Fibromyalgia Symptoms, Diet, Treatment: What is Fibromyalgia?

What is Fibromyalgia?

Fibromyalgia is the most common musculoskeletal condition after osteoarthritis. Still, it is often misdiagnosed and misunderstood. Its characteristics include widespread muscle and joint pain and fatigue as well as other symptoms. Fibromyalgia can lead to depression and social isolation.

This overview of fibromyalgia syndrome (FMS) covers symptoms, diagnosis and treatment, and the impact fibromyalgia has on lives. The impact comes from the tremendous physical and psychological strains that come with FMS. Those strains can lead to loss of work hours, reduced income, and even job loss.

Fibromyalgia Quick Facts

  • Fibromyalgia affects 3 to 5 percent of the general population

  • It occurs in people of all ages, even children

  • Men develop fibromyalgia too, although more women are diagnosed with it

  • It is characterized by chronic widespread pain and allodynia (a heightened and painful response to pressure) and causes stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation

  • Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some patients also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction

  • Symptoms are chronic but may fluctuate throughout the day

  • Roughly one-quarter of people with fibromyalgia are work-disabled

  • Three drugs are FDA-approved for fibromyalgia treatment

  • Fibromyalgia does not cause body damage or deformity

  • Fatigue occurs in 90% of patients with fibromyalgia

  • Irritable bowel syndrome can occur with fibromyalgia

  • Sleep disorder is common in patients with fibromyalgia

  • There is no test for the diagnosis of fibromyalgia

  • Fibromyalgia can be associated with other rheumatic conditions

  • Fibromyalgia treatment is most effective with combinations of education, stress reduction, exercise, and medications

Are Women More Likely to Get Fibromyalgia Than Men?

More than 12 million Americans have fibromyalgia. Most of them are women ranging in age from 25 to 60. Women are 10 times more likely to get this disease than men.

What Are Fibromyalgia Symptoms?

Fibromyalgia causes you to ache all over. You may have symptoms of crippling fatigueeven on arising. Specific tender points on the body may be painful to touch. You may experience swelling, disturbances in deep-level or restful sleep, and mood disturbances or depression.

Your muscles may feel like they have been overworked or pulled. They will feel that way even without exercise or another cause. Sometimes, your muscles twitch, burn, or have deep stabbing pain.

Some patients with fibromyalgia have pain and achiness around the joints in the neck, shoulder, back, and hips. This makes it difficult for them to sleep or exercise. Other fibromyalgia symptoms include:

  • abdominal pain

  • anxiety and depression

  • chronic headaches

  • difficulty maintaining sleep or light sleep

  • dryness in mouth, nose, and eyes

  • fatigue upon arising

  • hypersensitivity to cold and/or heat

  • inability to concentrate (called "fibro fog")

  • incontinence

  • irritable bowel syndrome

  • numbness or tingling in the fingers and feet

  • stiffness

Fibromyalgia can cause signs and feelings similar to osteoarthritis, bursitis, and tendinitis. Some experts include it in this group of arthritis and related disorders. However, while the pain of bursitis or tendinitis is localized to a specific area, pain and stiffness with fibromyalgia are widespread.

Fibromyalgia has been recognized as a diagnosable disorder by the US National Institutes of Health and the American College of Rheumatology. Fibromyalgia, a central nervous system disorder, is described as a 'central sensitization syndrome' caused by neurobiological abnormalities which act to produce physiological pain and cognitive impairments as well as neuro-psychological symptomatology. Despite this, some health care providers remain skeptical about fibromyalgia as a disease because of a lack of abnormalities on physical examination and an absence of objective diagnostic tests.

What Tests Are Used to Diagnose Fibromyalgia?

There are no specific laboratory tests to diagnose fibromyalgia. To make an accurate diagnosis, your doctor will rely on a comprehensive physical exam and your medical history. Fibromyalgia is mostly a diagnosis of exclusion. That means the doctor will rule out other conditions that could cause similar symptoms.

