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

Nov 29, 2007
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: Arthritis Treatment
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