Sunday, April 25, 2010

Fibromyalgia: Mystery Pain Explained

Sunday, April 25, 2010
Fibromyalgia: Mystery Pain Explained
By Robin H. Miller, M.D. and Janet Horn, M.D., Lifescript Women's Health Experts
Published April 25, 2010





* Fibromyalgia
* 13 Ways to Relieve Pain
* Chronic Fatigue Syndrome Treatments
* 10 Symptoms Women Shouldn't Ignore

Painful and puzzling, fibromyalgia primarily strikes women. Why? Researchers don't know. And with details scarce about its cause and treatment, dealing with the condition can be maddening. We have answers to 10 common questions. Plus, test your women's health IQ...

1. What causes fibromyalgia?
Genetics may play a role in developing fibromyalgia. But no one really knows what causes the syndrome and there are no known risk factors.

The most prevalent theory is that fibromyalgia results from a disturbance in the central nervous system called central sensitization, which may intensify pain signals.

Linked to that theory is the notion that patients have higher amounts of a compound called substance P in their spinal fluid, which increases their sensitivity to pain.

Another theory: There may be two types of fibromyalgia: “primary” fibromyalgia, which occurs spontaneously, and “secondary” fibromyalgia, which may be triggered by trauma – such as a car accident – or by certain infections, such as Lyme disease and hepatitis C.

Some researchers think that the primary type is caused by a sleep disturbance, but it’s also possible that the sleep disturbance is a symptom of fibromyalgia.

2. I often hear fibromyalgia, chronic fatigue syndrome and lupus mentioned together. Are they similar?
Although the three are separate conditions, symptoms of fibromyalgia and chronic fatigue syndrome overlap. And fibromyalgia and lupus both involve the muscle and bone network in our bodies, which can cause confusion between the two illnesses.

Fibromyalgia is characterized by many symptoms including muscle pain, fatigue, sleep disturbances, irritable bowel syndrome and, in some people, depression. Despite its consistent general characteristics, it can be tough to diagnose because symptoms vary from patient to patient.

The main symptoms of chronic fatigue syndrome (CFS) include:

* Overwhelming fatigue
* Memory loss
* Muscle soreness
* Sore throat
* Swollen glands


Symptoms can coincide or come and go in individual cycles. Doctors usually diagnose CFS through a process of elimination: They rule out other potential causes of long-term fatigue.

Lupus is an autoimmune disease in which the body attacks itself. It may start with joint pains, which patients can confuse with the muscle pains of fibromyalgia.

Diagnosed by blood tests that show a high level of certain antibodies, lupus can be progressive and cause serious illness throughout the body.

People with lupus appear more prone to develop fibromyalgia and chronic fatigue, although researchers don’t know why.
3. Why do more women than men get fibromyalgia?
The majority of people with fibromyalgia (80%-90%) are women, as is the case with lupus and CFS. No one knows why women are affected more often than men.

4. Is it age-related?
Fibromyalgia occurs most commonly in people between 20 and 55 years old, although it may arrive at any age, including childhood.

5. Is it an autoimmune disease or a form of arthritis?
Neither. In fact, unlike inflammatory arthritis and autoimmune disease, which cause joint destruction and inflammation, fibromyalgia causes neither, despite symptoms of joint and muscle pain.

6. What are warning signs or symptoms of fibromyalgia?
Alas, the symptoms arrive without warning. They can, as mentioned earlier, include muscle and joint soreness, fatigue, sleep problems, irritable bowel symptoms, morning stiffness, depression and brain fog.

7. How is it diagnosed?
Unfortunately, it’s not uncommon to be misdiagnosed or have to see several doctors before a diagnosis is made.

Your best bet is to see a rheumatologist, a doctor who specializes in conditions affecting muscles and joints. He or she will look for symptoms and physical findings that meet a specific definition of fibromyalgia established by the American College of Rheumatology.
For instance, a patient must have 11 out of 18 specific tender points on her body (neck, shoulders, back, hips, and upper and lower extremities), and she must have had widespread pain in her muscles and joints lasting for three months or more without explanation.

The doctor will also work to rule out other diseases that have similar symptoms, such as lupus and polymyalgia rheumatica (another autoimmune disease).

8. What lifestyle changes can I make to help alleviate the symptoms?
Get plenty of gentle aerobic exercise (like swimming or walking briskly), working up to at least 30 minutes most days of the week. Weight gain commonly accompanies fibromyalgia (thanks to the fatigue, muscle pain and poor sleep). Regular exercise will give you more energy, boost your mood, lower your weight and help you sleep better.

Eating a healthy diet with lots of vegetables, fruits, whole grains, lean meats and dairy also will energize you, lower your weight and improve your overall health as you battle fibromyalgia.

You can also try eliminating the following foods, which appear to bother some people with fibromyalgia:

* Food additives like MSG and nitrates (the preservative in hot dogs and bacon)
* Aspartame (NutraSweet)
* Sugar
* Caffeine drinks


But remember, what works for one person may not work for another.
9. What are the latest treatments?
Pregabalin (Lyrica), a fairly new medication, is the first to be approved by the Food and Drug Administration (FDA) for fibromyalgia. Studies suggest that it prevents pain and improves sleep by slowing the release of chemicals associated with pain.

Older standbys can help too. Anti-inflammatories such as ibuprofen and muscle relaxers can relieve pain. Antidepressants – especially tricyclics (amitriptyline or Elavil) – boost mood as well as lessen pain and improve sleep.

Supplements such as 5-HTP and SAM-e (S-adenosylmethionine) may also be useful. An amino acid, 5-HTP, converts to serotonin, a feel-good neurotransmitter that helps boost mood and sleep. SAM-e is an enzyme already present in the body that affects mood and lessens pain.

D-Ribose, a simple sugar in powder form, may lessen pain and fatigue when dissolved in water and taken 2-3 times daily.

Cognitive behavioral therapy, acupuncture, hypnotherapy and biofeedback may also be worth trying.

10. What is the long-term outlook for a woman with fibromyalgia?
The good news is that fibromyalgia does not cause damage to muscles and joints that can lead to debilitation, immobility or joint replacement.

The bad news is that the symptoms typically don’t resolve. Many women simply must learn to live with fibromyalgia.

The key is finding individual or combination therapies that help. Not all treatments help all patients with fibromyalgia; discovering which help you is a matter of trial and error. But scientists continue to work on finding the cause of fibromyalgia and, ultimately, a cure or effective treatment.

Want to learn more? Get your own copy of The Smart Woman's Guide to Midlife and Beyond. Plus, meet Dr. Robin Miller and Dr. Janet Horn.

Women’s Health: How Much Do You Know?
As a woman, your health concerns are as unique as your body. Test your smarts with this women's health quiz.

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