To rule out more serious illnesses, your doctor may run some specific blood tests. For example, your doctor may ask for a complete blood count (CBC). The doctor may also ask for tests for chemicals, such as glucose, that can create problems similar to problems caused by fibromyalgia. A thyroid test may also be done. An underactive thyroid (hypothyroidism) can cause problems similar to fibromyalgia. That includes fatigue, muscle aches, weakness, and depression.

Other laboratory tests used to rule out serious illnesses may include Lyme titers, antinuclear antibodies (ANA), rheumatoid factor (RF), erythrocyte (red blood cell) sedimentation rate (ESR), prolactin level, calcium level, and vitamin D level.

Your doctor may see if your symptoms satisfy the diagnostic criteria for fibromyalgia syndrome outlined by the American College of Rheumatology. These criteria include widespread pain that persists for at least three months. Widespread pain refers to pain that occurs in both the right and left sides of the body, both above and below the waist, and in the chest, neck, and mid or lower back. The criteria also include the presence of tender points at various spots on the body.

The doctor will evaluate the severity of related symptoms such as fatigue, sleep disturbances, and mood disorders. This will help measure the impact FMS has on your physical and emotional function as well as on your overall health-related quality of life.

What Is the Standard Treatment for Fibromyalgia?

There is no fibromyalgia cure. And there is no treatment that will address all of the fibromyalgia symptoms. Instead, a wide array of traditional and alternative treatments has been shown to be effective in treating this difficult syndrome. A treatment program may include a combination of medications, exercises -- both strengthening and aerobic conditioning -- and behavioral techniques.

What Drugs Are Used to Treat Fibromyalgia?

According to the American College of Rheumatology, drug therapy for fibromyalgia primarily treats the symptoms. The FDA has approved three drugs to treat fibromyalgia: Lyrica, Cymbalta, and Savella. The FDA says Lyrica -- which is also used to treat nerve pain caused by shingles, diabetes, and spinal cord injuries -- can ease fibromyalgia pain for some patients. Cymbalta and Savella are in a class of drugs known as serotonin and norepinephrine reuptake inhibitors (SNRIs).

Low doses of tricyclic drugs such as Flexeril and amitriptyline have been found effective in treating the pain of FMS. In addition, positive results have been shown with the antidepressants known as dual reuptake inhibitors (Effexor). Ultram is a pain-relieving medicine that can be helpful.

Your doctor may prescribe an antidepressant such as Prozac, Paxil, or Zoloft. These drugs may help relieve feelings of depression, sleep disorders, and pain. Recently, researchers have found that the antiepileptic Neurontin is promising for fibromyalgia treatment.

The nonsteroidal anti-inflammatory drugs (NSAIDs, including Cox-2 inhibitors, have not been found to be effective for treating FMS pain. It's usually best to avoid opioid pain medications because they tend not to work well in the long-run and can lead to problems with dependency.

Are There Alternative Treatments for Fibromyalgia?

Alternative therapies, although they are not well-tested, can help manage the symptoms of fibromyalgia. For instance, therapeutic massage manipulates the muscles and soft tissues of the body and helps ease deep muscle pain. It also helps relieve pain of tender points, muscles spasms, and tense muscles. Similarly, myofascial release therapy, which works on a broader range of muscles, can gently stretch, soften, lengthen, and realign the connective tissue to ease discomfort.

The American Pain Society recommends moderately intense aerobic exercise at least two or three times a week. They also endorse clinician-assisted treatments, such as acupuncture, therapeutic massage, and chiropractic manipulation for pain relief.

Along with alternative therapies, it's important to allow time each day to rest and relax. Relaxation therapies -- such as deep muscle relaxation or deep breathing exercises -- may help reduce the added stress that can trigger fibromyalgia symptoms. Having a regularly scheduled bedtime is also important. Sleep is essential to let the body repair itself.

Fibromyalgia Symptoms

You've probably read about fibromyalgia symptoms such as pain, fatigue and fibro fog, but the list of possible signs and symptoms of fibromyalgia are far-reaching and body-wide. Those tiny lists don't even begin to describe our experience! I put together this "monster list" of 60+ fibromyalgia symptoms to let you know that you're not alone! The list is adapted from one put together by fibromyalgia expert Devin Starlanyl along with recent research.

