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Fibromyalgia (FMS)

What is it?

Fibromyalgia syndrome is a common form of fatigue and general muscle pain that affects 2 percent of the US population, or 5 million people. The word fibromyalgia means pain in the muscles and tissues that connect the bones, ligaments and tendons. The cause of fibromyalgia is unknown.

Although people with fibromyalgia may have pain like those of people with joint disease, fibromyalgia does not cause inflammation, and therefore is not a form of arthritis (which is characterized by inflammation of the joints). Rather, fibromyalgia is a form of soft tissue rheumatism.

What is the cause?

It is not known what causes fibromyalgia, but it is thought to be due to abnormalities in the function of the central nervous system, resulting in an "amplification" of normal pain signals . It is as if the volume control is too high in the nerves of the person's body, so what does not cause pain to most people, generates pain for those who have fibromyalgia.

What are the symptoms?

Pain

Generalized musculoskeletal pain is the most prominent symptom of fibromyalgia. It usually occurs in several places around the body, although it could start in a region, such as the neck and shoulders and then appear in other areas after a certain time.

The pain produced by fibromyalgia has been described in various ways, such as: burning, nibbling, pulsating or as stiffness and sensitivity. It often varies according to the time of day, activity level , weather, sleep patterns and stress. Most people with fibromyalgia say that they always feel some pain. These people feel the pain mainly in the muscles. For some people, the pain can be quite severe.

Although the result of the general physical examination is almost always normal and people look healthy, a careful examination of the muscles of people with fibromyalgia reveals touch-sensitive areas in specific places, called hypersensitive points. Hypersensitive points are areas of the body that are painful when pressure is exerted on them (see figure). The presence and pattern of these characteristic hypersensitive points differentiate fibromyalgia from other conditions. Not all doctors know how to detect these points, but most rheumatologists can perform an assessment of hypersensitive points.

The hypersensitive points associated with fibromyalgia are similar in location to the hypersensitive points present in other common types of muscle and bone pain, such as tennis elbow (lateral epicondylitis). A hypersensitive point on one side of the body usually has a corresponding hypersensitive point in the same place, on the opposite side of the body.

People often do not know the exact location or even the presence of many of these hypersensitive points, until a doctor conducts an assessment of hypersensitive points.

Fatigue and disturbances in sleep

About 90 percent of people with fibromyalgia experience moderate or severe fatigue, less resistance to exertion, or the typical exhaustion that comes with the flu or lack of sleep . Sometimes fatigue is more problematic than pain.

People with fibromyalgia may experience a type of fatigue similar to that caused by another condition, known as chronic fatigue syndrome (CFS). The Centers for Disease Control and Prevention have developed criteria to diagnose CFS. To diagnose a person with CFS, they must present a history of at least six months of unexplained, clinically evaluated fatigue, in addition to four of the following eight symptoms: difficulty in thinking clearly, throat irritation, hypersensitivity of the lymph nodes , muscular pains, joint pains, headaches, sleep disturbances and discomfort for more than 24 hours after an effort.

You may notice that some people with fibromyalgia have symptoms that may fit the description of CFS, and vice versa. Other disorders that group similar symptoms are somatoform disorders (where physical pain and symptomatology are related to psychological factors), and multiple chemical sensitivities.

Most people with fibromyalgia experience sleep disorders. Although they can fall asleep without great difficulties, they have a very light sleep and wake up frequently during the night. Often, these people get up feeling tired, even after they have slept through the night. The resulting fatigue can range from apathy and decreased resistance to exhaustion. The level of fatigue experienced may vary from one day to the next.

Research has shown that deep sleep disturbance alters many critical functions of the body, such as the production of hormones needed to repair muscle tissue, as well as the levels of substances that control the perception of pain by the person. It is clear that sleep problems can aggravate the symptoms of fibromyalgia, so paying attention to improving sleep is an integral part of the management of this disorder.

Symptoms of the nervous system

When you have fibromyalgia, mood swings. They are common. Many individuals feel sad or depressed, although those who suffer from clinical depression account for only 25% of the total. People with fibromyalgia may also feel anxious. There are researchers who believe that there may be a connection between fibromyalgia and some types of depression and chronic anxiety. However, anyone with a chronic disease - not just fibromyalgia - may feel depressed at times, fighting the pain and fatigue they feel.

