in the minds of hysterical females; others will claim it is an unidentified health problem that requires additional sleep and an occasional pain reliever. A growing number of medical professionals, however, will tell you what the American College of Rheumatology (ACR) determined in 1990. They would confirm it is an actual medical syndrome that affects all four body quadrants, causes widespread pain for at least three months, and involves at least 11 “tender points†among 18 sites on the body. The sites are overly sensitive to stimuli that typically would not cause pain. Fibromyalgia is a real condition creating real problems for people of all ages and ethnic backgrounds and can be experienced concurrently with hepatitis B and C. Viral infections often appear in the medical backgrounds of those suffering from fibromyalgia. It is not known how the occurrence of a viral disease, such as hepatitis, is specifically linked to the condition. Studies have explored various potential triggers of the syndrome, including trauma, stress and hepatitis infections. For example, research findings published in a 2005 study suggested having chronic hepatitis B appeared to increase the risk of FM and its associated symptoms.According to the ACR, the American Medical Association, the National Institutes of Health, the Food and Drug Administration (FDA), and the American Pain Society, this condition is real. So why does it take an average of five years for a patient to get an accurate diagnosis? .. Unfortunately, as powerful as fibromyalgia can be, it is just as elusive. It does not show up on a blood test or X-ray. It doesn’t have a defining hallmark of symptoms but has generalized ones that can fit the parameters of other conditions. “Fibromyalgia has no specific physical abnormalities to see, just elevated tenderness,†explains Dr. Philip Mease, director of Rheumatology Research at the Swedish Medical Center in Seattle, Washington.Dr. Teitelbaum, medical director of Fibromyalgia and Fatigue Centers and author of “From Fatigued to Fantastic,†adds that there is no fancy test for the condition. “Doctors will say it doesn’t exist,†he notes. “If your physician tells you this, just say ‘goodbye,’ and walk out the door. You don’t want a doctor you have to educate.â€Head to ToeThe name fibromyalgia means pain in the muscle fibers. .. From mild annoyances to completely debilitating, the pain element only paints a limited picture of this pervasive condition. There are numerous other common complaints associated with fibro. (See Common Complaints.) A thorough medical history is the best way to discover most of these issues, although some doctors will order thyroid panels and complete blood counts to look for abnormal numbers. Dr. Braverman, director of the Place for Achieving Total Health, has been working with fibro patients for more than 20 years. .. “Technology has come a long way, so we have more effective ways of finding and treating fibro,†he says. “There have been more cases of fibromyalgia in recent years because of lack of health care in the U.S. Many people are finding they can’t visit their doctors as often so it goes untreated.â€Any combination of these symptoms can play havoc with a person’s life, not only physically, but also emotionally, socially and mentally. As Teitelbaum describes it, “Imagine you’re a busy mother of several children and suddenly you experience brain fog, so people see you as dumb. .. You gain the typical 32.5 pounds, your libido drops the typical 73 percent, you have no energy and you feel like you have a toothache throughout your entire body. Your medical tests come back normal—so now your friends, family and doctors think you’re crazy.â€Braverman agrees. “Physically, the pain can be excruciating and force a person to the confinement of their beds. Mentally, fibro has been proven to cause depression due to the pain and anguish that people experience. Socially, it definitely has an effect. Many people find that they cannot go out as much as before, to run errands, go to dinner, or attend social gatherings. It is an all-encompassing disease.â€Searching for an Answer, a former education student and now author of a children’s book called “ny the Phoenix†knows this feeling. He was diagnosed with the condition in 2006, after searching for an answer for two years. .. Constant headaches had resulted in four sinus surgeries and a battery of neurological tests. Nothing helped. Then a friend handed him a book about fibromyalgia. After a sleep study that showed apnea, he went to a new doctor and was diagnosed immediately. A husband and father, ’s days often depend on the weather. “I find that barometric pressure has a large impact, as well as extreme heat and cold,†he says. “I get as much sleep as possible, usually over nine hours. I look ahead to what needs to be done, and I try to use no more than 90 percent of the energy that I have available. .. It is a very frustrating disease, because there is no way to plan for good or bad days.