Many of these fibromyalgia symptoms also can be caused by other ailments and this list isn't intended as a diagnostic tool. Knowing the full range of symptoms, however, can help you track them either to help your doctor reach a diagnosis or to help you identify triggers.

Some of the following are noted as overlapping conditions, which means they commonly occur with fibromyalgia but actually are conditions that need to be diagnosed and treated separately.

People with fibromyalgia can have any combination of the following symptoms, and to varying degrees of severity.

FIBROMYALGIA SYMPTOMS CHECKLIST

General Fibromyalgia Symptoms

  • Delayed reactions to physical exertion or stressful events

  • Other family members with fibromyalgia (genetic predisposition)

  • Sweats

  • Unexplained weight gain or loss

  • Cravings for carbohydrate and chocolate

  • Headaches & migraines

  • Vision changes, including rapidly worsening vision

Muscle & Tissue-Related Fibromyalgia Symptoms

  • Pain that ranges from mild to severe, and may move around the body

  • Morning stiffness

  • Muscle twitches

  • Diffuse swelling

  • Fibrocystic (lumpy, tender) breasts (as an overlapping condition)

Sinus & Allergy-Related Fibromyalgia Symptoms

  • Allergies

  • Post nasal drip

  • Runny nose

  • Mold & yeast sensitivity

  • Shortness of breath

  • Earaches & itchy ears

  • Ringing ears (tinitis)

  • Thick secretions

Sleep-Related Fibromyalgia Symptoms

  • Light and/or broken sleep pattern with unrefreshing sleep

  • Fatigue

  • Sleep starts (falling sensations)

  • Twitchy muscles at night

  • Teeth grinding (bruxism)

Reproductive Fibromyalgia Symptoms

  • Menstrual problems

  • PMS (as an overlapping condition)

  • Impotence

Abdominal & Digestive Fibromyalgia Symptoms

  • Bloating & nausea

  • Abdominal cramps

  • Pelvic pain

  • Irritable bowel syndrome (as an overlapping condition)

  • Urinary frequency

Cognitive/Neurological Fibromyalgia Symptoms

  • Difficulty speaking known words, other language impairments (dysphasia)

  • Directional disorientation

  • Poor balance and coordination

  • Paresthesias in the upper limbs (tingling or burning sensations)

  • Loss of ability to distinguish some shades of colors

  • Short-term memory impairment

  • Confusion

  • Trouble concentrating

  • Staring into space before brain "kicks in"

  • Inability to recognize familiar surroundings

Sensory Fibromyalgia Symptoms

  • Sensitivity to odors

  • Sensitivity to pressure changes, temperature & humidity

  • Sensitivity to light

  • Sensitivity to noise

  • Night driving difficulty

  • Sensory overload

Emotional Fibromyalgia Symptoms

  • Panic attacks

  • Depression (as an overlapping condition)

  • Tendency to cry easily

  • Free-floating anxiety (not associated with situation or object)

  • Mood swings

  • Unaccountable irritability

Heart-Related Fibromyalgia Symptoms

  • Mitral valve prolapse (as an overlapping condition)

  • Rapid, fluttery, irregular heartbeat

  • Pain that mimics heart attack, frequently from costochondritis (as an overlapping condition)

Skin, Hair & Nail-Related Fibromyalgia Symptoms

  • Pronounced nail ridges

  • Nails that curve under

  • Mottled skin

  • Bruising or scarring easily

  • Hair loss (temporary)

  • Tissue overgrowth (non-cancerous tumors called lipomas, ingrown hairs, heavy and splitting cuticles, adhesions)

Most Common Fibromyalgia Symptoms

Pain All Over – People describe fibromyalgia pain as deep muscular aching, throbbing, shooting, stabbing, or intense burning. Muscle groups used the most may hurt more. In addition, the severity of regional pains can make your fibromyalgia symptoms worse.

Fatigue – Exhaustion can be one of the most incapacitating fibromyalgia symptoms. You may feel as though your arms and legs are weighted down by concrete blocks and your body may be so drained of energy that every task requires great effort.