Individuals with fibromyalgia can report difficulty concentrating or performing simple mental tasks. There is no evidence to show that these problems worsen over time; they simply appear and disappear. Similar problems have been observed in many people who have changes in mood, sleep disturbances or other chronic diseases.

Other problems

Headaches, especially muscle (tension) and migraine, are common symptoms of fibromyalgia. Abdominal pain, distension and the oscillation between constipation and diarrhea (called irritable bowel syndrome or "unstable colon") are also common. Spasms and irritability of the bladder may cause urgency or frequency.

Some studies on fibromyalgia suggest that other problems can be associated with this condition, such as cramps, dizziness and pain in the temporomandibular joint (TMJ), which joins the lower jaw to the skull on both sides of the face.

In some people, the skin may change color temporarily, due to circulatory sensitivity to temperature and humidity. They may feel tingling or numbness in their hands, arms, feet, legs or face.

How is it diagnosed?

The fibromyalgia syndrome can not be diagnosed through laboratory tests. The results of x-rays, blood tests and muscle biopsies are normal. Therefore, the diagnosis is based on a physical examination of the patient's symptoms, which is carried out by a doctor.

In addition to pain, people with fibromyalgia also report the following symptoms: difficulty sleeping; fatigue; chronic headaches (headaches); stomach or digestive problems; numbness or inflammation of the joints; anxiety or depression; and changes in pain that are associated with weather, tension or physical activity.

A person who has a history of generalized pain in at least three different parts of the body that lasts a minimum of three months is usually diagnosed with fibromyalgia. Doctors often make a diagnosis of fibromyalgia when there are multiple specific areas of pain or hypersensitive points and a history of generalized pain. Manifest these symptoms together with fatigue, insomnia, headache, anxiety or associated syndromes such asIrritable bowel disease or restless legs syndrome may also point to the diagnosis.

Treatment options

Your doctor can customize your treatment to fit your particular needs. Some people with fibromyalgia have mild symptoms and need little treatment once they understand what fibromyalgia is and how to avoid what worsens their condition. However, other people need a comprehensive care program that includes drugs, exercise and training on techniques to help them cope with pain.

The FDA (Food and Drug Administration) has approved the first specific medication for the treatment of fibromyalgia symptoms. Pregabalin ( Lyrica ) has been shown to reduce pain and promote sleep. Read more about the Lyrica Approval for the treatment of fibromyalgia. In addition, soon, those who do not respond well to current therapies will have a new option. In January 2009, the FDA approved the drug milnacipran ( Savella ) to help control the fatigue and pain associated with this syndrome.

How to control fibromyalgia

Often people with fibromyalgia have undergone many tests and have visited many specialists in search of an answer. They are often told that since their appearance is good and the test results are normal, they do not suffer from any real disorder. It is possible that friends and family, in addition to doctors, doubt the veracity of their complaints, which can increase their feeling of isolation, guilt and anger.

Both you and your family should understand that fibromyalgia causes chronic pain and fatigue. You must take an active role in the control of fibromyalgia, exercising regularly, educating yourself about your ailment, and learning to implement relaxation and stress management techniques.

Fortunately, fibromyalgia does not pose a threat to life and does not cause deformity. Although the intensity of the symptoms varies, the ailment in general does not usually get worse over time. In a small study that focused on the status of fibromyalgia patients 10 years after being diagnosed, the study authors found that despite the symptoms persisting, many people felt better with the help of treatments and the passage of weather.

However, some people who suffer from fibromyalgia have symptoms so severe that they are not able to function well, neither work nor socially. Such individuals may require more attention through a program that uses physical or occupational therapists , social workers, nurses, mental health professionals, rehabilitation counselors, and sleep specialists.

Options for treatment include:

Education: Understanding the nature of the condition and learning ways to control its symptoms are the basis of any treatment program ion: treatment program.

Medications: Some may decrease pain while others improve sleep.

Analgesics: There are different types of pain medications. Acetaminophen ( Tylenol ) is available through open shelving and is quite reliable; Tramadol ( Ultram ) is stronger than acetaminophen and not as addictive as narcotics. Narcotic analgesics are rarely prescribed for the pain of fibromyalgia.

or NSAIDs: Non-steroidal anti-inflammatory drugs , such as aspirin, ibuprofen ( Advil, Motrin ) and naproxen ( Aleve ), are frequently used for their analgesic rather than anti-inflammatory properties. They can help relieve muscle aches, menstrual pain and headaches often associated with fibromyalgia.

