What Is Fibromyalgia? Medscape Readers Weigh In
Bret Stetka, MD
What Is Fibromyalgia?
not an accepted diagnosis
not well defined clinically
"Fibromyalgia is a name in search of a meaning."
-Anonymous Canadian rheumatologist
3 US Food and Drug Administration (FDA)-approved treatments for fibromyalgia
duloxetine, milnacipran, and pregabalin: all at least partially effective
neurophysiologic reduction in pain threshold, heightened sensitivity
small fiber neuropathy
dysfunction of the pain signaling system
mitochondrial disease: low energy for cell metabolism
poor sleep, sleep apnea, chronic hypoxia may induce
Th2 dominance, increased mast cell counts in papillary dermis, easily stimulated-->inflam
deficiencies: Mg, B6
dormant viruses, trauma, stress
vitamin D deficiency
a somatic presentation of anxiety or depression
wheat and dairy intolerance
meds: fluoroquinolones such as Cipro® [ciprofloxacin], Levaquin® [levofloxacin], Avelox® [moxifloxacin], chronic use of benzodiazepines, Z drugs, and narcotics-->tolerance and chronic pain
talk therapy, exercise, improved sleep hygiene, nutrition, and avoidance of stressors
many improve on antidepressants
manage systemic inflammation (lower IL6)
75% improve with better sleep, consider nocturnal O2 or CPAP if hypoxia
Blanco I, Béitze N, Argülles M, et al. Abnormal overexpression of mastocytes in skin biopsies of fibromyalgia patients. Clin Rheumatol. 2010;29:1403-1412. Epub 2010 Apr 30.
Uceyler N, Kewenig S, Zeller J, et al. Fibromyalgia syndrome is associated with small fiber impairment and altered cortical activity. Program and abstracts of the International Association for the Study of Pain Annual Meeting; August 29-September 2, 2010; Montreal, Quebec, Canada. Abstract PW093.
Carruthers BM, van de Sande MI. Fibromyalgia Syndrome: A Clinical Case Definition and Guidelines for Medical Practitioners: An Overview of the Canadian Consensus Document. Binghamton, NY: Haworth Medical Press Inc.; 2005. Available at: http://www.sacfs.asn.au/download/consensus_overview_fms.pdf Accessed February 18, 2011.
Turner MK, Hooten WM, Schmidt JE, et al. Prevalence and clinical correlates of vitamin D inadequacy among patients with chronic pain. Pain Med. 2008;9:979-984. Epub 2008 Mar 11.
Blaney GP, Albert PJ, Proal AD. Vitamin D metabolites as clinical markers in autoimmune and chronic disease. Ann N Y Acad Sci. 2009;1173:384-390. Abstract
Mouyis M, Ostor AJ, Crisp AJ, et al. Hypovitaminosis D among rheumatology outpatients in clinical practice. Rheumatology (Oxford). 2008;47:1348-1351. Epub 2008 May 22.
Brannagan TH III, Hays AP, Chin SS, et al. Small-fiber neuropathy/neuronopathy associated with celiac disease: skin biopsy findings. Arch Neurol. 2005;62:1574-1578. Abstract
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