Sleep Difficulties – It’s not just about falling asleep. Repeat arousals prevent you from reaching deep, restorative sleep, so you wake up feeling as though you have been hit by a Mack truck. An overnight sleep study may show symptoms of repeat arousals, but a specific sleep disorder may not be found.

Brain Fog – Trouble concentrating, retaining new information, and word-finding are common fibromyalgia symptoms that seriously interfere with daily functioning. You may be easily distracted and this symptom appears to correspond to the severity of pain (as though the brain is consumed by the pain, limiting your ability to perform cognitive tasks).

Morning Stiffness – You may wake up to enhanced muscle soreness with fibromyalgia, but you probably also feel more stiff than usual. The cause of these muscle symptoms is unknown, but warm water and gentle stretching usually help alleviate them.

Muscle Knots, Cramping, Weakness – No matter how much you try to relax your muscles, they may feel tense. Many contain rope-like knots called myofascial trigger points, making you more susceptible to muscle cramping and weakness. The pain of fibromyalgia may also be a source of muscle weakness.

Digestive Disorders – Constipation, diarrhea, abdominal pain, gas and bloating, irritable bowel, and nausea are found in roughly 40 to 70% of fibromyalgia patients. Acid reflux and a slowed digestion are also common.

Headaches/Migraines – Recurrent tension headaches or migraines are present in 50 to 70% of fibromyalgia patients. Headache symptoms are usually rated as severe, occur at least two times per week, and often have a migraine component. This head pain is partly due to trigger points in the shoulder, neck, and head muscles.

Balance Problems – Balance confidence is greatly reduced in people with fibromyalgia. Walking patterns are altered and the odds of falling are increased.

Itchy/Burning Skin – Your skin may look normal or it may have itchy red bumps similar to hives. Burning pain, similar to a bad sunburn, is also common in fibromyalgia patients.

Other Strange Symptoms? – Do bright lights, sounds, or odors bother you? These symptoms could be part of your fibromyalgia.

IMPORTANT INFORMATION

If you have fibromyalgia you are ill.

You are NOT crazy.

"You may have been told that whatever you have is untreatable or that your symptoms are all in your head. People think you're a hypochondriac and doctors may not want to handle your case. Or you may have been overmedicated by well-intentioned health care providers who wanted desperately to help you. You may be having trouble getting refills for medications that make your life tolerable. You may be in danger of losing your job and your relationships. You may have fallen victim to those who are making billions of dollars a year off those desperately searching for something, anything, that will help..."

When we first put up this website many doctors didn't believe in fibromyalgia. As a result, patients faced a daunting journey at odds with their physicians, families, employers and insurance companies. But now that big pharmaceutical companies have discovered how lucrative chronic illnesses are, things have changed. Now everyone knows fibromyalgia is real because it's advertised on television and in magazines. Lyrica, Cymbalta, and Savella sound great until you read the small print or try one and it doesn't agree with you. Then you realize these "new"* potent drugs relieve some of your symptoms while altering the chemistry of your brain. Not to mention side effects such as weight gain, fatigue, hair loss, headaches and thinning of your bones... If you live in Europe these drugs may not even be available because their performance didn't outweigh their risks in studies.

*("new" is in quotes because none of these drugs are members of a new class, rather they are cousins of existing compounds which by an odd coincidence have recently gone generic)

What's lost in all this commotion is that none of these expensive compounds will actually treat fibromyalgia. They, and earlier medications like them, simply change the way your brain perceives your symptoms. Usually their side effects require other medications to counteract them. So here we are in 2013, and the accepted regimen for fibromyalgia is still a balancing act of polypharmacy while your illness continues to get worse and eventually requires stronger medications. To make a bad situation more dismal, many patients are disabled and simply cannot afford expensive medications, but the truth is that even in the best designed clinical trials their success rate was modest when compared,--not to other drugs--but to sugar pills!

Results are what count. There is hope. We use a simple medication with no side effects that can actually reverse your fibromyalgia. As time goes by, you'll need fewer drugs, not more. We have walked in your shoes. We have fibromyalgia too. Dr. St. Amand is in practice in Los Angeles, California, and is still accepting new patients.

