Fibromyalgia...pain, fatigue, and short term memory loss- a terrible combination
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Fibromyalgia (FM) is a common condition characterized by generalized pain and fatigue.
The cause is felt to be due to dysfunction of neurotransmitter pathways in the brain.
Several studies have demonstrated different abnormalities in CNS functioning. Abnormal sleep studies showing abnormal delta (stage 4) sleep and altered rapid eye movement (REM) sleep have been seen. In addition, abnormal SPECT scans and functional MRI scans have suggested lower blood flow to areas of the brain such as the thalamus and caudate nucleus.
Between 2-4 per cent of the population has fibromyalgia. About 80 per cent of patients with fibromyalgia are women. While fibromyalgia may occur as a primary condition, it is also a secondary condition, occurring in as many as 30 per cent of patients with systemic lupus erythematosus and rheumatoid arthritis.
Patients with fibromyalgia complain of generalized pain affecting both sides of the body and both the upper as well as lower part of the body.
Pain is aggravated by weather changes as well as by stress.
While patients will complain of subjective joint swelling, objective swelling is absent.
Sleep disturbance is common. Non-restorative sleep is common. Sleep apnea may contribute to the situation.
Tender points are noted in all patients. A patient with 11 of 18 tender points fulfills a major diagnostic criterion for the diagnosis of fibromyalgia. These tender point areas are stereotypic meaning the same areas are tender in all patients with the diagnosis of FM.
Other symptoms include migraine headache, decrease in short term memory, cognitive dysfunction, blurred or double vision, hypersensitivity to sound and smells, shortness of breath, chest pains, palpitations, irritable bowel, irritable bladder, painful menses, painful urination, multiple drug allergies, multiple sensitivities to chemicals.
Laboratory testing will not be diagnostic. However, laboratory testing will help to exclude other conditions such as polymyalgia rheumatica, hypothyroidism, rheumatoid arthritis, systemic lupus erythematosus, Lyme disease, and others that might mimic fibromyalgia. FM is a diagnosis of exclusion so it is important that other possible causes of aches and pains are ruled out.
Imaging tests may also be helpful in establishing the presence or absence of FM. An example might be a patient who complains of hand swelling and pain. MRI or diagnostic ultrasound can confirm the presence of synovitis that might point towards inflammatory arthritis, such as rheumatoid disease.
Treatment must be individualized. Most patients will respond to a combination of non impact aerobic exercise (swimming, stationary bike, elliptical trainer), cognitive behavioral therapy, and medication.
Medications that have been found to be helpful include muscle relaxants such as cyclobenzaprine, in low doses, and selective serotonin reuptake and selective serotonin and nor-epinephrine re-uptake inhibitors (SSRIs).
Other medicines such as gabapentin and tramadol may also be helpful. The most recent drugs approved for use in FM are Lyrica, a GABA stimulator, Savella, and Cymbalta, the latter two being serotonin/nor-epinephrine re-uptake inhibiting drugs. A more complete discussion of FM may be found elsewhere on this site.
Get more information about fibromyalgia as well as...
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Click here Second Opinion Arthritis Treatment Kit
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