Doctors' Answers to "Frequently Asked Questions" - Fibromyalgia

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Fibromyalgia [posted 1/14/99]
Question: I have been diagnosed with Fibromyalgia. Another person in the office said that she has heard that if you don't eat certain foods it can help your symptoms. Also you can take some herbs that might help. Do you know of any foods that I should stay away from and what herbs or vitamins might be of help? I am desperate. The pain is unbearable. I have been going through physical therapy three days a week with little relief. I had been on Relafen and am now on Clinoril. My pain is worse when I sit down and when I am laying in bed. Therefore, I don't get much sleep. I have been on trazadone and that helps somewhat, but not all the time. I am at my wits end. I just want to be able to live without pain. Is it possible? Is there anything else that I should be doing?

Answer: We don't have any effective treatment for Fibromyalgia. You will hear a lot. It's worth trying the ones that aren't crazy, but don't be disappointed if they don't work. Heat, massage, acupuncture will help for short periods.

Fibromyalgia Treatment [posted 1/8/99]
Question:Could someone please tell me what medicine doctors prescribe for the pain and multiple symptoms of Fibromyalgia? I find it hard to believe the medical profession expects people with this condition, to just live with it. It is wrecking my life.

Answer: We don't have satisfactory treatments at this time. Consequently, we use different types of narcotics, antidepressants, muscle relaxants and whatever seems to work best in specific patients.

Fibromyalgia and Librax  [posted 1/4/99]
Question: I have been diagnosed with Fibromyalgia 7 months ago after 3 years of looking for an answer following an automobile accident. I was taking Elavil but stopped since I wasn't seeing any improvements. Three weeks ago, I developed an abdominal pain, which lead to more tests and a tentative diagnosis of a spastic colon after ruling out appendicitis. My doctor put me on an anti-spasmodic drug (the generic form of Librax - Clindin) which has not taken care of the abdominal pain, but my back muscles have never been so relaxed. I'm sleeping like a baby, although the medication makes me drowsy during the day. Do you know if this medication has ever been tested with Fibromyalgia patients before and is it safe to take this long term? I still have some pain, but as far as I'm concerned, I'd rather be drowsy and a bit achy than feel as stiff as a tree.

Answer: It hasn't been tested as far as I know, but I think I will try it on some of my Fibromyalgia patients, thanks for the input.

Fibromyalgia & Flu Shots   [posted 11/25/98]
Question: I am a nurse practitioner in Durango, Colorado. A patient who has been diagnosed with fibromyalgia recently got a flu vaccine, can this exacerbate her symptoms?

Answer: Not usually, but, fibromyalgia has a history of waxing and waning without clear cause.

Fibromyalgia [posted 11/18/98]
Question:  If a patient has been on 54-6 vicodin hp and is changing to this patch And the 25 mg. Does not work ,should they be up graded to the next mg.? She has been on meds for pain (mainly vicodin 750-and changed to hp) for Over 6 years . She suffers from one of the worst cases of fibro-myalgia & myo-fascia disease. Not to mention spondylosis and several herniations from cervical through thorasic all the way to lumbar and Syadic nerve. I am the patient and my dr. Has no other patients on the Duragesic patch ,but I love the thought of giving up digesting all the Vicodin, zanex, soma, and etc. And only taking my thyroid pill , female hormone and wellibutrin for my depression. I understand it is not as hard on my liver or kidneys, true or false? Is the next mg. up habitual or dangerous. I so wanted the 25mg. to be the one. Do you offer experimental cases? to rid myself of this pain I would do anything!! Sometimes kevorkian has sounded inviting and I am only 46. My liver function tests showed perfetect emzymes and i am basically a health nut. That is why this is so hard for me.

Answer:  Hard to come up with an exact switch dosage since the metabolism is so much different. But, you'll probably need 50 or 75 mcg to start, 25 wouldn't be close to replacing what you're taking. Generally work well except for skin rash and cost. You won't see much difference in liver functions etc.

Fibromyalgia [posted 7/23/98]
Question: Could you define Fibromyalgia?

Answer: Fibromyalgia has several definitions. These range from the criteria established by the American College of Rheumatology to the disability criteria for social security. The patient has several classical and reproducible "trigger points". There is joint stiffness and pain with normal examinations. Fatigue is always present and there appears to be an associated disorder of Stage IV sleep. Classical tender points include several at the base of the skull, along the trapezius, above the scapula, and around the C5-7 cervical spine. The finding of numerous tender/trigger points at classic sites plus the above symptoms define fibromyalgia.

Fibromyalgia and Depression Drug Treatment
Question: I have just started to take this medication. My doctor has advised me that I have to weigh the side affects with the way I am feeling. She has suggested that I keep a daily journal, in which I am to describe my moods. I should also tell you that I am suffering from mild fibromyalgia as well as having lower back problems. We hope to control the pain which I am having, through various types of medication. What are the side affects of this drug, from mild to severe. I have several concerns which I would like to have addressed. Namely, eye sight, fine motor skills, etc. I have been on other types of medication such as paxil, and being just married and young, it had some draw backs. My mood, as well, came into question. No real depression, just major swings in mood. I hope that this medication brings the mood swings into line and control the amount of pain that I am in most waking hours (which tend to be quite long, since the pain also affects my ability to sleep). Other medications I have been on to help me sleep, as well as to support the paxil, has lead to weight gain, which in turn, has brought on deeper, and more spasms and pain. If it is at all possible, could you please address these concerns for me, as the doctor has mentioned some of the side affects, but she seemed reluctant to continue, resulting in many unanswered questions and many concerns. Communications between the doctor and myself is not good. Mostly due to distance, patient load, (she has an on going practice 8 hours away, and maintains, as best as possible, a practice in my home town), leaving very little time to address all concerns which I might have. I hope you will be able to enlighten me as to the affects, both good and bad that this medication would have for me. I have noticed that since I have been undergoing drug therapy to control pain, my joints have swollen in both my hands, hips, and knee. Is this due to some of the side affects of the paxil, or is it with the combination of the drugs which I am currently using.