We are not the latest miracle cure.

Treatment of fibromyalgia has become a multi-billion dollar industry and we have no objection to profit. We are often asked why the Fibromyalgia Treatment Center does not manufacture, distribute, or promote any particular brand of guaifenesin for the treatment of fibromyalgia. Simply, our mission is to educate -- based on fifty years of diligent, honest research. We will not risk compromising the integrity of our work with the perception of ulterior motivation.

In 2008 we published a paper showing that some abnormal findings in fibromyalgia were changed by patients taking guaifenesin. The link to that paper is on the upper right side of this site. Two more papers are currently being prepared.

 If, after thorough investigation you determine that implementing the guaifenesin protocol is appropriate for you, it is critically important that it be adhered to precisely. We are here to help.

To continue reading, please visit: http://www.fibromyalgiatreatment.com/

Advanced Information

What is Fibromyalgia?

Fibromyalgia is a chronic condition that causes pain, stiffness, and tenderness of the muscles, tendons, and joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, chronic fatigue, anxiety, depression, and disturbances in bowel function. Fibromyalgia is sometimes referred to as fibromyalgia syndrome and abbreviated FMS. Fibromyalgia was formerly known as fibrositis.

While fibromyalgia is one of the most common diseases affecting the muscles leading to chronic pain and disability, its cause is currently unknown. The painful tissues involved are not accompanied by tissue inflammation. Therefore, despite potentially disabling body pain, patients with fibromyalgia do not develop body damage or deformity. Fibromyalgia also does not cause damage to internal body organs. In this sense, fibromyalgia is different from many other rheumatic conditions (such as rheumatoid arthritis, systemic lupus, and polymyositis). In those diseases, tissue inflammation is the major cause of pain, stiffness, and tenderness of the joints, tendons and muscles, and it can lead to joint deformity and damage to the internal organs or muscles.

What causes fibromyalgia?

The cause of fibromyalgia is not known. Those affected experience pain in response to stimuli that are normally not perceived as painful. Researchers have found elevated levels of a nerve chemical signal, called substance P, and nerve growth factor in the spinal fluid of fibromyalgia patients. Levels of the brain chemical serotonin are also relatively low in patients with fibromyalgia. Studies of pain in fibromyalgia have suggested that the central nervous system (brain) may be somehow supersensitive. Scientists note that there seems to be a diffuse disturbance of pain perception in patients with fibromyalgia.

Also, patients with fibromyalgia have an impaired non-rapid eye movement, or non-REM, sleep phase (which likely, at least in part, explains the common feature of waking up fatigued and unrefreshed in these patients). The onset of fibromyalgia has been associated with psychological distress, trauma, and infection.

Whom does fibromyalgia affect?

Fibromyalgia affects predominantly women (over 80% of those affected are women) between the ages of 35 and 55. Less commonly, fibromyalgia can also affect men, children, and the elderly. It can occur independently or can be associated with another disease, such as systemic lupus or rheumatoid arthritis. The prevalence of fibromyalgia varies in different countries. In Sweden and Britain, 1% of the population is affected by fibromyalgia. In the United States, approximately 4% of the population has fibromyalgia.

What are fibromyalgia symptoms and signs?

The universal symptom of fibromyalgia is pain. As mentioned earlier, the pain in fibromyalgia is not caused by tissue inflammation. Instead, these patients seem to have an increased sensitivity to many different sensory stimuli and an unusually low pain threshold. Minor sensory stimuli that ordinarily would not cause pain in individuals can cause disabling, sometimes severe pain in patients with fibromyalgia. The body pain of fibromyalgia can be aggravated by noise, weather change, and emotional stress.

The pain of fibromyalgia is generally widespread, involving both sides of the body. Pain usually affects the neck, buttocks, shoulders, arms, the upper back, and the chest. "Tender points" are localized areas of the body that are tender to light touch. Fibromyalgia tender points, or pressure points, are commonly found around the elbows, shoulders, knees, hips, back of the head, and the sides of the breastbone and are typical signs of fibromyalgia.

