Fibromyalgia

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Fibromyalgia 2016-11-03T11:20:31+00:00

What is Fibromyalgia?

Fibromyalgia Explained by Las Vegas, Summerlin, and Henderson Nevada’s Top Pain Doctors

The term fibromyalgia stems from the Latin root “fibro,” which means connective tissue, and the Greek roots “myo” for muscle and “algia” for pain. Studies have shown that medical providers often struggle to diagnosis a patient with fibromyalgia due to its unknown etiology. Current research, however, has revealed that fibromyalgia is typically characterized by widespread pain accompanied by sleep problems, chronic fatigue, cognitive disturbances, and depression.

Fibromyalgia is considered a syndrome rather than a disease because its combination of symptoms cannot be traced to a solitary identifiable cause. It ranks second to osteoporosis as one of the most common complaints seen by rheumatologists. It shares similarities to other diseases such as arthritis. However, with fibromyalgia, the sensation of pain is magnified by brain pathways that transmit signals throughout the body. Therefore, it differs from arthritis due to the fact that it is not considered a disease of the joints. Fibromyalgia is currently classified as a rheumatic condition because it causes joint and soft tissue pain.

The majority of people with fibromyalgia seek medical assistance to relieve pain from a variety of medical providers. A multidisciplinary approach of primary care physicians, pain management doctors, and other health care professionals is often needed to cope with the variety of symptoms presented by fibromyalgia.

Epidemiology and Impact of Fibromyalgia

7 Types of Fibromyalgia PainFibromyalgia is one of the most common pain conditions affecting about 2% of the U.S. population. According to the National Fibromyalgia Association, more than 10 million people in the U.S. suffer from this disabling condition. Although fibromyalgia can be present at any age, the incidence increases with age. Positive diagnoses for fibromyalgia are usually made between the ages of 20 and 50. It is also most common in women. According to the National Fibromyalgia Association, approximately 75% to 90% of the people with fibromyalgia are women.

The Journal of Clinical Rheumatology has published research concerning the incidence of new cases of fibromyalgia in the United States. During a retrospective cohort survey, 62,000 health insurance claims were examined for potential cases of fibromyalgia. This study revealed incidence rates of 7 to 11 cases per 1000 people for both men and women. During this particular survey, women were 1.6 times more likely than men to have the syndrome.

The social impact of fibromyalgia in the United States is also substantial. The Centers for Disease Control and Prevention report that adults with fibromyalgia miss approximately 17 days of work per year. This accounts for about 1% to 2% of the nation’s overall productivity. Government statistics have shown that fibromyalgia costs $12 to $14 billion annually. This economic toll includes direct and indirect medical costs. One study published in the International Journal of Clinical Practice analyzed health insurance databases and found that the total annual health care expenses for patients with fibromyalgia were three times greater than those with other conditions. The research showed that this expense was often exasperated due to repeated visits to a variety of specialists due to the difficulty of diagnosing fibromyalgia.

Causes of Fibromyalgia

Fibromyalgia FactsResearchers have implicated a variety of factors that potentially contribute toward fibromyalgia; however, the exact cause remains unknown. Events, such as physical and psychological trauma, repetitive injuries, and viral infections have all been linked as triggers for fibromyalgia. Studies have also revealed that people with pre-existing conditions, such as lupus and rheumatoid and spinal arthritis have an increased risk for developing the condition.

Psychiatric conditions, such as anxiety and depression, have also been associated with fibromyalgia syndrome. Researchers have conducted reviews of patients with major depressive disorder (MDD) and have found strong links to fibromyalgia. According to these studies, the associations between MDD and fibromyalgia exist with similar physical symptoms, psychological characteristics, and neuroendocrine abnormalities.

Lifestyle and environmental issues, such as stress, may also be a mitigating factor for fibromyalgia. Physicians often find other stress-related conditions occurring with fibromyalgia, such as post-traumatic stress syndrome, chronic fatigue syndrome, and irritable bowel syndrome. Obesity, smoking, and a sedentary lifestyle may also potentially contribute toward the development of fibromyalgia.

