What is fibre myalgia
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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Fibre myalgia or fibromyalgia, as it is better known, is a common condition characterized by generalized pain and fatigue.
It is considered a form of arthritis. The cause is unknown but theories implicating abnormal hypothalamic pituitary axis function or dysfunction of neurotransmitter pathways in the brain are currently popular.
Fibromyalgia is one of the most common causes of aches and pains. The definition of fibromyalgia is best described by criteria formulated by the American College of Rheumatology in 1990. These criteria are:
• Widespread pain of three or more months duration. (Widespread pain being defined as pain affecting the spine and affecting both sides of the body and pain above and below the waist.)
• Pain present in 11 or more out of 18 specified tender points on pressure exerted with a force of 4 kg (the amount of pressure required to blanch a thumbnail).
These criteria were revised recently but the changes were not that great.
Several studies have demonstrated different abnormalities in CNS functioning. Abnormal sleep studies showing alpha intrusion during delta (stage 4) sleep and a reduction of rapid eye movement (REM) sleep have been seen. In addition, abnormal SPECT scans have suggested lower blood flow to the thalamus and caudate nucleus in fibromyalgia patients.
Approximately 2 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 tends to be aggravated by weather changes as well as by stress.
While patients will complain of subjective joint swelling, objective swelling is absent.
Sleep disturbance occurs in almost all patients. Complaints of chronic fatigue and non restorative sleep (feeling as if they haven’t slept) are common. Sleep apnea may confound 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 point tender areas are stereotypic meaning the same areas are tender in all patients with the diagnosis of FM. However, adhering to this specific pattern can be misleading since fibromyalgia patients are tender all over.
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.
In fact, the types of symptoms a patient presents with may determine what type of physician that patient will seek out. For instance, patients with bowel symptoms may see a gastroenterologist. Patients with bladder irritability may see a urologist. Patients for whom depression is a problem may see a psychiatrist, and patient s who complain of migraine headaches may see a neurologist. Unexplained aches and pains will usually send a patient to see a rheumat5ologist or even an orthopedic surgeon.
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, etc., that might masquerade as fibromyalgia. FM is a diagnosis of exclusion so it is imperative that other possible causes of aches and pains are ruled out.
Imaging tests may also be helpful in establishing the presence or absence of other conditions.
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 tricyclic antidepressants in low doses, muscle relaxants such as cyclobenzaprine, also in low doses, and selective serotonin reuptake inhibitors (SSRIs) as well as selective serotonin and norepinephrine re-uptake inhibitors (Savella, Cymbalta).
Other medicines such as gabapentin (Neurontin), pregabalin (Lyrica), Cymbalta, and tramadol (Ultram)may also be helpful. A more complete discussion of FM may be found elsewhere.
More recently, drugs such as Mirapex have been used for their dopaminergic effect.
Get more information about fibromyalgia and related topics as well as...
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Second Opinion Arthritis Treatment Kit
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