Fatigue occurs in 90% of patients. Fatigue may be related to abnormal sleep patterns commonly observed in these patients. Normally, there are several levels of depth of sleep. Getting enough of the deeper levels of sleep may be more important in refreshing a person than the total number of hours of sleep. Patients with fibromyalgia lack the deep, restorative level of sleep, called "non-rapid eye movement" (non-REM) sleep. Consequently, patients with fibromyalgia often awaken in the morning without feeling fully rested, even though they seem to have had an adequate number of hours of sleep time. Some patients awaken with muscle aches or a sensation of muscle fatigue as if they had been "working out" all night!

Mental and/or emotional disturbances occur in over half of people with fibromyalgia. These symptoms include poor concentration, forgetfulness, and memory problems, as well as mood changes, irritability, depression, and anxiety. Since a firm diagnosis of fibromyalgia is difficult and no confirmatory laboratory tests are available, patients with fibromyalgia are often misdiagnosed as having depression as their primary underlying problem.

Other symptoms of fibromyalgia include migraine and tension headaches, numbness or tingling of different parts of the body, abdominal pain related to irritable bowel syndrome ("spastic colon"), and irritable bladder, causing painful and frequent urination. Like fibromyalgia, irritable bowel syndrome can cause chronic abdominal pain and other bowel disturbances without detectable inflammation of the stomach or the intestines.

Each patient with fibromyalgia is unique. Any of the above symptoms can occur intermittently and in different combinations.

How is fibromyalgia diagnosed?

There are no blood tests or X-ray tests that specifically point the doctor to the diagnosis of fibromyalgia. These tests are done to exclude other possible diagnoses. Therefore, the diagnosis of fibromyalgia is made purely on clinical grounds based on the doctor's history and physical examination. In patients with chronic widespread body pain, the diagnosis of fibromyalgia can be made by identifying point tenderness areas (typically, but not always, patients will have at least 11 of the 18 classic fibromyalgia tender points), by finding no accompanying tissue swelling or inflammation, and by excluding other medical conditions that can mimic fibromyalgia. Many medical conditions can cause pain in different areas of the body, mimicking fibromyalgia. These conditions include

  • low thyroid hormone levels (hypothyroidism),

  • vitamin D insufficiency,

  • parathyroid disease (causing elevated blood calcium level),

  • muscle diseases causing muscle pain (such as polymyositis),

  • bone diseases causing bone pain (such as Paget's disease),

  • elevated blood calcium (hypercalcemia),

  • infectious diseases (such as hepatitis, Epstein Barr virus, AIDS),

  • and cancer.

Again, even though there is no blood test for fibromyalgia, blood tests are important to exclude other medical conditions. Therefore, thyroid hormone and calcium blood levels are obtained to exclude hypercalcemia, hyperparathyroidism, and hypothyroidism. The blood alkaline phosphatase (a bone enzyme) level is often raised in patients with Paget's disease of the bone. The CPK (a muscle enzyme) level is often elevated in patients with polymyositis, a disease with diffuse muscle inflammation. Therefore, obtaining alkaline phosphatase and CPK blood levels can help the doctor decide whether Paget's disease and polymyositis are the causes of bone and muscle pains. A complete blood count (CBC) and liver tests help in the diagnosis of hepatitis and other infections. A blood vitamin D level can detect vitamin D insufficiency.

Fibromyalgia can occur alone or in association with other systemic rheumatic conditions. Systemic rheumatic conditions refer to diseases that can cause inflammation and damage to numerous different tissues and organs in the body. Systemic rheumatic conditions associated with fibromyalgia include systemic lupus erythematosus, rheumatoid arthritis, polymyositis, and polymyalgia rheumatica. Blood tests which are helpful in evaluating these diseases when they are suspected include erythrocyte sedimentation rate (ESR), serum protein electrophoresis (SPEP), antinuclear antibody (ANA), and rheumatoid factor (RF). In patients with fibromyalgia without associated systemic illnesses, the ESR, SPEP, ANA, and RF blood tests are usually normal.