Certain biochemical imbalances may also play a role in the development of fibromyalgia. Researchers have linked abnormal levels of neurotransmitters, such as serotonin, cortisol, norepinephrine, and growth hormones to the disorder. People with fibromyalgia also have increased levels of substance P in the spinal cord. This neuropeptide regulates the perception of pain in the body. Neurotransmitters serotonin and norepinephrine control mood and sense of well-being. A decrease in these neurotransmitters along with an increase of substance P is thought to increase a person’s perception of pain.

The medical community has relied on functional and structural imaging studies to investigate how the spinal cord and brain processes pain signals. Research using functional MRI (fMRI) studies revealed that patients with fibromyalgia had increased blood flow to areas of the brain typically used for the processing of painful stimuli. These studies also showed that people with fibromyalgia had areas in the brain that showed dysfunction of descending pain pathways. This results in an increased perception of pain in these people. These studies ultimately concluded that patients with fibromyalgia felt amplified pain signals in both the brain and spinal cord.

Other studies have investigated the role genetics plays on people with fibromyalgia. One study evaluated fibromyalgia patients and first-degree relatives. The researchers in this study discovered that the first-degree relatives were not only more susceptible to the syndrome; they also felt pain at the same trigger point areas as their relatives. Although the exact reason behind this genetic influence is unknown, researchers believe that genes in the area of the brain involved with serotonin and dopamine production are involved. Additional studies are warranted to truly discover the role genetics has on fibromyalgia.

Symptoms of Fibromyalgia

The symptoms of fibromyalgia are characterized by the hallmark complaints of chronic fatigue, musculoskeletal pain throughout the body, and sleep disturbances. These signs may appear subsequent to an infection or after a physical or psychological trauma. In some cases, however, fibromyalgia may gradually develop over time with no triggering incident.

Patients typically describe the pain associated with fibromyalgia as stabbing, throbbing, aching, and shooting, which is often accompanied by burning, numbness, and tingling. The chronic fatigue manifests as a deep-seated feeling of lethargy and exhaustion that interferes with personal and professional activities. To compound the problems, the lack of sleep prevents patients from getting much-needed restorative sleep.

Along with these primary concerns, other symptoms include:

  • Headaches
  • Diminished attention span
  • Tingling sensations in the hands and feet
  • Sensitivity to heat or cold
  • Stiffness
  • Cognitive problems (known as “fibrofog”)
  • Mood swings
  • Depression
  • Anxiety
  • Stress
  • Cramping
  • Muscle spasms and twitching
  • Bowel disturbances
  • Anger
  • Restless leg syndrome
  • Poor balance

Pathophysiology of Fibromyalgia

Brain imaging studies have yielded valuable evidence concerning the body’s response to fibromyalgia. Functional neuroimaging has shown decreased blood flow in basal ganglia and thalamus regions of the brain. Defects in pain pathways, which send pain signals to the brain, are also present along with other neurotransmitter abnormalities. These defects and abnormalities cause an increased perception of pain and tenderness in people with fibromyalgia.

Positron emission tomography (PET) scans produce three-dimensional images to investigate irregularities in the body. PET scans of fibromyalgia patients have revealed decreased amounts of the (“feel-good”) neurotransmitters dopamine and serotonin in the brain. Dopamine plays a role in the perception of pain, due to the fact that healthy levels in the brain act as a natural analgesia. Serotonin helps to control pain perception, mood, and sleep as well as other physiological functions of the body. There is also evidence of increased amounts of the neuropeptide substance P. Along with helping to regulate the perception of pain, substance P acts as an inflammation mediator.

Clinical findings show that the sleep disturbances associated with fibromyalgia can alter certain hormones in the body. For example, the growth hormone is often decreased in people with fibromyalgia due to the fact that it is mostly secreted during deep sleep, which is often minimized in these cases. Healthy levels of growth hormone in the body help to maintain muscle tone and tissue repair.

Fibromyalgia patients also exhibit alterations in the functioning of their autonomic nervous system, which may contribute toward enhanced pain. These aberrations include changes in physical responses of the body, such as blood pressure and heart rate. During a study reported in the American Journal of Medicine, approximately 60% of patients with fibromyalgia exhibited an abnormal decrease in blood pressure. Researchers in this study concluded that this difficulty in maintaining blood pressure contributes toward some of the symptoms of fibromyalgia, such as dizziness and fatigue.

