Fibromyalgia

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is fibromyalgia?

Fibromyalgia, which means “pain in the muscles,” is more a condition defined by symptoms than a specific ailment. Nobody is sure what causes it, although the widespread soreness, headaches, poor sleep, and myriad of other symptoms are very real. Although you may feel extremely uncomfortable, there is no evidence of an actual disease occurring in your body, nor are there any lab tests to identify fibromyalgia (one reason why you may have gone to many doctors before it was finally identified).

Some experts believe fibromyalgia may originate in the brain, possibly due to low levels of a nervous system chemical called serotonin. Females have especially low levels of serotonin, which may explain why 9 out of 10 fibromyalgia cases occur in this sex. Women are also most often victims of migraines, irritable bowel syndrome, depression, anxiety, panic attacks, and other disorders that may be due to low serotonin levels. Serotonin seems to have been installed in humans as a buffer against the “fight or flight” response. Without enough serotonin, your body becomes more susceptible to stressful events. When you’re constantly stressed, your muscles contract, setting off a destructive chain of events.

Serotonin is also important for assuring deep, restorative sleep, and disruptive sleep patterns have been blamed for bringing on fibromyalgia or making it worse. Because your muscle pain makes it hard to get a good night’s rest, you get tired. Lack of sleep causes even more stress. You may also become anxious, forgetful, and depressed, which further contribute to the downward spiral of out-of-control stress that may ultimately lead to fibromyalgia. Other possible causes include injuries, infections, or hormonal disturbances, although these, too, remain uncertain.

Treatment for fibromyalgia

Even though fibromyalgia is poorly understood, effective therapies are at hand. Treatment usually follows four key steps.

• Have your doctor prescribe a good pain medicine.
• Get something to help you sleep better, if necessary.
• Antidepressants will help raise your serotonin levels.
• Address the sources of stress in your life and start making changes. Learning some relaxation techniques can help.

Getting fibromyalgia out of your life is truly a matter of trial and error: A nightly hot bath with Epsom salts, an electric blanket, a weekly massage, acupuncture, low-impact aerobics, muscle relaxants, antidepressants—all have helped others. If you’re in a stressful life situation and can’t figure out how to solve it, consider visiting a therapist who has worked with other fibromyalgia patients. The sooner you begin treatment, the better. Someone who has been suffering from fibromyalgia for only a few months, for example, typically responds much better than someone who has endured the condition for more than a decade.

Medications for fibromyalgia

You may start feeling better after you start taking the right medications. Most doctors begin by treating different sets of fibromyalgia symptoms with specific drugs. Pain relievers, for instance, may bring rapid relief to your sore and aching muscles. Acetaminophen (Tylenol) is often recommended, but stronger medications may be more appropriate. Opioids such as hydrocodone (Vicodin), available as a pill, or fentanyl (Duragesic), worn as a skin patch, act on the central nervous system and can be very effective for relieving pain. However, some physicians and patients worry about overdependence on these drugs. Tramadol (Ultram) or tramadol/acetaminophen (Ultracet) may be good alternatives, though they may cause dependence. Because fibromyalgia is not caused by inflammation, anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, won’t provide any long-term benefit.

You can sometimes get dramatic pain relief in minutes with trigger-point injections: The anesthetic lidocaine is injected into the muscle “tender points” that are sensitive to touch in those with fibromyalgia. Such injections help break the pain cycle, and may provide lasting relief.

Taking low doses of an antidepressant medication can help treat any underlying sleep disorder and alleviate its accompanying pain and fatigue. These medicines are called antidepressants only because they were first used to treat depression, one of many ailments caused by a disturbance of serotonin. Because they work in different ways to increase levels of this chemical in the brain, “serotonin modulators” is probably a far better name for them. The older tricyclic antidepressants, such as amitriptyline (Elavil, Endep), may be particularly effective for relieving pain. The newer SSRI antidepressants, such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), may help lift depression. Low doses of both are sometimes prescribed together. A third type of antidepressant, trazodone (Desyrel), may also help relieve symptoms of fibromyalgia.

Because not getting a good night’s sleep is probably contributing to your problem, a gentle sedative sleep aid, such as zolpidem (Ambien) or zaleplon (Sonata), may work wonders. They take effect within 30 minutes and you will wake up without the drug “hangover” so common with stronger sleeping pills. Muscle relaxants, such as cyclobenzaprine (Flexeril), may also be beneficial.

Lifestyle Changes

A number of strategies you can follow in your day-to-day life will make a real difference in how you feel.

• Reduce stress. Schedule a time each day to relax. Pace yourself, and don’t overcommit.
• Exercise regularly. The key is to start slowly and not overdo it. Doing low-impact activities such as swimming or aqua aerobics a few days a week is an excellent way to start. You can graduate to other aerobic activities like walking, and work up to strength training using light hand weights or machines. Stretching the muscles is also important for reconditioning them and reducing pain.
• Consider physical therapy, which concentrates on different muscle groups. It’s also a good complement to an exercise regimen.
• Get enough rest. Try to follow a regular sleep schedule. Limit daytime napping, and use your bed only for sleeping or sex.

Related Procedures for Fibromyalgia

A psychological counseling approach called cognitive-behavioral therapy may offer great benefits for those with fibromyalgia. The technique combines cognitive approaches, which help you address self-defeating thoughts that can aggravate pain, with behavioral therapies, which help you initiate changes that will relieve your symptoms. Unlike other types of psychotherapy, the course of treatment may be relatively brief, lasting from one to several months. If you feel that nothing can help your fibromyalgia improve or you can’t take the pain another day, cognitive-behavioral therapy may be a good step for you.

Alternative Therapies for Fibromyalgia

Relaxation techniques (meditation, yoga, hypnosis, biofeedback) can be beneficial for those with fibromyalgia. Massage may help to relieve stress and pain, so may a massage variant known as myofascial trigger point therapy, in which deep tissue around tender points is vigorously worked. Chiropractic manipulation of the back may ease soreness. Some sufferers find relief by applying magnets to painful areas, although this approach remains unproven.

Acupuncture, in which thin needles are placed at strategically situated points in the body, is a popular Chinese remedy for relieving the pain of fibromyalgia. You should begin to feel and sleep better within six to eight sessions. Another traditional Chinese treatment to bolster the body against stress is qigong, a 4,000-year-old healing art combining movement, focus, and controlled breathing.

Questions for Your Doctor

• Will my pain and fatigue keep getting worse?
• Why do all my tests and x-rays show there is nothing wrong with me?
• Why are you prescribing antidepressants when I’m not depressed?
• Are some of my other problems, like irritable bowel syndrome and PMS, related to my fibromyalgia?

Living with Fibromyalgia

If you’re living with Fibromyalgia, here are a few quick tips to help you take control:

• Choose a doctor who has experience treating fibromyalgia, not someone who thinks it’s “all in your head.“ A good choice may be a rheumatologist (a physician who specializes in diseases of the joints and muscles), a physiatrist (a doctor who is expert in physical medicine and rehabilitation), or a specialist in pain management. It may also be a good idea to see a physical or occupational therapist.
• Use memory aids. If you suffer from the bouts of forgetfulness and poor concentration commonly called “fibro fog,” try some basic memory-rechargers. Repeat things to yourself, write items down, and make plenty of lists. Break complex tasks into smaller steps, and keep distractions like loud music to a minimum.
• Keep a diary of your pain and energy levels to record your best times of day. Use those periods to do important things like writing letters or paying bills. Many people with fibromyalgia say they function best early in the day.
• Try heat. A heating pad, electric blanket, or warm bath may bring relief.