Fibromyalgia 2008- What's New... And How Do You Get Relief

Fibromyalgia 2008- What's New... And How Do You Get Relief If
You Suffer From This Disease?

Author: Nathan Wei

Article:
The American College of Rheumatology meeting held in Boston from
November 6-12 provided a platform for experts in the field of
fibromyalgia (FM) to present information that updates our
notions as to what this disorder really is.

Legitimacy as a medical condition has been supported by the FDA
approval of a drug, pregabalin (Lyrica), for the treatment of
fibromyalgia.

Unfortunately there are still skeptics including many
physicians. Dr. Daniel Clauw, of the University of Michigan in
Ann Arbor, and one of the foremost authorities on FM, told
attendees "it has now been proven convincingly that FM is
primarily a disorder of pain signaling, arising in the central
nervous system."

He went on to say though, that "many physicians, including
specialists, still regard the local manifestations, such as
tender points, as important," creating what he called "a
circular problem" in treatment.

What Dr. Clauw was alluding to were the diagnostic criteria
formulated a few years ago, which stated that among the classic
symptoms of fibromyalgia is abnormal pain in some or all of 18
points in the body when touched. The American College of
Rheumatology was the group that developed criteria for
diagnosing the condition that includes a finding that at least
11 of these points are tender.

But, a key point that Dr. Clauw stressed is that "the longer we
keep publishing review articles [with illustrations of] a woman
with 18 dots, the longer people are going to think there's
something wrong in (just) those 18 areas of the body, even
though we know that's not the case."

Dr. Clauw went on to say that it was better to think of
fibromyalgia as a "disorder of the pain-sensation system's
"volume control" that determines how the brain processes...
stimuli."

"This is likely set by the genes we are born with, and modified
by the environment," he added. Those with a high volume control
setting will feel more pain for a given level of stimulus.

As a result, he said, one can test for fibromyalgia with stimuli
in areas other than the classical 18 points, such as the
thumbnail. He said fibromyalgia can also be diagnosed without
touching patients at all.

Don Goldenberg, M.D., of Tufts University School of Medicine in
Boston, another FM expert, commented on the important dual role
of genetics and environment in the disorder. "Fifty percent of
my patients say they were born with it, had it since they were
kids. The rest say something happened" to trigger it.

Dr. Clauw agreed noting that a wide range of events appear to
trigger fibromyalgia, such as infections and injuries. A small
subset of people experiencing these events will go on to develop
regional or widespread pain syndromes as a result of their
particular genetic makeup.

He also said, "Getting effective treatment to fibromyalgia
patients is important because when they have had uncontrolled
symptoms for too long, they become resistant to treatment."

"They're upset because they can't function normally in their
societal roles. They become depressed because of what the pain
and fatigue has done to their life. They develop ways of
thinking, which has been confirmed by brain imaging, that can
actually increase their pain levels by changing the way pain is
transmitted in the brain. And... they develop bad habits that
are called 'maladaptive illness behaviors' where they make their
condition worse," Dr. Clauw added.

Fortunately, many therapies are available to make fibromyalgia
sufferers more comfortable.

Among them are exercise, certain analgesics, some classes of
antidepressants and, most recently, drugs classified as
anticonvulsants.

Fibromyalgia pain can be reduced with moderate and regular
aerobic exercise.

Opioid narcotics and most over-the-counter analgesics are not
effective in fibromyalgia. One analgesic, tramadol (Ultram) may
be useful.

Amitryptyline (Elavil) and cyclobenzaprine (Flexeril) are two
other drugs that have proven to be effective in
placebo-controlled trials.

Equivocal results have come out of studies of selective
serotonin reuptake inhibitors including fluoxetine (Prozac).

But antidepressants that affect both serotonin and
norepinephrine have demonstrated good results. Duloxetine
(Cymbalta) and milnacipran (Ixel) both show promise in this
condition.

Anticonvulsant drugs like gabapentin (Neurontin) and pregabalin
(Lyrica) have been used to treat fibromyalgia. The latter drug
is now the only medication approved in the United States to
treat fibromyalgia.

Editor's note: Another important modality that wasn't mentioned
is cognitive behavioral therapy. This type of treatment uses
devices such as guided imagery, visualization, time management,
etc. to help FM patients cope better. While not effective as a
lone treatment modality, it is crucial as an adjunctive method
for FM management.

About the author:
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the
Arthritis and Osteoporosis Center of Maryland. He is a Clinical
Assistant Professor of Medicine at the University of Maryland
School of Medicine. For more info: href="http://www.arthritis-treatment-and-relief.com/arthritis-tre
atment.html">Arthritis Treatment
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