Risk Factors for Fibromyalgia

Fibromyalgia DiagramRisk factors are composed of certain characteristics that increase an individual’s likelihood of getting a disease or condition. Although there are people who develop fibromyalgia without any identifiable risk factors, researchers have identified some common risk factors, such as genetics, gender, physical or psychological trauma, and poor physical conditioning.

Potential risk factors associated with fibromyalgia have been the topics of several investigations. In one recent study published by the American Journal of Medicine, researchers examined the potential risk associated with certain stressors. During this study, 896 new workers were recruited from 12 different settings. These employees were observed for two years in order to determine the extent psychosocial and physical stressors had on developing widespread pain. Examples of the physical stressors involved in this study were manual work, such as heavy lifting, repetitive motions, and standing or squatting for long periods of time. The results of the study were recorded at 12 months and at the conclusion of the 24 month study. After 12 months, the rate of new-onset pain was 15%. Results were also significantly different in men and women (12% vs. 19%). After 24 months, the rate of new widespread pain was 12% and there was no difference between men and women.

This study also examined the psychosocial stressors, such as dissatisfaction with work or problems with coworkers. Similar to the observations seen with physical stressors, employees with psychosocial issues also developed more widespread pain over time. According to the study, psychosocial stressors can also increase the severity of pain associated with fibromyalgia. Subjects in this study were asked to discuss, for 30 minutes, a stressful event that had occurred in their lives. The researchers found that fibromyalgia patients exposed to these short-term mood inductions reported greater increases in their levels of pain at the conclusion of the study.

In another study, researchers examined longer term psychological distress in fibromyalgia patients. During this study, rheumatologists recruited fibromyalgia patients for participation in a randomized controlled trial. These subjects were screened for the presence of heightened levels of anxiety and negative mood levels for inclusion into the program. At the conclusion of the study, researchers found that “acceptance” of the pain and “perceived support” were the largest determining factors that affected the long-term perception of pain in these fibromyalgia patients. Lower perceived social support and less acceptance of pain also had the compounding negative effect of exasperating the patient’s psychological distress.

Researchers have also tackled other psychosocial stressors as potential risk factors for fibromyalgia. One study examined the role of violence against women as a mitigating factor for fibromyalgia. During this study, researchers examined cases of women who were subjects of an abusive relationship. The conclusion of the study indicated strong association between psychological distress and fibromyalgia.

Conditions Related to Fibromyalgia

Research has also identified other comorbid diseases that are commonly associated with fibromyalgia. Prior to diagnosing a patient with fibromyalgia, physicians typically rule out the following conditions:

  • Chronic fatigue syndrome – chronic pain accompanied with mood and sleep disturbances
  • Osteoarthritis – chronic joint pain caused by loss of cartilage
  • Rheumatoid arthritis – autoimmune disease that results in pain and inflammation in the joints
  • Irritable bowel syndrome – abdominal pain or discomfort accompanied by diarrhea or constipation that typically lasts more than three months
  • Tension/migraine headaches – recurrent headaches that typically last more than 30 minutes
  • Localized myofascial pain disorder – muscular pain with fatigue and sleep disturbances
  • Polymyalgia rheumatica – pain in the hips, back, shoulders, and neck that generally occurs in people over the age of 50

Many of the characteristics and symptoms of the aforementioned conditions, such as chronic pain, mood disturbances, fatigue, and lack of sleep are similar to those of fibromyalgia. As part of their diagnostic arsenal, physicians rely on complete blood counts, along with metabolic and hepatic/renal panels to rule out these other conditions.

Diagnosis and Classification of Fibromyalgia

Prior to 1990, the diagnosis of fibromyalgia was based primarily on subjective information, which caused confusion between physicians and patients. While there is no single test to diagnose fibromyalgia, in 1990, the American College of Rheumatology established widely-accepted classification criteria for the disorder.

