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Fibromyalgia; Key Q&A.

* What are the symptoms of fibromyalgia?

The classic symptoms of fibromyalgia syndrome (FS) are widespread pain, fatigue and multiple tender points. People with this syndrome may also experience sleep disturbances, morning stiffness, irritable bowel syndrome and anxiety.

* What causes the disease--am I at risk?

No one knows exactly what causes fibromyalgia, but links have been found to central nervous system trauma, infection and low levels of certain biochemicals, such as cortisol and serotonin. Women are four to seven times more likely than men to develop the disorder. The most common time for women to develop FS is during the perimenopause or menopausal years.

* I think I may have fibromyalgia, but my doctor doesn't know much about the disease--what should I do?

Ask for a referral to a rheumatologist or physiatrist who is knowledgeable about the disease. A rheumatologist is a doctor who specializes in disorders that affect the joints, muscles, tendons, ligaments and bones. A physiatrist specializes in diagnosing and treating injuries and diseases causing pain, loss of function and disability.

* I have heard that aerobic exercise is good for fibromyalgia, but how can I possibly exercise when I'm in such pain?

If you've been sedentary awhile, you should start out with stretching exercises for several weeks. Therapy in warm water is easier than therapy on land. Heat, massage, hydrotherapy (exercising in a pool or using a whirlpool) and relaxation therapy are among the strategies that can help. Discuss any exercise plan with a health care professional.

* What medications are available to treat fibromyalgia pain?

The drugs usually prescribed for muscular pain--nonsteroidal anti-inflammatory drugs, such aspirin, ibuprofen and naproxen--are not as effective at treating fibromyalgia. Occasionally, injections of anesthetics or corticosteroids (synthetic hormones with anti-inflammatory properties) are used to relieve acute tender point pain. Narcotic pain medications should be avoided due to their addictive properties. Antidepressants, particularly fluoxetine (Prozac), nortriptyline (Pamelor), trazodone (Desyrel), doxepin (Sinequan) and amitriptyline (Elavil or Endep), alleviate pain and sleeplessness in some cases. In clinical trials, a combination of fluoxetine and amitriptyline worked better than the either drug alone. In clinical trials, Ultram (tramadol) was effective in some patients.

* What medications are available to treat the sleeping problems associated with fibromyalgia?

Antidepressants are sometimes effective, and occasionally a doctor may prescribe a short-term course of sleeping pills. A muscle relaxant called cyclobenzaprine (Flexeril) may temporarily help to improve sleep and reduce pain. The drug zolpidem tartrate (Ambien) is sometimes prescribed for short intervals to persons having severe sleep problems. If you're having trouble sleeping, you may also want to employ standard nonmedical remedies, such as avoiding caffeine, forgoing naps, avoiding alcohol, consistently going to bed at the same time every night and being outside every day for some time between 7 and 9 a.m. to help reset your biological clock.

* What is the relationship between fibromyalgia and depression?

Estimates vary, but it appears that between 18 percent and 36 percent of fibromyalgia patients are depressed at any given time, and they have a greater than 50 percent risk of experiencing depression in their lifetime. However, despite the association, not everyone with fibromyalgia is depressed or will experience depression. What causes the correlation between fibromyalgia and depression is unclear, though both conditions are associated with reduced levels of serotonin.

* Why has the diagnosis of fibromyalgia been so controversial?

Because up until the late 1990s, no pathological origin for the chronic, persistent pain could be found. Now multiple scientific studies have described abnormal pain processing in the central nervous system. Because women who presented with the syndrome often had concomitant depression and anxiety, some doctors thought fibromyalgia was largely psychosomatic. In recent years, however, skepticism has largely given way to interest in more fully characterizing symptoms and effective treatments.

* What are some nonmedical approaches to treating the disease?

Medications may be necessary, but there are a number of day-to-day strategies for coping with the disease. You might want to find a fibromyalgia support group for starters, to provide insight, advice and support. Sleep may be improved by avoiding naps and caffeine in the afternoon, and by going to bed at a consistent time. You should to monitor your pain and adjust activities accordingly--for example, by using lighter appliances or adjusting a desk chair to provide more back and neck support. To tamp down pain, fibromyalgia patients have reported success with massage, heat and cold packs, relaxation therapy, water therapy (such as whirlpools), biofeedback and acupuncture/acupressure.

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Editorial Staff of the National Women's Health Resource Center 2002/07/31 2005/06/08 Fibromyalgia syndrome (FS) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, multiple tender points and poor sleep. "Tender points" refers to tenderness that occurs in precise, localized areas, particularly in the neck, spine, shoulders and hips. Chronic pain,Corticosteroids,Fibromyalgia,Nonsteroidal anti-inflammatory drugs,NSAIDs,Parenthesia,Raynaud's phenomenon,Tender points
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Publication:NWHRC Health Center - Fibromyalgia
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Date:Jun 8, 2005
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