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Fibromyalgia

What is fibromyalgia?

Common fibromyalgia symptoms include deep muscle pain, fatigue, morning stiffness, headaches (often including migraine), sleep problems, constipation or diarrhea, memory problems, and anxiety or depression. But not all people with fibromyalgia suffer the same symptoms.

According to the Mayo Clinic,

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Women are much more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.

The pain associated with fibromyalgia often is described as a constant dull ache, typically arising from muscles. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

Symptoms

Fibromyalgia is characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points. Tender point locations include:

  • Back of the head
  • Between shoulder blades
  • Top of shoulders
  • Front sides of neck
  • Upper chest
  • Outer elbows
  • Upper hips
  • Sides of hips
  • Inner knees

Fatigue and sleep disturbances

People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is frequently disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea, that further worsen symptoms.

Coexisting conditions

Many people who have fibromyalgia also may have:

Causes

Doctors don’t know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include:

  • Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
  • Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
  • Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.

Why does it hurt?

Current thinking centers around a theory called central sensitization. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals.

Some have speculated that lower levels of a brain neurotransmitter called serotonin leads to lowered pain thresholds or an increased sensitivity to pain. It’s associated with a calming, anxiety-reducing reaction. The lowered pain thresholds in fibromyalgia patients may be caused by the reduced effectiveness of the body’s natural endorphin painkillers and the increased presence of a chemical called “substance P.” Substance P amplifies pain signals. (WebMD, Retrieved February 14, 2013)

Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain’s pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.

Risk Factors

Risk factors for fibromyalgia include:

  • Your sex. Fibromyalgia is diagnosed more often in women than in men. Female reproductive hormones may play a part in how women experience pain.
  • Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.
  • Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.

Complications

Fibromyalgia generally doesn’t lead to other conditions or diseases. But the pain and lack of sleep associated with fibromyalgia can interfere with your ability to function at home or on the job. The frustration of dealing with an often-misunderstood condition also can result in depression and health-related anxiety.

Coping with the pain

Fibromyalgia pain tends to fluctuate. On the days when your fibromyalgia pain flares, everything you try to do can seem more difficult. It’s easy to become discouraged.

One of the hardest things to accept may be that there is no cure for fibromyalgia. While lifestyle changes and medications can lessen the severity of your fibromyalgia pain or fatigue, you will continue to have good days and bad days.

Current medications for fibromyalgia

Current medications for fibromyalgia include Lyrica, Cymbalta, and Neurontin (available generically as gabapentin). Of these, only Lyrica was developed specifically for fibromyalgia symptoms.

Cymbalta belongs to a class of medications called serotonin and norepinephrine reuptake inhibitors (SNRIs). The FDA previously approved Cymbalta for the treatment of depression, generalized anxiety disorder, and diabetic peripheral neuropathic pain. The agency approved Cymbalta for the management of fibromyalgia in adults in June 2008. A similar medication, called Savella (milnacipran), gained FDA approval in early 2009. (WebMD, accessed February 14, 2013).

Researchers think that Cymbalta helps calm down pain signals by increasing the level of two naturally occurring substances called serotonin and norepinephrine. These substances, which are found in the brain and other parts of the nervous system, can affect mood and are believed to help control and suppress feelings of pain. Cymbalta and other SNRIs block serotonin and norepinephrine from re-entering cells, and therefore increase the levels of the substances in the rest of the body. This process is thought to improve mood and relieve pain in patients with fibromyalgia  (WebMD, accessed February 14, 2013).

Only one high-quality clinical trial has looked at gabapentin (Neurontin, others) as a fibromyalgia treatment. In that study, the drug reduced participants’ reported pain, fatigue and sleep disruption more effectively than did a placebo. Gabapentin has not been approved by the Food and Drug Administration (FDA) for the treatment of fibromyalgia, although some doctors may prescribe it off-label for such use. The FDA has, however, approved a similar drug — pregabalin (Lyrica) — for fibromyalgia treatment.

Gabapentin and pregabalin were originally approved to treat certain types of epilepsy and nerve pain. Both drugs work by limiting the release of pain-communicating chemicals by nerve cells in the brain and spinal cord. Because gabapentin is available in generic form, it may be less expensive than pregabalin. But you have to take gabapentin three or four times a day, which makes it less convenient than pregabalin, taken in two daily doses. The most common side effects of both drugs are dizziness and drowsiness.

Lyrica (pregabalin) is an FDA-approved drug treatment for fibromyalgia. Scientists aren’t exactly sure how Lyrica improves fibromyalgia symptoms, but laboratory research suggests Lyrica helps decrease the number of nerve signals, and as a result calms down overly sensitive nerve cells. This appears to alleviate pain in patients with fibromyalgia.

Pain relievers such as Ultram and Ultracet can help break cycles of fibromyalgia pain, relieve flare-up pain, and reduce muscle spasms. The muscle relaxant Flexeril can help reduce pain and improve sleep. Local injections of painkillers and/or cortisone at painful trigger points can be especially effective in breaking cycles of pain and muscle spasm (Web MD, retrieved February 14, 2013).

Insomnia is a big problem in people with fibromyalgia. Research shows that frequent disruptions in sleep prevent growth hormone — an important restorative hormone — from being produced by the body. Without growth hormone, muscles don’t fully heal and neurotransmitters (like serotonin) are not replenished.

Without deep sleep, the body can’t recuperate from the day’s stresses. This can overwhelm the body’s systems, creating a great sensitivity to pain.

In some patients with fibromyalgia, there is an underlying cause for insomnia, such as restless leg syndrome or sleep apnea. If it’s not clear what’s causing the sleep problem, your doctor can prescribe one of several medications to help with sleep.

  • A low-dose tricyclic antidepressant (like Amitril) can help improve deep, restorative sleep.
  • A prescription sleep medication like Ambien, Lunesta, Rozerem and Sonata is not addictive in low doses. These are called “short-acting” drugs because they stay active in the body for the shortest amount of time. Each of these drugs works a bit differently. Some help people fall asleep more quickly; others make sure you stay asleep.
  • The anticonvulsant drug Lyrica is also prescribed to treat other symptoms of fibromyalgia such as insomnia and fatigue.
  • In small studies, the narcolepsy drug Xyrem has been reported to help both sleep and pain. Xyrem, a potent medication used to treat narcolepsy and help with daytime sleepiness, helps patients with fibromyalgia get the deep sleep they need.

Why prepare a doctor’s list in advance?

When fibromyalgia pain or fatigue is severe, you might not be thinking clearly. A flare of fibromyalgia symptoms can send you into a spiral of stress and despair if you aren’t prepared. But having a plan to follow gives you a sense of control over your signs and symptoms.

Write down your options for coping and keep your list where you can find it when you feel a bad day coming. Different strategies work better for some people than for others. Some may work fine for you on one day but not on another. That’s why it’s good to have a variety of options to choose from.

Avoid negative self-talk

Studies have shown that what we say to ourselves inside our heads can affect our perception of pain. Turning negative thoughts into positive ones takes practice but is worth the effort.

Negative
Positive
I can’t do anything because of my symptoms. I can do many things. I just need to pace myself and take breaks.
I have no control over my happiness. The pain controls me. I can control my happiness. I can be happy and enjoy life despite pain.
People at work are upset with me. They don’t think I’m doing my share. I will do the best job I can and feel good about my accomplishments.
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