â€Today, is on disability because it is impossible for him to work. “If you find that you have severe fibro as I do, fight for your disability,†he advises. “Sit down and take stock of what you have left. .. For me, it is my ability to tell stories, so I write. Just because you have fibromyalgia doesn’t mean that your life has ended. It simply means you need to go to your back-up abilities.â€To Make Matters WorseJust as the condition does not have a definitive test, it does not have a distinct cause or treatment either. Over 150 clinical trials are being conducted at any one time trying to determine the answers. So far, researchers have proposed that fibromyalgia may be an abnormality in brain chemicals. An imbalance in neurotransmitters, such as norepinephrine, serotonin and dopamine, directly affects how pain is experienced and how it is blocked.“A person with fibro is like a house with a thermostat that is off kilter,†explains Mease. .. “There is an alteration in sensory processing in the individual. There is an excess of sensory input and a deficiency in the body’s ability to inhibit or block it. Too much comes in and not enough protects it.â€Teitelbaum compares it to an energy crisis. “With fibro, the body blows a fuse,†he explains. “And that fuse is the hypothalamus.†Other theories are that fibro is a genetic condition (it tends to run in families) or that it comes along as a “fellow traveler†as Mease calls it, with other infectious or autoimmune diseases, such as hepatitis.Regardles s of the cause, what many patients want most, once they have their diagnosis, is help. Unfortunately, treatment is as complex an issue as the condition itself. .. Patients may take a variety of medications designed to battle specific symptoms, including pills to combat pain, diarrhea, and depression. They may need pills to increase energy or sleep at night. Prescription costs easily run into the hundreds or even thousands of dollars. The FDA has approved several drugs for the condition including milnacipran (Savella®), duloxetine (Cymbalta®) and pregabalin (Lyrica®). As with most medications, however, there are side effects to consider. Other possible treatments include massage, acupuncture, chiropractic care and heat applications. Some fibro patients also have had trigger point (spots that are tender to palpation) injections in which an anesthetic is injected into the muscle, which is then gently stretched. .. The problem with this method is that the injections are usually quite painful, and it can take days for the patient to feel relief.Teitelbaum recommends treatment through what he calls the SHINE Protocol. “Ninety-one percent of fibro patients show improvement after following these steps,†he says.In the protocol, “S†stands for sleep. “It’s essential that the body gets at least eight hours of sleep, even if it means helping it by using herbs, medication or other techniques,†explains Teitelbaum.“H†stands for hormonal support, as in taking supplements to support the thyroid and adrenal glands. “I†stands for infection because fibro patients often deal with a variety of infections. “N†stands for nutritional support, indicating the importance of a healthy diet, and “E†stands for exercising as able. While exercise typically helps, it is hard to do when dealing with intense exhaustion and muscles that are already complaining. Cutting off SleevesLee’s life hasn’t been easy for some time. After a full life as an educator and syndicated newspaper columnist, he began to experience health problems. In 1990, he was diagnosed with multiple sclerosis. Later, he developed several types of arthritis. Everything got worse in 1995 when a speeding semi-truck loaded with a payload of stone broadsided him, burying him under 75 tons of rubble. .. “The police thought I was dead,†he admits. He almost was. It took six hours to extricate him. He spent a month in intensive care and six months in the hospital. When he appeared in the courtroom, he was still in a wheelchair and hooked up to an IV. “I was so out of it, I had no idea what was even going on. I got absolutely nothing.â€It wasn’t until 2004 that Lee was diagnosed with fibro. Amazingly, after all his health problems, it is fibro that has had the most profound effect on his life. “This pain supersedes everything else,†he states. “There are spots on my arms that hurt so much I have had to cut off all the sleeves on my shirts. I can’t stand the touch of the fabric.