Louisiana Pain Specialists - Pain Diagnosis and Intervention Experts

Fibromyalgia is a disorder of unknown etiology characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often psychological distress (CDC, 2009). Fibromyalgia affects 5 million Americans age 18 or older, and in approximately 25-65% of cases may present with other rheumatic conditions such as rheumatoid arthritis (RA), lupus, and anklyosing spondylitis (CDC, 2009). For unknown reasons, between 80 and 90 percent of individuals diagnosed with the disorder are women; however, men and children also can be affected (NIAMS, 2010).

Symptoms

People with fibromyalgia report a wide range of symptoms. An individual need not experience all of the symptoms to be diagnosed with the condition. Symptoms of the disorder may include (CDC, 2009):

• Allodynia (extreme sensitivity to touch/pressure)
• Fatigue
• Sleep disturbances
• Morning stiffness
• Tingling or numbness in hands and feet
• Headaches, including migraines
• Irritable bowel syndrome and bladder abnormalities
• Cognitive  and memory problems (sometimes called “fibro fog”)
• Painful menstrual periods and other pain syndromes

Unfortunately, many fibromyalgia sufferers characterize their quality of life as less than optimal. For example, a study found that fibromyalgia patients rated their perceived “present quality of life” at only 4.8 on a scale of 1 to 10 (1 = low to 10 = highest) (Bernard et al, 2000). Further, adults with fibromyalgia are 3.4 times more likely to have major depression than peers without fibromyalgia (Patten et al, 2005).

Criteria for diagnosis of fibromyalgia, developed by The American College of Rheumatology (ACR) are based on the presence of widespread pain of at least 3 months duration and tenderness on 11 of 18 pressure points.

The Pain of Fibromyalgia

Perhaps the greatest challenge of living with fibromyalgia is managing the chronic, widespread pain associated with the condition. Most often, pain is felt over certain pressure points, such as the back of the head. Some fibromyalgia patients describe nerve pain, which can cause numbness and tingling. And some report heightened sensitivity to tactile pressure, or allodynia; a consequence of central sensitization.

Central sensitization is overreaction of pain receptors in the central nervous system to normal physical sensations. This occurrence is thought to be a consequence of prolonged pain from any long-term condition like fibromyalgia. Low-threshold sensory fibers activated by light touch of the skin trigger neurons in the spinal cord that normally respond only to painful stimuli. Eventually, harmless stimuli provoke feelings of pain, a phenomenon known as allodynia. To avoid central sensitization, do not delay seeking help for your fibromyalgia-related pain.

Ironically, one group of researchers found that fibromyalgia patients they studied had less gray matter volume in pain-processing areas of the brain (Robinson et al, 2010).  In the study, they compared 19 pain-related brain areas of 14 fibromyalgia patients with 11 healthy people without fibromyalgia, and discovered the fibromyalgia patients had significantly less gray matter volumes in three key pain-related areas. Further, the atrophy in these areas was confirmed to be unrelated to depression, as shown in some studies. Although the researchers remained unclear as to why these fibromyalgia patients had these apparent brain abnormalities, they theorized gray matter depletion in pain-related areas of the brain may contribute to some of the core symptoms of the disorder.

Treatment

Although there is no cure for fibromyalgia, the intensity and frequency of symptoms may vary as time passes. Some individuals may even experience intermittent symptom-free periods in which they have significantly lower levels of pain. It is important to remember that fibromyalgia is not a progressive or life-threatening condition and certain treatments can significantly improve the discomforts associated with the disorder.

Since patients with fibromyalgia often experience physical distress as well as psychological and emotional difficulties, doctors generally recommend treatment of both the body and the mind for successful management of the disorder. Treatment goals of patients with fibromyalgia include improvement of physical pain, increase in daily activities, and restoration of normal sleep cycles. The doctors at our pain relief clinic are ready to help you manage your fibromyalgia with a personalized plan that may include medications and non-pharmacological therapies.

The U.S. Food and Drug Administration (FDA) has approved various medications for the treatment of fibromyalgia. Some of these drugs modulate neurotransmitters such as serotonin and norepinephrine, which are involved in pain processing.  These medications have side effects related to their specific formulation therapies (American College of Rheumatology, 2010). Other FDA-approved medications for fibromyalgia work in a different way by blocking excessive activity of nervous tissue involved in pain transmission. Side effects of these medications may include dizziness, sleepiness, swelling and weight gain.