The American College of Rheumatology guidelines for diagnosing fibromyalgia include:

  • History of widespread pain persisting for more than three months
  • Pain must be localized in all four quadrants of the body (above/below the waist and on both sides of the body). Axial shoulder pain must be present along with cervical spine or chest, lower back, and thoracic spine pain.
  • Pain in 11 of 18 tender points. These tender points are located in regions where muscles attach to joints, such as knees, hips, chest, elbows, biceps, shoulder blades, and buttocks
  • Clinical symptoms including fatigue, stiffness, depression, anxiety, tenderness, sleep disturbances, and dyscognition

During the tender point examination, the physician applies pressure to the suspect area. Once pain occurs, the patient tells the physician to stop. The physician then documents the identification of pain at that specific point in the patient’s record.

This widespread pain is described as three out of four quadrant pain in the following universal fibromyalgia tender point scale:

Fibromyalgia Pain Scale

Fibromyalgia Tender Point Sites

The American College of Rheumatology’s 1990 classification and tender point examination bases its digital palpation examination on the following specific tender point sites:

  • Occiput – at the suboccipital muscle insertions
  • Low cervical – at the anterior aspects of the intertransverse spaces at C5-C7
  • Trapezius – at the midpoint of the upper border
  • Supraspinatus – at origins, above the scapula spine near the medial border
  • Second rib – upper lateral to the second costochondral junction
  • Lateral epicondyle – 2 cm distal to the epicondyles
  • Gluteal in upper outer quadrants of the buttocks in the anterior fold of muscle
  • Greater trochanter – posterior to the trochanteric prominence
  • Knee – at the medial fat pad proximal to the joint line

Illustration of Tender Points

Fibromyalgia Illustration

Source – American College of Rheumatology

In 2010, the American College of Rheumatology further simplified the classification of fibromyalgia syndrome by introducing a series of questions, known as the “widespread pain index” (WPI) and a “symptom severity” (SS) scale.

These American College of Rheumatology’s new guidelines for diagnosing fibromyalgia include the following criteria:

  1. A WPI score of greater than or equal to seven
  2. An SS score of greater than or equal to five
  3. Symptoms have been present for at least three months

Physicians using the WPI scoring method will document the number of areas in which the patient has felt pain over the past week. The score will be between zero and 19, and the areas of evaluation include:

  • Left shoulder girdle
  • Right shoulder girdle
  • Left hip (buttock, trochanter)
  • Right hip (buttock, trochanter)
  • Left jaw
  • Right jaw
  • Left upper back
  • Right upper back
  • Lower back
  • Left upper arm
  • Right upper arm
  • Left upper leg
  • Right upper leg
  • Left chest
  • Neck
  • Right abdomen
  • Left lower arm
  • Right lower arm
  • Left lower leg
  • Right lower leg

Physicians will indicate the severity of pain for each of the areas using the following SS scale:

  • 0 = No problem
  • 1 = Slight or mild problems, generally mild or intermittent
  • 2 = Moderate number of symptoms present at the moderate level
  • 3 = Great deal of symptoms present

Other somatic symptoms that may affect the body include fatigue, muscle weakness, headache, muscle pain, irritable bowel syndrome, nausea, blurred vision, shortness of breath, seizures, dry eyes, heartburn, bladder spasms, frequent urination, loss of appetite, changes in taste, and bruising.

While the new 2010 American College of Rheumatology guidelines complement the 1990 classification scale, it remains uncertain if this diagnostic criteria will completely replace the 1990 scale in primary care settings.

Along with the classification scale, initial workups include thyroid function and muscle enzyme tests, complete blood count, erythrocyte sedimentation rate, or C-reactive protein. Physicians will order additional imaging or radiography studies if previous examinations have indicated a coexisting pain condition, such as nerve impingement, cervical radiculopathy carpel tunnel syndrome, osteoarthritis, or spinal spondylosis.

During the patient assessment diagnosis of fibromyalgia, physicians pay careful attention to certain characteristic phrases. Patients with the disorder often make statements, such as “I hurt all over,” “It feels like I always have the flu,” and “I just don’t feel like getting out of bed because of the pain.” Some specialists also use the American Psychological Association’s Diagnostic Statistical Manual of Mental Disorder V (revised in 2013) to ascertain the level of anxiety or depression, which may be present in patients with fibromyalgia disorder.

