Fibromyalgia Pain Treatment Options


Treating Fibromyalgia Pain: Medication Options

5 types of medications help ease fibromyalgia symptoms.
By Jeanie Lerche Davis
WebMD Feature

If you have fibromyalgia pain, hang in there -- pain relief is possible.
Today doctors have better insight into fibromyalgia, and are using many types of medications to treat its symptoms. Antidepressants, anticonvulsants, narcolepsy drugs, pain relievers, sleep aids -- all these medications work with brain chemistry to reduce pain, improve sleep, and ease anxiety or depression.
Helping patients with fibromyalgia to function better is the top goal for treatment, says Kim Jones, PhD, president of the Fibromyalgia Information Foundation and associate professor at Oregon Health & Science University School of Nursing and Medicine in Portland.
"That's the key with fibromyalgia," she tells WebMD, "doing what we can to decrease the symptoms so patients can maintain employment, so they can be involved with family and community."
Treatment usually includes medication and aerobic exercise -- swimming or walking -- which research shows is important in controlling fibromyalgia pain, says Doris Cope, MD, director of Pain Management at the University of Pittsburgh School of Medicine.
"Everyone wants a magic pill,” Cope tells WebMD, “but a pill can't do everything."

The Symptom-By-Symptom Approach to Treating Fibromyalgia

In working with a patient, Jones targets the person’s top two or three worst fibromyalgia symptoms. Common fibromyalgia symptoms include deep muscle pain, fatigue, morning stiffness, headaches, sleep problems, constipation or diarrhea, memory problems, and anxiety or depression. But not all people with fibromyalgia suffer the same symptoms.
She looks at which symptoms are taking the biggest toll on the person’s life. Then she and the patient try various medications until they find the one -- or a combination -- that works.
"There's a bit of trial and error while you're trying to land on a good treatment," Jones says. Not every patient will respond well to a particular medication. It’s difficult to know which medication to try first. But working as a team during this trial and error phase is often an effective strategy.
5 types of medications help ease fibromyalgia symptoms.
 (continued)

Fibromyalgia Pain Treatment Options

If pain is the primary fibromyalgia symptom, Jones may prescribe a prescription pain reliever, an anticonvulsant, or an antidepressant.
Anticonvulsants, developed to treat seizures, help relieve many types of pain. Lyrica, an anticonvulsant, was the first medication approved by the FDA specifically for fibromyalgia pain.
Two more antiseizure drugs are being studied as fibromyalgia medications -- Neurontin and Ativan.
Antidepressants are very helpful in relieving fibromyalgia pain and improve deep restorative sleep. They work by balancing serotonin and other brain chemicals.

  • The new selective SNRIs (serotonin and norepinephrine reuptake inhibitors)help relieve fibromyalgia pain, whether the patient is depressed or not. SNRIs include Cymbalta and Effexor. Cymbalta is the only antidepressant approved by the FDA to treat fibromyalgia pain. Effexor is also used to relieve fibromyalgia pain.  The FDA has also approved the SNRI Savella to treat fibromyalgia. A caveat for SNRIs: These drugs cannot be used if the patient takes a type of drug called monoamine oxidase inhibitor (MAOI) or has narrow angle glaucoma.
  • Research shows that SSRIs (selective serotonin reuptake inhibitors) such as Paxil and Zoloft can help with sleep, overall well-being, and pain relief -- with lesser effects on fatigue and tender points from fibromyalgia. However, research indicates the SSRIs aren’t as effective as the SNRIs in treating fibromyalgia.
  • Amitril, Elavil, and other tricyclic antidepressants are often prescribed for fibromyalgia, but many people don't like their side effects (weight gain, dizziness, fatigue). At low doses, these medications don't help mood or anxiety disorders, which fibromyalgia patients often have. However, this type of antidepressant can help with sleep.
Combination antidepressants: At times, a combination of antidepressants can help reduce muscle pain, anxiety, and depression in fibryomyalgia. Patients also get more restful sleep, feel less fatigue, and have an overall better sense of well-being.
Pain relievers such as Ultram and Ultracet can help break cycles of fibromyalgia pain, relieve flare-up pain, and reduce muscle spasms. The muscle relaxant Flexeril can help reduce pain and improve sleep. Local injections of painkillers and/or cortisone at painful trigger points can be especially effective in breaking cycles of pain and muscle spasm.

Treating Insomnia From Fibromyalgia

Insomnia is a big problem in people with fibromyalgia. Research shows that frequent disruptions in sleep prevent growth hormone -- the important restorative hormone -- from being produced by the body. Without growth hormone, muscles don't heal and neurotransmitters (like serotonin) are not replenished.
Without deep sleep, the body can't recuperate from the day's stresses. This can overwhelm the body’s systems, creating a great sensitivity to pain.
In some patients with fibromyalgia, there is an underlying cause for insomnia, such as restless leg syndrome or sleep apnea. If it's not clear what's causing the sleep problem, Jones will prescribe one of several medications to help with sleep.
  • A low-dose tricyclic antidepressant (like Amitril) can help improve deep, restorative sleep.
  • A prescription sleep medication like Ambien, Lunesta, Rozerem and Sonata is not addictive in low doses. These are called "short-acting" drugs because they stay active in the body for the shortest amount of time. Each of these drugs works a bit differently. Some help people fall asleep more quickly; others make sure you stay asleep.
  • The anticonvulsant drug, Lyrica, is also prescribed for insomnia and fatigue caused by fibromyalgia.
  • In small studies, the narcolepsy drug Xyrem has been reported to help both sleep and pain. Xyrem is a potent sleep medication that helps patients get the deep sleep they need.
Cope considers sleep aids to be a last resort. "We can give you medication for sleep, but we have to be careful," she tells WebMD. "We don't want to take over the body's ability to produce neurochemicals -- or it will stop producing them."

Don’t Forget Lifestyle Approaches to Treating Fibromyalgia Pain

Chronic pain is tough to beat, so you need every bit of help you can get.
Exercise boosts the body's natural production of serotonin (the mood-enhancing brain chemical). It also improves blood flow to muscles, releases stress and tightness, improves sleep, all of which helps relieve pain, Cope tells WebMD.
Other lifestyle approaches also help with fibromyalgia. “Stress reduction, relaxation techniques, prayer, yoga, visual imagery -- those help, too,” Cope says. “Try different things. Find what works for you. These things will make a difference."
But complete relief from fibromyalgia pain is not always possible, Cope admits. “If your pain is moderate but you're living a normal life, going to work, we've made progress.”



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Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

video

movie

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here