Answer: Paxil is an antidepressant that belongs to the same class of drugs as Prozac, Zoloft, etc. -The SRI antidepressants. They are useful in depression. However, usually not so much in sleep disorders (a major component of fibromyalgia). Usually for this problem we proscribe tri-cyclid antidepressants like Elavil, etc. Paxil usually decreases sleep threshold and may actually make fibromyalgia worse. It also tends to decrease sexual drive, ability to reach orgasm, and patients either gain or lose weight. Serzone might help, but try another type of antidepressant, or try Elavil(amitriptyline). Another option might be to try St. John's Wort for the depression. I am not aware of side effects concerning fibromyalgia with this medication (available over the counter).

Fibromyalgia Drugs
Question: I have Fibromyalgia and I have been talking to people across the world and they have suggested taking some drugs that I am unable to find here in the United States. The people I have been talking to are mostly people from Australia. They have recommended Lamictal and Ultram . Do we have these drugs in the United States and could you give me some information about them?

Answer: Lamictal(lamotrigine) is a drug initially used for control of seizure activity. It is in a class of its own and the mode of action is not perfectly clear. Side effects include a rash (10% of patients), headache, fever, abdominal pain, nausea, and dizziness. Ultram is an analgesic used for pain control. It is a centrally acting(brain), but its mode of action is not clear. It is not related to the opiates and does not appear to be addicting. Side effects include dizziness, constipation, headache, drowsiness, dry mouth and nausea.

Fibromyalgia
Question: Is there a cure for this syndrome on the horizon?

Answer: To cure a disease it is necessary to understand the cause. Unfortunately, there is no current explanation for fibromyalgia. There are several internet sites concerning this disease and a national newsletter. I would follow them, although much of the information on these sites is not researched. This disease suffers from a lack of diagnostic or treatment options. As a consequence, many “treatments” have sprung up. In general, when there are many treatment options none is very successful.

Fibromyalgia medications
Question: I was diagnosed with FMS 3 years ago. Since then I have been taking Elavail. I have many side effects but few drug options. I take 75 mg. of elavail at night. It makes me shaky and so dry that I have water in my hand at all times, including at work. I have gained 30 lbs. Winter isn't bad for the sweating part of the side effects, but in the summer I get so hot on these medications that I panic almost all the time (I take 20 mg. of Xanax a day), It's almost a claustrophobic feeling. I am hoping someone in the pharmacology field may know of a new medication for fibromyalgia. I take flexiril p.r.n. when the going really gets tough. Usually only around 20 mg a day for a few days. I also take Clinoril (150 mg every 12 hours), for trochanteric bursitis in both hips. I understand that Elavail is used for pain and depression, and to put patients into a stage 4 sleep. I wake up every 2 or 3 hours even when on the medications. Can you think of any alternative medications?

Answer: Fibromyalgia or fibrocytsis is a tough disease. Because it is hard to quantify and there is no "blood test diagnosis" many physicians lack awareness of this problem. However, it is horribly incapacitating and painful. We have no clear idea of the cause or of any effective treatment. This is borne out by the number of "remedies" on the Internet, etc. Elavail will not cure the problem, but hopefully help with Stage 4 sleep and decrease some of the muscle stiffness and pain. I have some patients who are helped by massage therapy and acupuncture. Ensure that the acupuncture specialist is familiar with the typical trigger points, needless elsewhere are a waste. Some patients have benefited from steroid injections at particular severe trigger points. Avoid treatments that are potentially dangerous or not supervised by someone with common sense. With the severity of the pain and the lack of effective treatments, patients are naturally drawn to all sorts of untried ideas.

General Information
Question:What is fibromyalgia?

Answer: Fibromyalgia, also referred to as fibrositis is a syndrome consisting of chronic musculoskeletal (muscle and bone) pain, that is widespread and can affect any site in the body. Typically, there are no laboratory test abnormalities, and muscle biopsies are normal. On examination by a health care provider, patients with fibromyalgia can have areas of particularly intense tenderness or pain, known as trigger points or tender points. These include the upper neck, shoulders, chest muscles, elbow, knee, upper buttocks, and hips. The cause of this disorder is not known, but theories include chronic viral infection, sleep disturbances, and abnormalities in muscle metabolism. Ninety percent of patients with fibromyalgia are women, and most experience initial symptoms between the ages of 25 to 45. Symptoms include stiff aching muscles, which occur frequently but wax and wane (have period of severe symptoms alternating with periods of little to no symptoms). Symptoms can be aggravated by physical or emotional stress, inactivity, weather/climate changes, or other illness. Other symptoms can include headache, sore throat, fatigue, depression, bowel irregularity, and difficulty concentrating. The evaluation of patients with suspected fibromyalgia is in part designed to exclude other disorders which can produce similar symptoms and require different therapy. These include, but are not limited to hypothyroidism, hyperthyroidism, adrenal gland dysfunction (Addison’s disease), Parkinson’s disease, kidney disease, infection, malignancy, or rheumatoid arthritis. Treatment of fibromyalgia involves several components. Firstly, there are many support groups available to sufferers of this painful disorder, which can reek havoc with the ability to have a normal and functional day to day life. Physical therapy, stress reduction programs, as well as certain medications are also shown to be of benefit. The latter includes agents such as amitriptyline, and/or muscle relaxants such as cyclobenzaprine. Working with your physician to develop a complete treatment regimen is key in controlling symptoms and maximizing day to day functioning.



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