Treatment for Fibromyalgia

The goal of a treatment program for patients with fibromyalgia is not to cure the disorder; rather, it should be to improve quality of life and help regain function. This can be accomplished by creating an individualized multidisciplinary approach to pain that includes traditional pharmacotherapy treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), anti-depressants, benzodiazepines, muscle relaxants, opioid medications, and sleep aides. The pharmacological approach is often successfully combined with alternative and environmental treatment programs, which include exercise, yoga, relaxation and guided imagery, biofeedback, acupuncture, and cognitive-behavioral therapy.

This multi-disciplinary healthcare team includes primary physicians, pain management specialists, nurses, physical therapists, occupational therapists, chiropractors, and exercise physiologists. The healthcare team emphasizes that the patient must also adapt the necessary lifestyle changes, which can help to increase the quality of life despite of this often- disabling condition.

Pharmacological Treatment

The goals of the pharmacological approach are to help assist in daily functioning by reducing pain, as well as improving mood and sleep. Pharmaceutical treatment often involves several different classes of medications to treat the wide variety of symptoms associated with fibromyalgia.

Tricyclic Anti-depressants (TCAs)

Physicians prescribe anti-depressants to help reduce common symptoms, such as pain, depression, fatigue, and sleep disturbances. Anti-depressants elevate neurotransmitters in the brain, such as serotonin and norepinephrine. Low levels of these chemicals are associated with pain, depression, and fatigue.

Recent meta-analysis research analyzed studies that compared the use of tricyclic anti-depressants to placebos for patients with fibromyalgia. The results of these studies indicated positive clinical outcomes for reducing pain and depression, as well as helping to regulate normal sleep patterns in these patients.

Some examples of tricyclic medications include:

  • Nortriptyline (Pamelor, Aventyl)
  • Amitriptyline (Elavil, Endep)
  • Imipramine (Praminil, Tofranil, Janimine)
  • Clomipramine (Anafranil)
  • Lofepramine (Gamanil, Lomont)
  • Doxepin (Adapin, Sinequan)

Selective Serotonin Reuptake Inhibitors (SSRIs)

This class of anti-depressants also promotes the release of serotonin by inhibiting the reuptake, or reabsorption, of serotonin in the brain. This action has the desired effect of allowing the release of more serotonin in the brain. SSRIs are a newer class of antidepressant than TCAs. However, similar to TCAs, they are prescribed at lower dosages when used to treat patients with fibromyalgia than they are to treat patients with depression.

Several investigations regarding their effectiveness for treating fibromyalgia have yielded positive clinical results concerning the associated symptoms of pain and depression.

Some samples of this class of medication include:

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)

Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs)

This class of medication is specifically designed to increase both serotonin and norepinephrine. Examples of SSNRIs include:

  • Duloxetine (Cymbalta)
  • Milnacipran HCl (Savella)
  • Pregabilin (Lyrica)
  • Venlafaxine (Effexor)

Several of these medications have been recent topics of investigation regarding their efficacy in alleviating some of the symptoms of fibromyalgia. Venlafaxine was the first SSNRI available in the United States. Researchers conducted trials that were specifically designed to investigate its effectiveness at alleviating pain associated with fibromyalgia. The study enrolled 15 patients and lasted eight weeks. Physicians prescribed the patients 37.5 to 375 mg of immediate-release venlafaxine chloride daily. The other trial enrolled 20 patients and lasted 12 weeks. These patients were prescribed 75 mg of venlafaxine chloride daily. The results of the trials indicated that patients benefited from reductions in pain during both occasions.

Reviews of the literature concerning the use of the newer drug, duloxetine, for fibromyalgia revealed five trials. In all five trials, duloxetine was generally well tolerated by patients and was also found to be efficacious in relieving pain. In all five trials, duloxetine therapy was also found to increase the quality of life in patients suffering from fibromyalgia.

Researchers also conducted randomized, controlled trials (RTCs) of milnacipran. One of the trials involved 125 subjects and lasted 12 weeks. During this study, physicians prescribed 100 mg of milnacipran twice daily or 200 mg once daily. The results of this investigation revealed that this medication was effective in treating both pain and fatigue associated with fibromyalgia.

