Fibromyalgia
May 4, 2005
By Tari Roche, DO
Achy all over????? Read on…
Fibromyalgia is becoming one of the more common health problems I see. While we still lack basic knowledge of what causes Fibromyalgia, we do have a pretty clear understanding of how to diagnose and treat it.
Affecting about six million Americans, Fibromyalgia is estimated to plague 3.4% of all women and 0.5% of all men. The disease peaks between the ages of 45 and 60. Symptoms include achiness at specific “trigger points” throughout the body (see diagram), fatigue, sleep disturbances, anxiety, irritable bowel syndrome, headache, or other neurological problems. Diagnosis of this syndrome requires widespread pain over a minimum of three months, plus at least 11 of the 18 “trigger points”
Although no one knows for sure what causes the problem, researchers have found some common themes that may lead to a discovery. For one, it is estimated more than 50% of Fibromyalgia patients suffer from some sort of posttraumatic stress disorder as well. The theory involves the incoming and outgoing pathways for pain, and that traumatic events cause the outgoing pathways to change the chemistry of the incoming messages. In my own practice, I have come to recognize Fibromyalgia as the body’s memory, at a biochemical level, of past painful experiences. Almost all of the patients I treat for Fibromyalgia can connect a traumatic event in the past to their pain. The inciting injury can be whiplash, a history of physical abuse, or surviving a terrifying natural disaster. It may also be an emotional traumatic event such as the unexpected death of a loved one, or being a victim of emotional or sexual abuse. Certain viral exposures and autoimmune disorders may also trigger the onset of Fibromyalgia.
Treatment for Fibromyalgia focuses on symptom control. I encourage my patients to look at it as a chronic disease for which certain life style changes can vastly improve their quality of life. First, I get them to exercise for 30 minutes at least three or four times a week. If this is too painful I suggest they exercise in a pool. Often physical therapy and chiropractic treatments can help. Massage and acupuncture also may be helpful.
Medication for Fibromyalgia varies based on the associated symptoms. Often antiseizure or antidepressant medications can be helpful. Anti-inflammatories are useful for pain control, and sometimes muscle relaxers help too. Special medication for treatment of associated migraine headaches or irritable bowl syndrome can be used. Often a seratonin reuptake inhibitor is added to control anxiety and depression, and to help with pain control. I have found it helps my patients to treat the specific trigger point pain with local anesthetic, either in the form of injections or patches. Steroid injections into painful areas can help too. Many doctors discourage the use of narcotics for the treatment of Fibromyalgia, especially for long-term care. I find my patients who stay involved in work, social interactions, and activities they enjoy, despite the pain, make the most progress.