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Slef-Management is key to fibromyalgia treatment: treating this common chronic pain disorder has baffled patients and physicians for years.

Fibromyalgia is the most frequent cause of pain cited by patients, and affects six to 12 million people--mainly women--in the U.S. Unfortunately, the condition tends to be dismissed because it can't be diagnosed using the traditional medical "model" of a specific pathology leading to distinctive symptoms.

However, according to Daniel J. Clauw, MD, professor of anesthesiology, medicine (rheumatology) and psychiatry at the University of Michigan, fibromyalgia is much better understood currently than in years past, and effective treatment is now possible. "Fibromyalgia may be considered as a discrete diagnosis or as a constellation of symptoms," Dr. Clauw observes.

What causes the condition isn't clear, but a recent review (Journal of the American Medical Association, April 16, 2014) led by Dr. Clauw suggests that it may be related to disturbances in how the brain processes pain and sensations.

CENTRALIZED PAIN STATE. Dr. Clauw describes fibromyalgia as a centralized pain state. "Centralized refers to central nervous system origins of, or amplification of, pain," he explains. "Put simply, the pain isn't actually coming from the area that hurts, but from the brain and spinal cord." That pain is widespread, manifesting in the muscles, ligaments and tendons, along with multiple "tender points" that hurt if pressure is applied. Chronic fatigue also is common.

MULTIPLE CAUSES. It isn't clear what causes fibromyalgia, but several factors may be involved. Many people associate its development with a physically or emotionally stressful or traumatic event, such as an automobile accident. Some connect it to injuries or illness.


"Patients developing fibromyalgia commonly have lifelong histories of chronic pain throughout their body," Dr. Clauw notes in the review. "Patients with fibromyalgia are likely to have a history of headaches, temporomandibular joint disorder, chronic fatigue, irritable bowel syndrome and other gastrointestinal disorders, cystitis/painful bladder syndrome, and other regional pain syndromes, especially back and neck pain. Family members of patients with fibromyalgia also may have a history of chronic pain."

Psychological stress also may trigger fibromyalgia; people with the condition are more likely to have psychiatric disorders, including depression, anxiety, obsessive-compulsive disorder, and posttraumatic stress. "This may result from common triggers for these psychiatric conditions and fibromyalgia, like early-life stress or trauma," Dr. Clauw suggests.

SELF-MANAGEMENT STRATEGIES CRUCIAL. Dr. Clauw says that understanding centralized pain is important for doctors because patients with disorders like fibromyalgia may request surgical interventions--for example, back surgery--to treat their discomfort. He points to a combination of pharmacological and non-pharmacological therapies as the best treatment approach. "Pharmacological therapy should be guided by the predominant symptoms that accompany pain," Dr. Clauw advises. Antidepressants are a standard option, but the three best-studied, non-pharmacological therapies are education, cognitive behavioral therapy, and exercise, he says.

"All have strong evidence for efficacy in fibromyalgia. The magnitude of treatment response for these therapies often exceeds that for pharmaceuticals." says Dr. Clauw.

Complementary and alternative therapies such as t'ai chi, yoga and acupuncture also can be useful as adjunct therapy. "Some evidence suggests that these treatments give patients a greater sense of control over their illness," says Dr. Clauw. "However, as with other disorders, relative ly few controlled trials support their use."

Dr. Clauw emphasizes that fibromyalgia patients also should be reassured that the pain they are experiencing is not due to damage to the painful regions and is not progressive.

He also stresses the importance of stress reduction, sleep, and exercise in managing the condition. "Patients rarely achieve meaningful improvements without adopting these core self-management strategies," he concludes.


* Pain is diffuse or multifocal, and often waxes and wanes. It may manifest as muscular aching, throbbing, shooting pain, or sharp, stabbing pain.

* Pain may be accompanied by numbness, tingling, and a burning sensation.

* You may feel discomfort when touched or when wearing tight clothing.

* A history of pain in other body regions earlier in life is common.

* Fatigue, sleep disturbances, and memory and mood difficulties tend to accompany fibromyalgia.

* Patients frequently suffer from sensory hyper-responsiveness: sensitivity to bright lights, loud noises, and odors.
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Title Annotation:BONES & JOINTS
Publication:Duke Medicine Health News
Date:Jul 1, 2014
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