A Simple Guide to Fibromyalgia II

A Simple Guide to Fibromyalgia II
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What are the investigations needed in assessment of Fibromyalgia?
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These criteria for diagnosis of Fibromyalgia:

1.history of widespread pain lasting more than three months-affecting all four quadrants of the body, i.e., both sides, and above and below the waist.

2.Tender points-there are 18 designated tender or trigger points
During diagnosis, four kilograms-force is exerted at each of the 18 points
The patient must feel pain at 11 or more of these points for fibromyalgia to be diagnosed.

3.fibromyalgia patients show sensitivity to pressure, heat, cold, electrical and chemical stimulation.

4.hyperactivity of the sympathetic nervous system
lower heart rate variability,
sympathetic hyperactivity,

5.laboratory blood testing appears normal

6.Cerebrospinal fluid abnormalities
cerebrospinal fluid levels of substance P, a putative nociceptive neurotransmitter, is raised.
Metabolites for monoamine neurotransmitters serotonin, norepinephrine, and dopamine are lower,
Nerve growth factor, a substance known to participate in structural and functional plasticity of nociceptive pathways within the dorsal root ganglia and spinal cord, is higher
Excitatory amino acid release within cerebrospinal fluid is higher

7.Brain imaging studies
Abnormal brain involvement in fibromyalgia has been provided via functional neuroimaging
decreased blood flow within the thalamus and elements of the basal ganglia and mid-brain.
Hippocampal disruption is shown by reduced brain metabolite ratios
Normal age-related brain atrophy occur with areas of reduced gray matter located in the cingulate cortex, insula and parahippocampal gyrus.
Dopamine synthesis in the brainstem is reduced.

What is the treatment for Fibromyalgia?
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There is no cure for fibromyalgia,

B.Medical treatment:
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1.corticosteroid seems to help especially to those with adrenal dysfunction and low blood pressure.
Injection of steroids with local anethestics at trigger points or nodules can help relieve pain.

2.Analgesics are able to relieve pain:
a.NSAID medications
b.COX-2 inhibitors,
c.tramadol

3.Muscle relaxants
Muscle relaxants, such as cyclobenzaprine or tizanidine to treat the muscle pain associated with the disorder.

4.Tricyclic antidepressants
Low doses of sedating antidepressants (e.g. amitriptyline and trazodone) help to reduce the sleep disturbances associated with fibromyalgia
Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain.

5.Anti-seizure medication
Anti-seizure drugs are also sometimes used, such as gabapentin and pregabalin
Pregabalin, originally used for the nerve pain suffered by diabetics, has been approved for treatment of fibromyalgia.

6.Dopamine agonists
Dopamine agonists (e.g. pramipexole (Mirapex) and ropinirole(ReQuip)) have been studied for use in the treatment of fibromyalgia with good results

7.Combination therapy
A combination of amitriptyline and fluoxetine appeared to be more effective in relieving pain.

8.Central nervous system stimulants
Cognitive dysfunction in fibromyalgia may be treated with low doses of central nervous system (CNS) stimulants such as modafinil, adderall or methylphenidate.
Stimulants may be habit forming and can have other serious side effects

9. Cannabis and cannabinoids
Cannabis is used therapeutically to treat symptoms of the disorder.
Cannabinoid agonists can also help in the treatment of chronic pain conditions


B.Non-drug treatment
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1. regular floatation tank sessions substantially improves sleep patterns leaving users more optimistic and with reduced nervousness, tension and pain.

Relaxing in a weightless state in the silent warmth of a floatation tank activates the body's own system for recuperation and healing

2..Whirlpool therapy is very beneficial.

C.Psychological therapies
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1.Cognitive behavioral therapy has help to improve quality of life

2.Neurofeedback has also shown to provide temporary and long-term relief

3.Biofeedback and self-management techniques such as pacing and stress management can help ,

D. Healthy lifestyle
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1. Stop smoking in smokers.

2. Reduce weight in the obese

3. Exercise to improve blood flow can improve symptoms(sleep , pain and fatigue)

4..heat to painful areas.

5. physical therapy, massage, or acupuncture

6. reduce intake of monosodium glutamate

E Surgical treatment:
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Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication.

F.Investigational treatments
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a.Milnacipran, a serotonin-norepinephrine reuptake inhibitor (SNRI) has help patients in Europe.

b.Dextromethorphan is an over-the-counter cough medicine with activity as an NMDA receptor antagonist.

What is the prognosis for Fibromyalgia?
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Fibromyalgia is not degenerative or fatal,

the chronic pain associated with fibromyalgia is pervasive and persistent.

Fibromyalgia can severely curtail social activity and recreation,

Some with fibromyalgia are unable to maintain full-time employment.

It rarely affects activities of daily living.


How can Fibromyalgia be prevented?
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1.Stop smoking

2.Reduce weight

3.Exercise

4.Avoid monosodium glutamate in diet

5.Avoid stress and depression

6.Live a healthy lifestyle