Are exercise, stress reduction, or changes in diet helpful in the treatment of fibromyalgia?

Since the symptoms of fibromyalgia are diverse and vary among patients, treatment programs must be individualized for each patient. Fibromyalgia treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Recent studies have verified that the best outcome for each patient results from a combination of approaches that involves the patient in customization of the treatment plan.

Patient education

Patient education is an important first step in helping patients understand and cope with the diverse symptoms. Unfortunately, not all physicians are intimately acquainted with the vagaries of this illness. Therefore, community hospital support groups and the local chapters of the Arthritis Foundation have become important educational resources for patients and their doctors. The Arthritis Foundation is a national voluntary health organization that provides community education through their many local chapters. Community hospital support groups also provide an arena for patients to share their experiences and treatment successes and failures.

Stress reduction

It is extremely difficult to measure stress levels in different patients. For some people, spilling milk on the table can represent a significant tragedy. For others, a tank rolling into the living room might represent just another day! Therefore, stress reduction in the treatment of fibromyalgia must be individualized. Stress reduction might include simple stress modification at home or work, biofeedback, relaxation tapes, psychological counseling, and/or support among family members, friends, and doctors. Sometimes, changes in environmental factors (such as noise, temperature, and weather exposure) can exacerbate the symptoms of fibromyalgia, and these factors need to be modified. Optimal sleep is encouraged.

Exercise

Low-impact aerobic exercises, such as swimming, cycling, walking, and stationary cross-country ski machines, can be effective fibromyalgia treatments. Exercise regimens are most beneficial when performed on an every-other-day basis, in the morning. How exercise benefits fibromyalgia is unknown. Exercise may exert its beneficial effect by promoting a deep level of sleep (non-REM sleep). Sometimes physical therapy can be helpful to optimally guide the exercise plan.

Fibromyalgia diet

Similarly, avoiding alcohol and caffeine before bedtime can also help promote a more restful sleep. Foods that lead to comfortable sleep should be favored. While these dietary changes may not apply to everyone, they can be very helpful for some. There is no specific fibromyalgia diet or food supplements that are recommended for all patients. When patients have accompanying irritable bowel syndrome, the diet should be adjusted to not aggravate the bowels. Likewise, when patients have accompanying interstitial cystitis, foods that irritate the bladder should be avoided.

What are medications and other forms of treatment for fibromyalgia?

Traditionally, the most effective medications in the treatment of fibromyalgia have been the tricyclic antidepressants, medications traditionally used in treating depression. In treating fibromyalgia, tricyclic antidepressants are taken at bedtime in doses that are a fraction of those used for treating depression and actually can be beneficial as sleep aids. Tricyclic antidepressants appear to reduce fatigue, relieve muscle pain and spasm, and promote deep, restorative sleep in patients with fibromyalgia. Scientists believe that tricyclics work by interfering with a nerve transmitter chemical in the brain called serotonin. Examples of tricyclic antidepressants commonly used in treating fibromyalgia include amitriptyline (Elavil) and doxepin (Sinequan).

Studies have shown that adding fluoxetine (Prozac), or related medications, to low-dose amitriptyline further reduces muscle pain, anxiety, and depression in patients with fibromyalgia. The combination is also more effective in promoting restful sleep and improving an overall sense of well-being. These two medications also tend to cancel out certain side effects each can have. Tricyclic medications can cause tiredness and fatigue, while Prozac can make patients more cheerful and awake. A study of patients with resistant fibromyalgia found that lorazepam (Ativan) was helpful in relieving symptoms. Prozac has also been shown to be effective when used alone for some patients with fibromyalgia. Trazodone can be taken at bedtime to improve sleep when tricyclic antidepressants are not tolerated.

In 2007, pregabalin (Lyrica) became the first medication approved specifically for treating fibromyalgia. Lyrica may work by blocking nerve pain in patients with fibromyalgia. Lyrica has advantages of flexible dosing that can be adjusted according to persisting symptoms. A related medication, gabapentin (Neurontin), is also used to treat fibromyalgia.

