Fibromylagia: a world of pain

Mon, 04/09/2007 - 00:00
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Investigators have found alterations in the stress response of people
with fibromyalgia. The stress response is a mechanism that allows for
interactions between the brain and body to help people respond to physical
and emotional challenges.

Researchers are also interested in examining in the role of environmental
factors in fibromyalgia. Studies have shown that fibromyalgia can be
triggered by musculoskeletal pain due to arthritis or injury. Almost 20
percent of people with rheumatic diseases, such as systemic lupus,
osteoarthritis or rheumatoid arthritis, also have fibromyalgia. Certain
types of infections, such as Lyme disease, can also trigger fibromyalgia.
Ongoing research aims to determine what factors may make certain people
susceptible to fibromyalgia.

Some studies suggest that genes may also play a role. “Now that we’ve
started to map the human genome, research suggests that there may be
twenty genes or more that could be responsible for fibromyalgia,” says Dr
Kim Jones, assistant professor at the Oregon Health and Science University
in Portland. “People with a greater number of potentially affected genes
may require little or no environmental stimulation to turn on their
fibromyalgia genes. Others may need stimuli.”

Fibromyalgia is difficult to treat. As such, a team approach is recommended. The team members usually consist of a general practitioner (family medicine), a rheumatologist, a physiatrist (rehabilitation medicine specialist), an orthopedic surgeon, and a pain specialist (sometimes an anesthesiologist with special training in pain care).

Fibromyalgia features one of the longest lists of medications used for any malady, none of them actually developed for the condition. In the United States, a number of medications have shown effectiveness in randomized clinical trials: these include antidepressants such as amitriptyline, duloxetine, fluoxetine and paroxetine; muscle relaxants such as cylobenzaprine and certain analgesics, including tramadol.

Although fibromyalgia is a chronic condition, there is much a patient can
do to relieve and control his or her symptoms. Home treatment plays a significant role in this, with experts recommending that those afflicted:

* Exercise regularly. Of all the treatments for fibromyalgia,
cardiovascular (aerobic) exercise may have the most benefit in reducing
pain and other symptoms and in improving the overall condition.

* Improve sleep. Sleep disturbances seem to both cause and result from
some of the other symptoms of fibromyalgia, such as pain. Learn good sleep
habits, and try to get enough sleep each night.

* Relieve pain. Heat therapy, massage, gentle exercise, and short-term
use of nonprescription pain relievers may be helpful.

* Reduce stress. Cognitive behavioral therapy helps teacxh relaxation
techniques, such as deep breathing, meditation, and techniques for coping
with stress.

* Learn more about fibromyalgia. The more a patient knows about
fibromyalgia, the more control he or she will have over his or her
symptoms. People who feel more in control also tend to be more active and
report less pain and other symptoms.

* Work on keeping a positive attitude. It's hard to stay positive when a
patient doesn't feel well, but a positive attitude helps him or her
focuses less on his or her challenges and feel more healthy.

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