Although anti-depressants can have beneficial qualities for people with fibromyalgia, as in all medications, there are potential side effects. In some cases, anti-depressants have been shown to increase suicidal thoughts in young adults, children, and teens. Another rare condition, known as serotonin syndrome, can be a potential serious side effect. The chance of developing this condition increases when anti-depressants are combined with other medications, such as 5-hydroxytryptamine receptor agonists used to treat migraine headaches. Symptoms of serotonin syndrome include rapid heartbeat, change in blood pressure, loss of coordination, restlessness, vomiting, diarrhea, and coma.

Benzodiazepines

Physicians prescribe this class of medications to people with fibromyalgia to help reduce muscle pain. These drugs are known to help with anxiety and have sleep-inducing effects. Benzodiazepines increase the neurotransmitter gamma-aminobutyric acid (GAMA), which, at increased levels, helps produce increased levels of deep sleep. Because of the potential for addiction, benzodiazepines are typically prescribed for short durations.

Examples of this drug include:

  • Diazepam (Valium)
  • Clonazepam (Klonopin)

Analgesics

Tylenol is an example of an over-the-counter analgesic. Physicians also prescribe stronger prescription narcotic pain killers for pain associated with fibromyalgia. The goal of painkillers is to interfere with pain signals that are transmitted to the brain.

Some examples of this class of medication include:

  • Hydrocodone (Vicodin)
  • Propoxyphene (Darvon)
  • Oxycodone (Percocet)
  • MScontin (Morphine)
  • Acetaminophen (Tylenol)

These drugs help to relieve pain by decreasing inflammation. NSAIDS reduce substances in the body, known as prostaglandins, which are associated with inflammation and pain. Current double-blind studies have failed to show any marked improvement concerning people who take NSAIDs for fibromyalgia.

Examples of this class of drug are:

  • Ibuprofen (Advil, Motrin)
  • Naproxen sodium (Aleve, Anaprox)

Muscle Relaxants

Physicians sometimes prescribe a short-term regimen of muscle relaxants to people with fibromyalgia to help relax muscles to alleviate pain. A meta-analysis concerning the drug cylcobenzaprine examined five randomized, placebo-controlled trials concerning patients who were administered the medication to help treat muscular pain associated with fibromyalgia. The results of the analysis revealed that pain was significantly decreased after four weeks of therapy; however, at eight to 12 weeks the pain-relieving effects were minimal.

Some examples of this class of medication include:

  • Cyclobenzaprine (Flexeril)
  • Tizadine (Zanaflex)
  • Carisopeodol (Soma)
  • Orphenadrine citrate (Norflex)

Antiepileptic Drugs

Physicians have traditionally used antiepileptic drugs for seizures; however, they are now commonly used “off-label” for a variety of conditions associated with neuropathic pain. Scientists believe that this type of medication helps to control the excess excitatory neurotransmitters that are associated with fibromyalgia patients. Recent meta-analysis of several RTCs evaluated the use of this drug for fibromyalgia. According to this research, antiepileptics showed substantial improvements in pain relief for people with fibromyalgia, when compared to the placebo group.

Some examples of this class of drug include:

  • Gabapentin (Neurontin, Horizat, Gralise)
  • Pregabilin (Lyrica)

Atypical Antipsychotics

These drugs have traditionally been used to help control psychotic symptoms of disorders, such as schizophrenia. Physicians, however, are using these medications to treat other conditions such as Tourettes Syndrome and autism.

Atypical antipsychotics have D2 receptor antagonist properties. Since fibromyalgia has been known to have D2 receptor hypersensitivity, atypical antagonists have been used to treat some of the symptoms associated with the syndrome. One recently reported trial revealed that atypical antipsychotic therapy has been successful in reducing stiffness, fatigue, and depression. However, patients involved in this trial did not report any reduction in pain after taking atypical antipsychotics.

