Options ease bromyalgia

Fibromyalgia is a common musculoskeletal problem. It is characterized by widespread pain in the muscles, tendons and ligaments. The pain is especially noticeable in the neck, shoulders, hips and low back.

While arthritis is characterized by in ammation in the joints, in ammation is not a major component of bromyalgia.

Hundreds of years ago, the widespread pain of bromyalgia would have been called “rheumatism.”

From about 1920 to 1990, the term brositis was used. That term implied in ammation in the brous or connective tissues.

By the late 1980s, it became clear that in ammation was not the disease mechanism of this illness. In 1990, the name changed to “ bromyalgia,” which more accurately describes the condition. The suf x “algia” refers to pain.

Fibromyalgia affects approximately 9 million people in the United States making it the second most common musculoskeletal problem after osteoarthritis.

Women are affected six times more commonly than men. In most cases, the cause is unknown.

It seems to be related to lack of sleep, stress and occasionally trauma.

Other associations include anxiety, depression, irritable bowel syndrome, endometriosis and headaches. Sleep apnea can also be a contributing factor to bromyalgia.

Fibromyalgia is diagnosed in the patient who has widespread pain both above and below the waist, and a large number of tender points discovered by the examining physician.

This widespread pain is often described as a deep, constant ache in the muscles. In addition to widespread pain, patients with bromyalgia frequently experience fatigue and report mental confusion known as “ bro fog.”

They often have dif culty sleeping at night and don’t feel rested when they awaken in the morning.

Lab tests and routine X-rays are generally normal.

Recent research has found that people with bromyalgia have increased activity in their brain in the limbic system and the amygdala, which are involved in the pain processing area of the brain.

These changes show up on special functional MRI scans.

These scans are not used in everyday medicine to diagnose bromyalgia but are used in clinical research of the disease.

In addition, pain gateways in an area of the spinal cord, called the posterior horn cells, seem to “open up” at a lower threshold in individuals with bromyalgia than in individuals who don’t have the condition.

While there is no cure, treatment can dramatically improve the lives of patients with bromyalgia.

Lifestyle changes can be particularly helpful.

Reducing stress and getting enough sleep can be very helpful to minimize symptoms of bromyalgia.

Regular exercise, especially aerobic exercise, is bene cial. This can include walking, low-impact aerobics and swimming.

Incorporating a treadmill, elliptical machine or exercise bicycle into your workout can also be helpful. Recent clinical research has also advocated Tai Chi and yoga.

Dietary changes can be helpful in controlling some of the symptoms associated with bromyalgia.

Eliminating caffeine, especially later in the day when it might affect sleep, can also help. Check with your physician regarding suggested dietary changes and before beginning a new exercise program.

In 2007, the FDA approved the rst medication indicated for bromyalgia. That medication, Lyrica, had previously been approved for other diseases that involved the pain gateway in the spinal cord. It was rst used for the neurologic pain of shingles and diabetes.

A second medication, Cymbalta, previously used for depression, was found to also target that same pain gateway in the spinal cord. Cymbalta was approved by the FDA as an effective medication for bromyalgia in 2008.

A third medication, Savella, also received FDA approval for bromyalgia by targeting these same pain gateways. Other medications like acetaminophen, tramadol and gabapentin may also be used. Amitriptyline, uoxetine and cyclobenzaprine may be used to help promote sleep in patients with bromyalgia.

Fibromyalgia was once a misunderstood and frustrating disease.

Now with better understanding of the disease and new treatment options, patients can experience dramatic improvement and control of their symptoms and have a better quality of life.

Dr. Robert E. Goodman is a board-certified rheumatologist at the Arthritis & Rheumatology Clinic in Shreveport. For more information or to make an appointment, call 424- 9240 or visit the clinic website: www.arthdoc.com.

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