WedMD health assessment on my Fibro

You report that you have already had a doctor diagnose you with fibromyalgia and that you are taking prescription medication for the condition. If your pain has been reduced or eliminated, you should continue with the treatment recommended by your doctor. But if your pain is not well-controlled, your doctor may keep adjusting your treatment regimen to find a combination of medication and nonmedication therapies that work for you. Responses to treatment vary by person, and finding the right mix that eliminates or reduces your pain may take a few months. MEDICATIONS A wide variety of prescription medications are used to treat the symptoms of fibromyalgia. Although all of the prescription medications mentioned below have been studied in people with fibromyalgia, only three medications have been approved by the U.S. Food and Drug Administration (FDA) specifically for use in those who have fibromyalgia: Cymbalta (duloxetine), Lyrica (pregabalin), and Savella (milnacipran). *Analgesics. Although pain is a key symptom of fibromyalgia, certain types of analgesics, or pain relievers, have not been found effective, including some opioids, such as OxyContin (oxycodone) or Percocet (acetaminophen and oxycodone). The mild opioid Ultram (tramadol), with or without acetaminophen, has been shown to be effective for those with fibromyalgia. However, due to side effects and dependency issues, opioids should be used only when other medications and therapies have proven ineffective. Over-the-counter medications, such as acetaminophen and NSAIDs, may also benefit those with fibromyalgia. However, NSAIDs have been shown to be ineffective when used alone for fibromyalgia pain, which may be because fibromyalgia pain is not related to inflammation. * Antidepressants. Many people with fibromyalgia also suffer from depression. The relationship between the two is unclear. Depression may be due to fibromyalgia symptoms, such as chronic pain and fatigue. It may also be related to imbalances of the brain chemicals serotonin and norepinephrine, which are seen in both conditions. For many, taking an antidepressant often helps decrease the sense of pain. While Cymbalta (duloxetine) is the only antidepressant FDA-approved to treat fibromyalgia, others prescribed for people with chronic pain or depressed mood associated with fibromyalgia include Elavil (amitriptyline), Paxil (paroxetine), and Prozac (fluoxetine). While not an antidepressant, Savella (milnacipran) is approved for fibromyalgia and works much like an antidepressant by altering chemical imbalances in the brain. * Antiseizure Medications. Recent fibromyalgia research has found that altered function of the central nervous system (brain and spinal cord) may play a role in fibromyalgia symptoms. Antiseizure medications that act on the central nervous system have been proven to sustain pain reduction and improve sleep quality in people with fibromyalgia. Lyrica (pregabalin) is the only antiseizure medication approved for fibromyalgia, although Neurontin (gabapentin) is also used. * Muscle Relaxants. These medications help relieve painful muscle spasms. Muscle relaxants commonly used in people with fibromyalgia include Cycloflex (cyclobenzaprine), Flexeril (cyclobenzaprine), Norflex (orphenadrine citrate), and Soma (carisoprodol), and Zanaflex (tizanidine). * Sleep Medications. When pain prevents you from getting an uninterrupted night's sleep, your body will feel the effects, which may include memory loss, difficulty concentrating, a weakened immune system, weight gain, irritability, and an increased sense of pain. If you are waking unrefreshed due to poor sleep caused by fibromyalgia symptoms, your doctor may recommend over-the-counter or prescription medications to help with sleep such as Ambien (zolpidem), Lunesta (eszopiclone), or Sonata (zaleplon).Medications are just part of the treatment plan for people with fibromyalgia, however. Studies have also shown that exercise, patient education programs, and cognitive behavioral therapy can treat fibromyalgia. COGNITIVE BEHAVIORAL THERAPY (CBT) Studies show that CBT, which adjusts maladaptive patterns of thinking, can be as beneficial for treatment of pain and depressed mood. Working with a therapist, you can learn how to overcome negative thoughts and to learn to focus on activities and thoughts that bring you pleasure instead. PATIENT EDUCATION CLASSES There is strong evidence showing that such classes, especially when combined with CBT and exercise, greatly help reduce some of the symptoms of fibromyalgia for three months to one year. In a patient education class, lectures, written materials, and demonstrations are used to teach people with fibromyalgia how to reduce their symptoms and maintain control of their condition.