Tricyclic antidepressants: This class of antidepressants, such as amitriptyline ( Elavil, Endep ), nortriptyline ( Pamelor ) and duloxetine ( Cymbalta ), works by raising the levels of norepinephrine (formerly named adrenaline) in the brain. Supplied in doses lower than those required for antidepressant effects, these drugs can improve the quality of sleep. They can also relax sore muscles and amplify the effect of endorphin - the body's natural analgesic.

or SSRIs: Selective serotonin reuptake inhibitors are antidepressants such as fluoxetine ( Prozac ), paroxetine ( Paxil ), sertraline ( Zoloft)), which increase the amount of serotonin in the brain, reducing fatigue and possibly pain in people with fibromyalgia. SSRIs are often prescribed together with tricyclic antidepressants because SSRIs alone can hinder sleep.

Mixed reuptake inhibitors: Some new antidepressants raise the levels of serotonin and norepinephrine and are being studied for the treatment of fibromyalgia. These medications include venlafaxine ( Effexor ), nefazadone ( Serzone ), and milnacipran ( Savella ).

Muscle relaxants: The muscle relaxant cyclobenzaprine ( Cicloflex, Flexeril, Flexiban) has been shown to be useful for the treatment of fibromyalgia and is often prescribed to help relieve muscle tension and improve sleep.

Other drugs: Benzodiazepines (clonazepam [ Klonopin ] and diazepam [ Valium ]) can help relax painful muscles, promote sleep and relieve symptoms of restless legs syndrome (unpleasant sensations in the legs that force you to move them constantly) , but they are addictive. Tegaserod ( Zelnorm ) and alosetron ( Lotronex)) are available for the treatment of irritable bowel syndrome (episodes of diarrhea and constipation with abdominal distension). Another drug that is being studied for use in people with fibromyalgia is the antispasmodic gabapentin ( Neurotin ) and tizanidine ( Zanaflex).

Exercise: Studies have shown that exercise is essential to lessen the symptoms of fibromyalgia. Due to pain , fatigueand the weakness felt by individuals with this disease, most have an inadequate physical condition. Aerobic exercise, however, has analgesic and antidepressant effects, and improves your sense of control and well-being. If you start an exercise program slowly and increase it gradually, you will reap the benefits of exercise without increasing your fatigue or pain.

Stretching: Stretching the stiff and sore muscles once a day or in small segments several times throughout the day will provide pain relief. Warming the muscles with gentle movements or with warm water before stretching them will make the stretch more comfortable.

Everyday Strategies: There are many techniques you can learn to help relieve tension, anxiety and pain, including relaxation, visualization, meditation and biofeedback, as well as minimize negative thoughts, feelings of hopelessness and being victimized.

Complementary therapies: Certain people with fibromyalgia have found relief with massage treatments, meditation, movement therapies (such as Pilates), chiropractic manipulations and acupuncture, among others.

Who is at risk?

The typical fibromyalgia patient is a woman between 30 and 50 years old. Studies in the country indicate that the disease affects 3 - 5% of adult women and about 0.5% of adult men. The incidence increases with age, but the syndrome also exists in children.

People with pre-existing autoimmune diseases may experience symptoms of fibromyalgia. Studies indicate that up to 25% of individuals with inflammatory disorders, such as SLE ( lupus ), RA, and ankylosing spondylitis , also meet the criteria for fibromyalgia.

Science and research

One of the research funded by the Arthritis Foundation is examining how pain and stress affect people with fibromyalgia. Recent studies suggest that problems with the body's pain control systems may be responsible for the disease.

In order to improve treatments, another study analyzes the connection between biofeedback using relaxation and breathing techniques, and its potential to reduce pain, fatigue, sleep problems and depression. Biofeedback is a method that allows people to see the effects of breathing and relaxation techniques on the body's stress levels. During biofeedback sessions, patients are connected to a monitor that records stress signals while practicing the technique. This helps individuals to train themselves to then perform relaxation and breathing properly alone, without the monitor.

Another project is investigating an innovative method of exercise using static contractions (the muscle contracts but the limb does not move). The objectives of this study are to identify the most appropriate exercises using static contractions and to identify how exercise-induced pain relief works.

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