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CHALLENGE OF FIBROMYALGIA

Q: After a lifetime of aches and pains I have been diagnosed with fibromyalgia. I'm a female in my fifties and would like to know more about the disease. I do exercise, but because it hurts I don't do much of it anymore. Your opinions would be greatly appreciated.

-- Anonymous

A: Fibromyalgia is characterized by long-lasting and widespread achy pain, multiple tender points and muscle stiffness. Fatigue, insomnia, headaches and numbness are other common symptoms. Symptoms are often triggered by physical or mental stress, depression or inadequate sleep.

Fibromyalgia occurs most often in women between the ages of 20 and 50. The cause is unknown, but some recent research indicates that it may be a combination of an autoimmune disorder and the impact of stress.

Recent studies have identified the sympathetic nervous system as the source of the pain and perhaps all of the symptoms. That's one explanation why pain medications that are effective in treating typical pain, which comes from the other part of the nervous system, are not effective in people with fibromyalgia.

To make it even more complicated, and confusing, this year research showed that changes in blood flow to different parts of the brain were associated with fibromyalgia pain and it's improvement with treatment.

Unfortunately, there are no lab tests or exams to confirm the specific diagnosis of fibromyalgia. So the diagnosis must be based on excluding each of the many other problems that may be causing these symptoms. Other disorders that may cause similar symptoms include some forms of arthritis, thyroid disease, lupus, chronic fatigue syndrome and depression.

Fibromyalgia is a long-term disorder without a known cure. A bit of good news is that it usually doesn't get worse over time, and many people get better over time. Also, there are many things a person can do to help manage it. But this means the person needs to take control, make lifestyle changes and adopt coping techniques. For example, stress should be reduced and sleep activity improved. Massage, stretching and aerobic exercises are valuable for many.

Although not enough research has been done on the effectiveness of alternative and complementary medical treatments, many people use one or more of these modalities with some success.

Typical pain medications, including narcotics, are not very helpful. Neither are steroids. Tricyclic antidepressants, such as amitryptyline, have shown some modest effectiveness, as have some of the serotonin reuptake inhibitor (SSRI) class of antidepressants.

Recent research has shown that an even better response is obtained from the class of antidepressants that inhibit the reuptake of serotonin and norepinephrine (another neurotransmitter). Two examples of these drugs are duloxetine and milnacipran.

The new drugs are known to have major effect on the sympathetic nervous system, which further confirms its role in this condition. But the major challenge in developing improved treatment for fibromyalgia is to confirm this information further and to find out what is causing the sympathetic system to malfunction. A lot of research is being focused on this problem (more than 200 research studies were publish in the past 12 months). So, hopefully, much more will be known in the next few years.

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