 How To Treat Fibromyalgia Effectively
Fibromyalgia is a multisystem disease characterized by various and
diffuse symptoms including sleep disturbance, fatigue, headache,
dizziness, reduction in short term memory, hypersensitivity to
environmental stimuli, morning stiffness, irritable bowel and irritable
bladder, numbness and tingling, premenstrual syndrome, restless leg
syndrome, temporomandibular joint pain, noncardiac chest pain,
Raynaud's phenomenon, sicca syndrome, and anxiety.
Prevalence in the United States is 3.4% in women and 0.5% in men, with
increasing prevalence to age 80 years and women being affected 10 times
more frequently than men and familial clustering suggesting a genetic
etiology.
It is chronic and, because the symptoms do not follow strict anatomic pathways, is often misdiagnosed and poorly treated.
Functional MRI studies have demonstrated that the brains of patients
with fibromyalgia react differently to pain stimuli than the brains of
patients without fibromyalgia. Thus, the problem appears to be that the
brains of fibromyalgia patients have different functional, electrical,
and chemical differences than the brains of people without the
disorder. In other words, patients with fibromyalgia handle brain
inputs and outputs of different stimuli in an abnormal fashion.
Triggers for symptoms include emotional stress, illness, surgery, and trauma.
Criteria for diagnosis of fibromyalgia were formulated by the American
College of Rheumatology (ACR) in 1990. ACR criteria include 2
components: widespread pain above and below the waist including the
axial skeleton and presence of 11 tender points among 18 specified
points.
A careful history, physical examination, and laboratory testing are helpful in defining the diagnosis.
The Fibromyalgia Impact Questionnaire is a self-administered instrument
that is useful in assessing functional abilities in daily life and
outcomes of treatment.
Conditions that should be considered in the differential diagnosis of
fibromyalgia include chronic fatigue syndrome, Lyme disease, rheumatoid
arthritis, systemic lupus erythematosus, Sjogren's disease, polymyalgia
rheumatica, and hypothyroidism. Furthermore, these conditions may also
be present in patients with fibromyalgia, which renders the diagnosis
more difficult.
In recent years, recognition, understanding, and diagnosis of
fibromyalgia have improved. It appears from multiple well controlled
studies that a multidimensional approach is probably the most effective
approach.
Specific treatment recommendations are:
* Patient education
* Cognitive behavioral therapy
* Non impact aerobic exercise
* Physical therapy may be beneficial for some patients.
* Drugs including tricyclic medications, selective serotonin reuptake
inhibitors, selective serotonin and nor-epinephrine uptake inhibitors
may alleviate pain and improve sleep quality and global well-being in
patients with fibromyalgia.
* Cyclobenzaprine (Flexeril) at bedtime, may decrease pain and improve sleep quality in patients with fibromyalgia.
* GABA pathway drugs such as gabapentin (Neurontin) and pregabalin (Lyrica) are helpful for reducing pain.
* Nonnarcotic analgesics and mu antagonists such as tramadol (Ultram) may help with pain.
* Modafinil (Provigil) can help with fatigue. Low grade amphetamines
such as phentermine can also help with fatigue but may aggravate
hypertension.
Nonpharmacologic therapies with moderate evidence of effectiveness in
fibromyalgia are balneotherapy, biofeedback, hypnotherapy, and strength
training.
Evidence to support the use of chiropractic therapy, electrotherapy,
manual and massage therapy, or ultrasound, in patients with
fibromyalgia is weak, but worth trying in selected individuals.
Acupuncture has been used successfully. Serum levels of substance P and
serotonin have been found to be significantly elevated after
acupuncture treatment, suggesting possible mechanisms in pain relief.
Although their effectiveness has not been proven by controlled trials,
other treatment modalities employed include chiropractic therapy, yoga,
Tai Chi, massage therapy, magnetic therapy, and tender-point injections.
Opioids (narcotics), as a rule, are not indicated in the management of fibromyalgia.
Conclusion: Fibromyalgia is a real disease manifested by abnormal
sensory processing of environmental stimuli. It is quite clear that a
multi-faceted approach to the management of this disorder is required
for optimal response. The primary components should consist of patient
education, cognitive behavioral therapy, non impact aerobic exercise,
and individualized medications. The addition of
alternative/complementary therapies should also be considered.
About the Author
Nathan Wei, MD FACP FACR is a Rheumatologist and Director of the
Arthritis and Osteoporosis Center of Maryland. He is a Clinical
Assistant Professor of Medicine at the University of Maryland School of
Medicine. For more info: Arthritis Treatment
|