Some examples of this class of medication include:

  • Rispiridone (Risperdal)
  • Aripiprazole (Abilify)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)

Other Treatment and Management Strategies for Fibromyalgia

In addition to pharmacological treatments, clinicians often seek additional forms of therapy to help patients with fibromyalgia. An intensive patient education program is typically the first step to help the patient feel better. Recent literature has shown that patients who take an active role in the management of fibromyalgia often experience less negative symptoms than those who do not take the time to understand their condition. Physicians should encourage patients to take small steps that they can control, such as eating a nutritious diet, avoiding too much caffeine and alcohol, not smoking, getting enough sleep, and exercising.

One of the hallmark symptoms of sleep deprivation can be potentially mitigated by understanding some key factors that can help patients sleep. These tips include:

  • Avoiding caffeine before bedtime
  • Limiting naps during the day
  • Keeping routine sleeping habits
  • Avoiding large or spicy meals just before bedtime
  • Maintaining an active physical fitness program
  • Not exercising just before bed

Exercise

One essential step in the self-care plan is for patients to participate in a routine fitness program. Exercise has been known to help a wide variety of diseases and conditions. According to research published in the American Journal of Medicine, the deconditioning from lack of physical activity aggravates the symptoms of fibromyalgia. A recent Cochrane Review of 34 studies concerning exercise as a treatment method for fibromyalgia revealed that after a 12-week conditioning program, participants had marked improvement in their physical function and well-being.

Another study reported that patients with fibromyalgia should participate in moderate intensity exercise for 30 to 60 minutes to reap the maximum benefits. These non-impact activities should include water resistance training, cycling, and walking. A study published in the American Journal of Lifestyle Medicine added that Pilates, yoga, and resistance training have also yielded favorable results for patients with fibromyalgia.

The key to a successful exercise program is moderation. Proper rest is just as important as a well-balanced program. According to the Centers for Disease Control and Prevention (CDC), an effective exercise program for adults consists of at least two and a half hours of weekly moderate-intensity aerobic activity along with muscle strength training on at least two days during the week. The CDC also suggests an alternative program of one hour and 15 minutes of vigorous-intensity activity every week along with the standard strength training exercises. These guidelines are different for children and seniors.

Complimentary Treatments

BioFeedbackEmerging research has opened the doors to the possibilities that adjunctive therapy, such as acupuncture and biofeedback, has on relieving pain associated with fibromyalgia. A recent systematic review and meta-analysis, published in the Journal of Rheumatology, showed strong evidence that acupuncture may reduce pain in fibromyalgia patients.

Biofeedback uses electrical equipment to gauge respiration and heart rate in order to teach users how to harness the power of breathing and relaxation techniques to help control pain. One study, which assessed several types of mind-body techniques, such as guided imagery, hypnosis, and biofeedback, showed favorable pain-reducing results for relaxation techniques associated with biofeedback therapy.

Cognitive behavioral therapy is another complimentary therapy that has gained considerable attention in recent years. Cognitive behavioral therapy consists of teaching fibromyalgia patients how to better cope with their condition. Therapists rely on relaxation techniques and cognitive reconstructuring to help patients come to terms with their condition and take the necessary lifestyle changes to control the disorder. One recent study assessed 71 patients in a 10-week cognitive behavioral therapy program concerning its efficacy in improving fibromyalgia symptoms. According to researchers of the study, the treatment resulted in substantial improvement in pain coping skills as well as depression.

Conclusion

Fibromyalgia presents a myriad of symptoms that include chronic pain, fatigue, mood disorders, and sleep disturbances. Nevertheless, patients are not alone in their fight against this potentially disabling condition. The multidisciplinary team of physicians, pain specialists, therapists, and other medical professionals all play an active role in the healthcare management approach.

A wide variety of new studies have acted like beacons of light to help guide people with fibromyalgia down the road of intimidating symptoms. Research has also helped clinicians better understand the disorder through newer classification scales developed by experts in the field. By diagnosing fibromyalgia early, both patients and physicians gain a sound foothold on developing an approach to reduce symptoms.

This approach, now more than ever, includes newer medications, alternative treatments, and patient education programs. People with fibromyalgia no longer have to make countless doctors’ appointments during their quest to find an answer to their suffering. Today, the healthcare community is armed with the research, methods, and technology to help manage fibromyalgia syndrome.

At Nevada Pain our goal is to relieve your fibromyalgia pain and improve function to increase your quality of life.
Give us a call today at 702-912-4100.

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