â€Not much makes Lee feel better. He uses a massage pad in his chair but says he has to put several towels or blankets between the rollers and his skin or he can’t stand the pressure. .. Each month Lee’s medications cost $3,000. After being unemployed for more than 14 years, this is money he simply does not have so he stopped taking most of the medication.“Each night I plan to do things the next day, but then it gets here, and I just can’t shake the exhaustion,†he explains. “I try to go out, but I can’t . . . often for days or even weeks on end. Fibromyalgia saps all my energy.â€Lee lives alone and depends on his friends and daughter to stop by and help with chores. He spends a great deal of time in bed. .. “Mentally, there is so much I want to do,†he says, “but physically, it isn’t possible.â€Fibromyalgia is an unwelcome visitor that creeps in the body. It brings pain, fatigue, fog, and insomnia. Noticing it doesn’t take long; identifying it can take what seems like forever. Treatment is often a hit and miss process. Eviction is rarely possible, but sometimes, with a skillful doctor and appropriate treatments, a truce can reached.. .. http://www.liverhea lthtoday. org/ ____________ _________ _________ _____ AAPM: Help for Pain and Mood in Fibromyalgia Feb 7 2010SAN ANTONIO -- Patients with fibromyalgia and comorbid depression had significant improvement in both conditions when treated with duloxetine (Cymbalta), according to pooled data from four clinical trials presented here at the American Academy of Pain Medicine meeting.The magnitude of improvement in pain was consistent across all severity levels of depression. Conversely, patient mood improved to a similar extent across the range of pain severity.Analysis of treatment effect showed that 60% to 70% of the benefit for pain and mood resulted from a direct effect of the drug. The remaining 30% to 40% of improvement arose from an indirect effect."Improvement in pain and improvement in major depressive disorder are positively correlated," B. Marangell, MD, of Eli Lilly & Co. in Indianapolis, and colleagues reported in a poster presentation."Improvement in pain reflected greater direct treatment effect with an indirect effect of improved mood, indicating that the improvement seen with duloxetine in fibromyalgia is not solely a mood effect. Improvement in mood was found to reflect a greater direct treatment effect, with an indirect effect of pain improvement. ""These data support the independent analgesic properties of duloxetine in the treatment of fibromyalgia. "As many as a third of patients with fibromyalgia have comorbid major depression, and as many as 70% have a history of major depression. Sorting out the association between the two conditions is complicated by the fact that the pain can obscure the depression and lead to underdiagnosis and undertreatment, the researchers wrote.On the other hand, major depression can intensify as pain interferes with daily activities, and comorbid depression can lead to increased pain complaints, intensity, and duration among patients with fibromyalgia, they noted.In an effort to clarify the clinical course of patients with both conditions, Marangell and colleagues analyzed data from four placebo-controlled clinical trials of duloxetine in patients with fibromyalgia. They limited the analysis to patients who had comorbid major depression at enrollment and who received 60 to 120 mg of duloxetine.The investigators performed two path analyses to determine the direct and indirect treatment effects on pain and on depression.The study involved 350 patients with fibromyalgia and comorbid depression, 147 randomized to placebo, and 203 to duloxetine. Baseline characteristics included a median Hamilton depression (HAMD) score of 15 and a Brief Pain Inventory (BPI) average of 6 to 7.The analysis showed that about half of the patients with a HAMD score above or below the median had ≥30% improvement in pain score.Moreover, 35% to 40% of patients treated with duloxetine had ≥50% improvement in pain score whether they had a low (HAMD <15)> Iyengar S, et al "Fibromyalgia and comorbid major depressive disorder: Assessment of mood and pain response to duloxetine hydrochloride compared to placebo" AAPM 2010; Abstract 121. http://www.medpaget oday.com/ MeetingCoverage/ AAPM/ http://Hepatitis Cne wdrugs.blogspot. com/2010/ 02/fibromyalgia- and-hcv.html Quote Link to comment Share on other sites More sharing options...
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