More recently, drugs that simultaneously increase the amount of two brain nerve transmitters, serotonin and norepinephrine, have been approved to treat fibromyalgia in adults. These drugs include duloxetine (Cymbalta) and milnacipran (Savella). Research studies have shown significant effectiveness in decreasing pain and improving function in patients with fibromyalgia with these drugs. Cymbalta has been effective in treating depression and relieving pain in people with depression and is also used to treat anxiety.

Other fibromyalgia treatments

Local injections of analgesics and/or cortisone medication into the tender point areas can also be helpful in relieving painful soft tissues, while breaking cycles of pain and muscle spasm. Some studies indicate that the pain reliever tramadol (Ultram) and tramadol/acetaminophen (Ultracet) may be helpful for the treatment of fibromyalgia pains. The muscle relaxant cyclobenzaprine (Flexeril) has been helpful for reducing pain symptoms and improving sleep.

The nonsteroidal anti-inflammatory drugs (NSAIDs), while very helpful in treating other rheumatic conditions, have only a limited value in treating fibromyalgia pain. Narcotic pain relievers and cortisone medications have not been shown to be beneficial in this condition. Narcotics and cortisone medications are avoided because they have not been shown to be beneficial, and they have potential adverse side effects, including dependency, when used long term.

Both biofeedback and electroacupuncture have been used for relief of symptoms with some success. Standard acupuncture has also been reported to be effective in treating some patients with fibromyalgia. Massage therapy is beneficial for some.

Of note, there are many other modalities and medications that are touted to be helpful for patients with this chronic condition. Unfortunately, most have no scientific basis for their usage. This includes guaifenesin (Humibid, Humibid LA, Robitussin, Organidin NR, Fenesin), copper bracelets, and magnets. Consumers should be especially cautious when products come with marketing claims such as "will cure," "ancient remedy," "has no side effects," and "revolutionary new scientific breakthrough."

What is the outlook (prognosis) for patients with fibromyalgia?

The outlook for patients with fibromyalgia is generally quite good. It is important to note that fibromyalgia is not an organ-threatening illness. Those patients with an approach to treatment that involves optimal understanding of the condition, as well as sleep improvement, stress reduction, and exercise, tend to do best.

Can fibromyalgia be prevented?

There is no method of preventing fibromyalgia. Exacerbations of fibromyalgia can be minimized with exercise, promotion of optimal sleep, stress reduction, and proper medical treatment.

What is in the future for fibromyalgia therapy?

The key to unlocking the mystery of fibromyalgia has yet to be found. Research scientists have been studying numerous viruses as potential causes for fibromyalgia. Identification of an infectious agent or toxin which causes the disease may one day lead to a laboratory test that can help doctors diagnose fibromyalgia. Specific fibromyalgia treatment aimed at a cure awaits future research that uncovers the exact cause of the disease.

Recent scientific studies suggest that a specific area of the brain called the insula may be involved in the pathophysiology of fibromyalgia. New drugs may be developed that block substance P or nerve growth factor to relieve pain of fibromyalgia. Many fibromyalgia patients can be helped by improved patient education, proper exercise, and medications. With ongoing research, the future prognosis will certainly improve for those affected by fibromyalgia.

Fibromyalgia and Diet

Use Food to Help Fight Fatigue

Choosing the right foods may help you keep your energy level more consistent and prevent fatigue.

"We know anecdotally that certain dietary choices -- like eating small meals frequently throughout the day -- can help energy levels," says Ann Vincent, MD, assistant professor of medicine and medical director of Mayo Clinic's Fibromyalgia Clinic in Rochester, Minn. "It can help to eat a snack with a little protein, for example, when you're feeling tired at three in the afternoon," she says.

Make sure you eat breakfast, which should include some protein and whole grains, says Christine Gerbstadt, MD, RD, MPH, a spokeswoman for the Academy of Nutrition and Dietetics and a registered dietician and practicing physician in Sarasota, Fla.

"You could try eating a boiled egg and some oatmeal," Gerbstadt says. "That will prevent your blood sugar from spiking and will give you the right kind of energy to get you going through the morning, even if your body is aching and you're feeling tired.

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