WELL-BEING

Sounds like you are having a tough time. Your responses to several questions indicate that fibromyalgia significantly affects your life and health. That's understandable, but it's time for you to start feeling better more often by considering whether you are doing everything you can to help manage your fibromyalgia. Focusing on living a healthy lifestyle certainly can make a big difference in how you feel. EAT RIGHT AND LIGHT Everybody, regardless of health condition, should strive to eat a balanced diet in the right portion sizes. Optimal nutrition contributes to optimal health. The body simply works best when it gets the nutrients it needs through a wide variety of foods taken in moderation. EXERCISE A LITTLE EVERY DAY Aerobic exercise and muscle strengthening have been found to improve the ability to function, boost mood, and decrease fatigue. If you are experiencing any of these symptoms, you should consider beginning an exercise program. However, do not start any exercise program until you have gotten your doctor's approval. You may experience mild-to-moderate muscle pain at first as the body adjusts, but the long-term benefits of sticking with exercise far outweigh any short-term discomfort you may experience. Some exercise may be less painful than others, such as walking or doing aerobics in a heated pool, although doctors suggest experimenting to find a program that you feel most comfortable doing. Eventually, you can gradually increase how often and how intense you exercise, so your body can benefit even more. KEEP STRESS IN CHECK The standard pace of life these days seems fast and furious, so slowing down to relax may feel like a waste of time. But it's not. In fact, finding time every day to slow down and take it easy is an extremely valuable part of a healthy lifestyle. Reducing stress reduces the intensity of pain. Simply sitting comfortably in a quiet room and breathing deeply can help. If you have trouble simply letting stress go, therapists can help you learn simple mind-over-matter techniques, such as guided imagery to visualize a calm place, progressive muscle relaxation to eliminate tension in the body, meditation, biofeedback, and even hypnosis. BE A SOCIAL ANIMAL It's true: People do need people. If you have a strong, supportive social network, tapping into it to visit friends or asking for help when you need it may help with some of your symptoms. Being connected to others has been shown to reduce pain and anxiety. One-on-one counseling, group counseling, and support groups also provide a place to vent about your frustrations, while receiving encouragement and coping techniques from others who may share similar symptoms.

If you are doing everything you are supposed to be doing and still suffering, then you should set up an appointment with your doctor to have your treatment plan re-evaluated. Perhaps it is time for a change in medication or medication dosage.

KNOWLEDGE

How much do you really know about fibromyalgia? See how your answers stacked up. You answered 5 of 5 questions correctly or 100 percent.


There are no blood tests that help to diagnose fibromyalgia. [TRUE] Fibromyalgia is a condition that affects mainly women, mostly between the age of 20 and 50. It is characterized by widespread pain and aching in the body, as well as fatigue, sleep problems, and morning stiffness. Blood tests cannot pinpoint the source of the pain or measure fatigue. Instead, doctors examine 18 specific tender points on the body. If a patient reports widespread pain (that is, in both the top and bottom of the body and on both the left and right sides) and experiences pain in 11 or more of the 18 tender points during a physical examination, a doctor may diagnose fibromyalgia. If a patient had previously been diagnosed with another significant condition, such as a rheumatic disorder like rheumatoid arthritis, and yet experiences widespread pain and pain in tender points, a patient may also have fibromyalgia.

Fibromyalgia does not shorten life span. [TRUE] Fibromyalgia doesn't directly decrease the quantity of years lived, but it can greatly impact the quality of them. Pain and severe fatigue can make keeping up with responsibilities at work and at home quite difficult, leading some people with the condition to file for disability. Fibromyalgia can make physical movements painful, so many people with the syndrome tend to limit exercise; some even develop a fear of physical movement. Ultimately, avoiding movement reduces fitness level and leads to a sedentary state, which can increase the risk for other health problems, such as obesity, heart disease, diabetes, or stroke. Although there is no cure for fibromyalgia, proper treatment can help improve the quality of life and help prevent further health problems that could shorten life span.

All doctors know how to diagnose and treat fibromyalgia. [FALSE] Diagnosing fibromyalgia can be tricky, and not all doctors are experienced in doing so. For many people with fibromyalgia, the doctor initially may suspect that symptoms, such as widespread pain, fatigue, waking unrefreshed, and headaches, are caused by another condition with overlapping symptoms. If you have been diagnosed with a condition that has the same or similar symptoms and your symptoms are not improving with treatment, talk to your doctor about the possibility of a fibromyalgia diagnosis.

People with fibromyalgia feel pain when they start to exercise, but they should continue to exercise anyway. [TRUE] Scientific studies show that when people living with fibromyalgia participate in a daily exercise routine, they have less pain and experience improved function. Talk to your doctor about your exercise regimen. Depending on your health and physical condition, some exercises may not be recommended. When beginning an exercise program, you may experience mild-to-moderate muscle pain as the body adjusts, but the long-term benefits exceed the short-term pain experienced. The key is to overcome exercise-related pain, along with any fear of pain exercise might cause, by preparing the body for exercise and finding an exercise program that you feel comfortable doing. And some exercises may be less painful than others, such as walking or doing aerobics in a heated pool instead of walking or doing aerobics on land. You should speak with your doctor for help finding the right exercise routine for you.