Opioids are typically not recommended for the treatment of fibromyalgia unless patients have failed to achieve relief with other therapies. Opioids are habit forming, and anecdotal evidence suggests these drugs are not of significant benefit to most people with fibromyalgia and in fact may cause greater pain sensitivity or persistence of chronic pain (Ngian et al, 2011).

Other medications prescribed to control fibromyalgia may include:

• Antidepressants
• Analgesics (NSAIDs)
• Muscle relaxants
• Acetaminophen
• Membrane Stabilizing Drugs
• Sleeping aids

Medications represent only one route for controlling the symptoms of fibromyalgia. Non-pharmacological methods of treatment have proven to be very successful in many patients with the disorder. For example, patient education, exercise, self-management skills and alternative therapies may help treat fibromyalgia symptoms (American College of Rheumatology, 2010). A recent study showed a 2-month educational intervention program benefitted fibromyalgia patients, who reported improvements in physical impairment, days not feeling well, pain, general fatigue, morning fatigue, stiffness, anxiety, and depression (Luciano et al, 2011).

The American College of Rheumatology (2010) recommends “self-management” to fibromyalgia patients to promote meaningful improvement in symptoms and daily function. Specifically, it suggests that patients schedule daily relaxation time, establish a regular sleeping pattern, get regular exercise, and educate themselves on their condition. It also advocates deep-breathing exercises and meditation to help curb stress that can exacerbate symptoms.  Another therapeutic option recommended by the American College of Rheumatology is cognitive behavioral therapy, which can help redefine a person’s perceptions and opinions about illness, and teaches symptom reduction skills, which may help alter an individual’s behavioral response to pain.

In addition to the therapies endorsed by the American College of Rheumatology, Louisiana Pain Specialists may recommend to its fibromyalgia patients any of a variety of beneficial therapies. Many of these are offered within the practice. These therapies include:

• Physical Therapy
• Acupuncture
• Yoga
• Massage therapy
• Meditation
• Prayer
• Cognitive Behavioral Therapy
• Exercise Therapy
• Aquatic Therapy
• TENS Unit
• Trigger Point Injections
• Nutritional guidance
• Botox

In many cases, these treatments can help individuals with fibromyalgia safely and effectively improve their quality of life. At Louisiana Pain, we have not only seen these therapies benefit countless fibromyalgia patients, but many of these treatment modalities are backed by published research.

For example, a Japanese study found acupuncture improved pain and quality of life in 16 fibromyalgia patients (Itoh et al, 2010), and a recent meta-analysis found acupuncture and other traditional Chinese therapies appeared to be effective in treating fibromyalgia (Cao et al, 2010).

Concerning yoga, one study showed a sample of 53 fibromyalgia patients who were randomized to an 8-week yoga-based treatment program (gentle poses, meditation, breathing exercises, yoga-based coping instructions, group discussions) or to “standard care,” showed significantly greater improvements in functioning including pain, fatigue, and mood, acceptance, and other coping strategies, than the group in standard care (Carson et al, 2010).

According to a treatment comparison study conducted at the University of Miami, fibromyalgia patients receiving massage therapy reported lower anxiety and depression, and their cortisol levels were lower immediately after therapy sessions; further, subjects receiving massage therapy reported less pain the last week, less stiffness and fatigue, and fewer nights of difficult sleeping (Sunshine et al, 1996).

The efficacy of Cognitive Behavioral Therapy for fibromyalgia treatment is also backed by clinical research. According to a systematic review of 14 randomized, controlled trials, Cognitive Behavioral Therapy improved coping with pain and reduced depressed mood in fibromyalgia patients (Bernardy et al, 2010).

