E-Note for Adult
Stat | Lytes |
Drugs | ID |
Heart | Lungs |
Kidneys | GI |
Rheum | Heme-Onc |
Endo | Neuro |
Derm | Misc. |
DX | RX
See Fibromyalgia 2007
Fibromyalgia is a problem that many people, particularly women, have in which
there is diffuse pain . The pain is worse with movement and to touch
or pressure. There is also a feeling of stiffness. The pain leads
the sufferer to becoming inactive , and creates a cycle of pain , less activity,
then pain with less activity. Many people with Fibromyalgia have common local
problems that seem to be part of their pain, such as lower back pain,
neck pain, shoulder problems, epicondylitis (tennis elbow), or trochanteric
bursitis. Many people who have fibromyalgia have a disturbance in
their sleep pattern that can often be measured on EEG, and treating the
sleep disturbance can be very helpful. They also often have irritable
bowel, chronic fatigue and chronic headaches.
Cause of Fibromyalgia
- Unknown !
But there are many things that seem to trigger fibromyalgia such as:
Disc problems in the neck and back
Shoulder problems such as rotator cuff, impingement, tendonitis.
Lifestyle changes and problems such as new job, weight gain, posture problems,
Work related problems such as repetitive activity and posture problems
Sleep disturbance - many things can lead to a disturbance of normal sleep
pattern and this contributes to the cycle of poor sleep causing more sensitivity
to pain which in turn causes poor sleep.
Drugs - many drugs cause sleep disturbance and also chronic use of drugs
can lead to stress. Some of the many drugs that have these effects are :
Alcohol, Caffeine, Nicotine, Diuretics, Street drugs, Others
Psychiatric problems - untreated depression affects sleep. Many people who
suffer with fibromyalgia have been found to be victims of abuse. Dealing
with these issues is very important in trying to get well.
Undiscovered Elements - Research has focused on hormonal imbalances as a
cause of fibromyalgia, but there is no conclusive evidence for this as yet.
Other possible contributing factors such as allergy, infections or toxins
in the environment have also been considered.
Diagnosis of Fibromyalgia
Fibromyalgia is diagnosed primarily from listening to the patient's
history and examining the patient . The characteristic story is one of
long-standing, nonfocal pain, sleep disturbance, often accompanied
by frequent headaches and irritable bowel symptoms, as well as fatigue.
Examination reveals no signs of inflammation such as swollen joints, and
many tender areas in characteristic locations: the base of the skull, the
medial supraspinatus and scapular areas, the anterior neck, sternoclavicular
areas, lateral epicondyles, sacral dimples, greater trochanters, and medial
knees. Many other area are often tender, and not much pressure is required
to produce pain. Sometimes there is muscle spasm detectable.
Laboratory testing should focus on ruling out specific entities:
CBC and sedimentation rate to rule out inflammatory disorders
TSH to rule out hypothyroidism
Calcium, Liver function studies, Glucose to rule out metabolic disease.
CPK to rule out muscle disease (if the patient is weak. Creatinine and Urinalysis
to rule out chronic renal disease.
Avoid ordering nonspecific tests such as ANA unless there is a good reason
to order such (signs of scleroderma, lupus, Rheumatoid Arthritis).
Xray only areas of physical abnormality.
Treatment of Fibromyalgia
The treatments of fibromyalgia are aimed at treating the factors that aggravate
it. Local problems, problems with various parts of the body such as neck,
back, shoulder, elbow, feet are treated with:
Posture support - supportive pillows
to maintain normal back curve and a supportive neck pillow at night. Proper,
supportive footwear is beneficial. Tennis elbow bands prevent stretching
or the ligaments that pull on this tender area.
Exercises - shoulder, back, and neck
exercises strengthen and stretch the muscles around the joints and improve
range of motion, preventing muscle spasm. A program of slowly progressive,
regular , exercise is essential in order to get well from fibromyalgia.
Ergonomics - proper organization of work
area so that the normal back and neck curves are not upset. Maintain proper
support for the back when sitting (lumbar pillow). If a computer is used
be sure the screen is positioned properly. There are proper ways to stand
and lift. Inactivity has to be avoided.
Work Issues- It is best to analyze your work situation and list the
factors there that can be changed, such as your work station, noise, and
cold, and to work with your employer in getting help in changing these factors.
Tricyclic medications as Amitriptyline/Elavil -
can help pain , sleep disturbance & depression.
Pain medications - aspirin,
acetaminophen/ Tylenol, non-steroid anti-inflammatory medications
as: ibuprofen/Motrin & muscle relaxant if there is spasm .
Attempt to achieve pain relief with
local measures such as massage (using baby oil or ointments such as
Zostrix can make this more effective), application of heat/cold (a
hot water bottle works best for this), support - pillows, good chairs, firm
mattress & physical therapy.
Lyrica (pregabalin) 300 mg or 450 mg
The most common side effects of pregabalin include mild to moderate
dizziness and sleepiness. Blurred vision, weight gain, dry mouth, and swelling
of the hands and feet were also reported in clinical trials. The side effects
appeared to be dose-related. Because pregabalin can impair motor function
and cause problems with concentration and attention, the FDA advises that
patients talk to their health care provider about whether use of pregabalin
may impair their ability to drive. The manufacturer has agreed to perform
a study of pregabalin in children with fibromyalgia and in breast-feeding
FDA Approves First Drug for Treating Fibromyalgia. FDA News. U.S. Food and
Drug Administration, June 21, 2007
Savella (Milnacipran) - a selective serotonin
and norepinephrine reuptake inhibitor (SNRI). 100-200 mg /day
What to expect with the Fibromyalgia sufferer:
Most Rheumatologists experience fibromyalgia as a life long problem for most
patients, but that the majority get better to the point that they can perform
and enjoy most activities, but do have some pain. Through a program of regular
exercise, a full life can be not only tolerable but enjoyable. There is a
lot of research being done on fibromyalgia and new treatments may be available
John Scavulli, MD - REF: Kaiser Intranet
Information Fact Sheet on Fibromyalgia from ARA