Fibromyalgia is a complex medical condition that circles around pain, fatigue, pressure, and other symptoms. It is not well understood, but it appears to affect the central nervous system.

Fibromyalgia is often a condition that is also closely related or affected by other conditions such as depression, post-traumatic stress disorder, and anxiety. Not all individuals experience the entire range of symptoms.

It is seen in women almost 9 times for every 1 times it is seen in men. This condition remains to be elusive in defining a cause or acceptability throughout the medical world.

The belief by some health care providers is that there is a lack of abnormalities on physical exam and there are no objective diagnostic tests that show an abnormality.

It has been recognized as a diagnosable disorder by the National Institute of Health and the American College of Rheumatology.

This is a major issue of Women’s Health

Fibromyalgia breaks down into:

1.)  Fibro  – meaning fibrous tissues

2.)  Myo – meaning muscle

3.)  Algos – meaning pain

Symptoms

–  Heightened sense of pain
–  Pain
–  Pressure
–  Fatigue
–  Sleep problems
–  Joint Stiffness
–  Bowel problems
–  Bladder problems
–  Numbness
–  Tingling
–  Cognitive Dysfunction

*** Pain is often in many locations therefore the diagnosis is often made after several different complaints of body pain with normal X-ray, MRI, and blood work examinations

Causes

–  Currently the cause of fibromyalgia is unknown.
–  Theories range from a mental health initiated pain change.
–  To lower pain threshold because of increased brain sensitivity.
–  Stress may be a cause or at least a precipitating factor.
–  But it is unclear why it affects some people and not others.
–  Lack of sleep may also be a risk factor for this condition.

Diagnosis

–  No single test can help diagnosis a patient.
–  The debate about a proper diagnosis procedure is underway.
–  Lab tests are often normal.
–  Usually diagnosis occurs after many other problems have been eliminated as possibilities.
–  Consideration for age, gender, symptoms, location, medical history, and other factors should be given.

Additional consideration:

–  Widespread pain lasting for more than 3 months affecting both sides of the body and above and below the waist.
–  Tender points – patient must feel pain in 11 of the 18 tender points.

Treatment

–  There is no universally accepted treatment.
–  Symptoms can be different in many cases.
–  Behavioral therapies are designed to help with mental health, fatigue, and inactivity.
–  Exercise if often helpful, though this is light exercise such as walking or pool use for many patients.

Physical Treatment

–  Exercise and fitness helps reduce pain, fatigue, and it improves overall sleep and health
–  Strong evidence that cardiovascular exercise is effective in some patients

Medications

1.) Pregabalin  –  approved for use in Fibromyalgia in June 2007
2.) Duloxetine  –  approved in 2008
3.) Milnacipran  –  approved in 2009

Pregabalin and Duloxetine can help reduce pain in some patients

Antidepressants

–  Quality of life were improved in patients with fibromyalgia by taking something for depression
–  Sleep, fatigue, depression, and other symptoms were improved.

Tramadol

–  This medication is a long acting pain medication
–  Is moderately effective in treating fibromyalgia

Neurontin (gabapentin)

–  An atypical seizure medication that is also used to help tingling and nerve problems.
–  Is also used in some diabetics to help with Neuropathy
–  Is approved for neuropathic pain but is not approved for fibromyalgia
–  Is occasionally used for fibromyalgia

Lyrica  (pregabalin)

–  Is used for treatment of nerve pain in Diabetics
–  Some benefit is seen in a small population of patients with fibromyalgia
–  Is not approved for fibromyalgia
–  Is occasionally used for fibromyalgia

Mirapex and Requip

–  Has some improvement
–  Many side effects make these medications more of a concern than a treatment option

Muscle Relaxers

  –  Flexeril (Cyclobenzaprine) is occasionally used to help muscle pains felt by those with fibromyalgia.
–  It has been studied for this use
–  Has mild improvement overall
–  Tizanidine is another muscle relaxer
–  Is typically used less often than Flexeril

Opioids

–  These are stronger pain medications called Narcotics
–  This medication should be the last tried medication for pain
–  It is not often a good option unless all other avenues have been evaluated
–  The risk for abuse often outweighs the benefits gained.
–  Addiction is another concern
–  No actual studies have shown benefit of opioids and fibromyalgia
–  Symptoms may actually worsen when taking

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