Exercise is another well-researched modality for fibromyalgia treatment. A two-year study in 207 women with fibromyalgia who were also taking medication found progressive walking, simple strength training movements, and stretching activities improved functional status, key symptoms, and self-efficacy in the test subjects, and these were enhanced when combined with targeted self-management education (Rooks, 2007). And a randomized, controlled trial found strength training improved strength and some functionality in test subjects with fibromyalgia; the researchers concluded resistance training has important implications on independence and quality of life issues in women with fibromyalgia (Kingsley et al, 2005). Further, a study of aquatic exercise therapy in fibromyalgia patients found warm water produced relevant gains in muscle strength at low velocities of movements, some of which predicted improvements in physical problems, emotional problems, mental health and balance, in 30 fibromyalgia patients (Tomas-Carus et al, 2009).

And TENS has been shown in the medical literature to benefit individuals with fibromyalgia. Swedish researchers reported TENS lowered pain according to fibromyalgia patients receiving the therapy, and praised TENS for being self-administered, safe and inexpensive (Löfgren et al, 2009).

At Louisiana Pain Specialists, we believe that both the body and the mind need to be addressed for successful treatment of fibromyalgia and we will work with you to develop a winning individualized treatment plan. For more information, contact Louisiana Pain Specialists to schedule an appointment.

Sources

Bernard A et al. (2000). “Quality of life issues for fibromyalgia patients.” Arthritis Care Res. 13(1):42–50.

Bernardy K et al. (2010). “Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome – a systematic review and metaanalysis of randomized controlled trials.” J Rheumatol. 37(10):1991-2005. http://www.ncbi.nlm.nih.gov/pubmed/20682676

Cao H et al. (2010). “Traditional Chinese Medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials.” J Altern Complement Med.16(4):397-409. http://www.ncbi.nlm.nih.gov/pubmed/20423209

Carson J et al. (2010). “A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia.” Pain. 2010 Nov;151(2):530-9. http://www.ncbi.nlm.nih.gov/pubmed/21146930

Crofford L. (2010). “Fibromyalgia.” American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/fibromyalgia.asp

CDC (2009). “Fibromyalgia.” http://www.cdc.gov/arthritis/basics/fibromyalgia.htm

Itoh K et al. (2010). “Effects of acupuncture to treat fibromyalgia: a preliminary randomised controlled trial.” Chin Med 23;5:11. http://www.ncbi.nlm.nih.gov/pubmed/20331844

Kingsley J et al. (2005). “The effects of a 12-week strength-training program on strength and functionality in women with fibromyalgia.” Arch Phys Med Rehabil. 86(9):1713-21. http://www.ncbi.nlm.nih.gov/pubmed/16181932

Löfgren M et al. (2009). “Pain relief in women with fibromyalgia: a cross-over study of superficial warmth stimulation and transcutaneous electrical nerve stimulation.” J Rehabil Med. 41(7):557-62. http://www.ncbi.nlm.nih.gov/pubmed/19543667

Luciano J et al. (2011). “Effectiveness of a Psychoeducational Treatment Program Implemented in General Practice for Fibromyalgia Patients: A Randomized Controlled Trial.” Clin J Pain. 2011 Feb 11. http://www.ncbi.nlm.nih.gov/pubmed/21317775

Ngian G et al. (2011). “The use of opioids in fibromyalgia.”  Int J Rheum Dis. (1):6-11. http://www.ncbi.nlm.nih.gov/pubmed/21303476

Patten SB, Beck CA, Kassam A, Williams JV, Barbui C, Metz LM. Long-term medical conditions and major depression: strength of association for specific conditions in the general population. Can J Psychiatry 2005;50(4):195–202.

Robinson M et al. (2010). “Gray Matter Volumes of Pain-Related Brain Areas are Decreased in Fibromyalgia Syndrome.” J Pain. Dec 9, 2010. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/21146463

Rooks D et al. (2007). “Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial.” Arch Intern Med. 2007 Nov 12;167(20):2192-200. http://www.ncbi.nlm.nih.gov/pubmed/17998491

Sunshine et al. (1996). “Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation.” J Clin Rheumatol. 2(1):18-22. http://www.ncbi.nlm.nih.gov/pubmed/19078022

Tomas-Carus et al. (2009). “Improvements of muscle strength predicted benefits in HRQOL and postural balance in women with fibromyalgia: an 8-month randomized controlled trial.” Rheumatology (Oxford). 48(9):1147-51. http://www.ncbi.nlm.nih.gov/pubmed/19605373