Strong narcotics, such as Lortab (hydrocodone) or Percocet (oxycodone) are recommended for the pain of fibromyalgia. [FALSE] Narcotic opioid pain relievers, such as Lortab (acetaminophen and hydrocodone), OxyContin (oxycodone), or Percocet (acetaminophen and oxycodone), are not recommended for treating fibromyalgia pain simply because they don't work for many people who have the condition. A study from the University of Michigan helps explain why. Researchers there found that the opioid receptors in the brains of people with fibromyalgia have a decreased ability to bind and therefore less of a chance for medications targeting those receptors to ease fibromyalgia pain. The study also found that people with fibromyalgia and depression had the least available opioid receptors, making pain relief even more challenging. Because researchers have learned more about how fibromyalgia affects the central nervous system (brain and spinal cord), they have found that anticonvulsants (antiseizure medications) are helpful. These medications include Lyrica (pregabalin), which has been FDA-approved for fibromyalgia, and Neurontin (gabapentin). Both work directly on the brain and spinal cord to reduce the production of pain signals. These medications not only ease pain but also decrease fatigue and help patients get more refreshing sleep, which also helps improve symptoms.


1. Wolfe, F, Smythe, HA, Yunus, MB, et al. American College of Rheumatology (ACR) 1990 Criteria for the Classification of Fibromyalgia. Arth & Rheum 1990; 33(2):160-172.
2. Goldenberg, DL, Burckhardt, C, Crofford, L. Management of fibromyalgia syndrome. JAMA 2004; 292(19):2388-2395.
3. Carville, SF, Arendt-Nielsen, S, Bliddal, H, et al. EULAR evidence based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 2007; online.
4. Burckhardt, CS, Clark, SR, Bennett, RM. The Fibromyalgia Impact Questionnaire: Development and validation. J Rheum 1991; 18(5):728-733.
5. Crofford, L. Pain management in fibromyalgia. Curr Opin Rheumatol 2008; 20(3):246-250.
6. Harris, R, Clauw, D, Scott, D, et al. Decreased central mu-opioid receptor availability in fibromyalgia. J Neurosci 2007; 27(37):1000-1006.
7. Zautra, A. Strengthening resilience capacity might light the way to a brighter future for patients with fibromyalgia. Nat Clin Pract Rheumatol 2008; published online.
8. Gowans, S, deHueck, A. Effectiveness of exercise in management of fibromyalgia. Curr Opin Rheumatol 2004; 16(2):138-142.
9. Rooks, D, Gautam, S, Romeling, M, et al. Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial. Arch Intern Med 2007; 167(20):2192-2200.
10. Jones, K, Clark, S, Bennett, R. Prescribing exercise for people with fibromyalgia. AACN Clin Issues 2002; 13(2):277-293.
11. Chakrabarty, S, Zoorob, R. Fibromyalgia. Am Fam Physician 2007; 76(2):247-254.
12. Goldenberg, D. Multidisciplinary modalities in the treatment of fibromyalgia. J Clin Psychiatry 2008; 69(Suppl 2):30-34.
13. Zozulya, A, Gabaeva, M, Sokolov, O, et al. Personality, coping style, and constitutional neuroimmunology. J Immunotoxicol 2008; 5(2):221-225.
14. Karp, J, Shega, J, morone, N, Weiner, D. Advances in understanding the mechanisms and management of persistent pain in older adults. Br J Anaesth 2008; 101(1):111-120
15. American College of Rheumatology:”Fibromyalgia.”
16. Nickerson , B PharmD, BCPS; Recent Advances in the Treatment of Pain Associated With Fibromyalgia; US Pharm. 2009;34(9):49-55.
17. Russell IJ, Kamin M, Bennett RM, et al. Efficacy of tramadol in treatment of pain in fibromyalgia. J Clin Rheumatol. 2000;6:250-257.
18. Bennett RM, Kamin M, Karim R, et al. Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study. Am J Med. 2003;114:537-545.
19. Bennett RM, Schein J, Kosinski MR, et al. Impact of fibromyalgia pain on health-related quality of life before and after treatment with tramadol/acetaminophen. Arthritis Rheum. 2005;53:519-527.
20. Buckhardt CS, Goldenberg D, Crofford L, et al. Guideline for the management of fibromyalgia syndrome pain in adults and children. Glenview, IL: American Pain Society; 2005.
21. Fibromyalgia Symptoms.Org: “Muscle Relaxants”
22. Tofferi, J. Jackson, J. O’Malley, P. Treatment of Fibromyalgia With Cyclobenzaprine: A Meta-Analysis; Arthritis & Rheumatism; 2004; 51: 9–13.
23. Bernardy K, Fuber N, Kollner V, Hauser W.; Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome - a systematic review and metaanalysis of randomized controlled trials; J Rheumatol. 2010 Oct;37(10):1991-2005.
24. Fors EA, Sexton H, Gotestam KG. The effect of guided imagery and amitriptyline on daily fibromyalgia pain. J Psychiatr Res. 2002;36:179