Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
What are medications and other forms of treatment for fibromyalgia?
Since the symptoms of fibromyalgia are diverse and vary among
patients,
treatment programs must be individualized for each patient. Fibromyalgia treatment
programs are most
effective when they combine patient education, stress
reduction, regular
exercise, and medications. Recent studies have verified that
the best outcome for each patient results from a combination of
approaches that involves the patient in customization of the
treatment plan.
Patient education
Patient education is an important
first step in helping patients understand and cope with the diverse symptoms.
Unfortunately, not all physicians are intimately acquainted with the vagaries of
this illness. Therefore, community hospital support groups and the local
chapters of the Arthritis Foundation have become important educational
resources for patients and their doctors. The Arthritis Foundation is a national
voluntary health organization that provides community education through
their many local chapters. Community hospital support groups also provide
an arena for patients to share their experiences and treatment successes
and failures.
It is extremely difficult to measure stress levels in different
patients. For some people, spilling milk on the table can
represent a significant tragedy. For others, a tank rolling into the living
room might represent just another day! Therefore, stress
reduction in the treatment of fibromyalgia must be individualized. Stress
reduction might include simple stress modification at home or work, biofeedback,
relaxation tapes, psychological counseling, and/or support
among family members, friends, and doctors. Sometimes, changes in
environmental factors (such as noise, temperature, and weather exposure) can
exacerbate the symptoms of fibromyalgia, and these factors need to be modified. Optimal sleep is encouraged.
Low-impact aerobic exercises, such
as swimming, cycling, walking, and stationary cross-country ski machines, can be
effective fibromyalgia treatments. Exercise regimens are most beneficial when
performed on an every-other-day basis, in the morning. How exercise benefits
fibromyalgia is unknown. Exercise may exert its beneficial effect by
promoting a deep level of sleep (non-REM sleep). Sometimes physical therapy can be helpful to optimally guide the exercise plan.
Fibromyalgia diet
Similarly, avoiding alcohol and
caffeine before bedtime can also help promote a more restful sleep. Foods that lead to comfortable sleep should be favored. While these dietary changes may not apply to everyone, they can be very helpful for some. There is no specific fibromyalgia diet or food supplements that are recommended for all patients. When patients have accompanying irritable bowel syndrome, the diet should be adjusted to not aggravate the bowels. Likewise, when patients have accompanying interstitial cystitis, foods that irritate the bladder should be avoided.
Fibromyalgia medications
Traditionally, the most effective medications in the treatment of
fibromyalgia have been the tricyclic antidepressants, medications traditionally used in
treating depression. In treating fibromyalgia, tricyclic antidepressants
are taken at bedtime in doses that are a fraction of those used for
treating depression and actually can be beneficial as sleep aids. Tricyclic antidepressants appear to reduce fatigue,
relieve muscle pain and spasm, and promote deep, restorative sleep in
patients with fibromyalgia. Scientists believe that tricyclics work by
interfering with a nerve transmitter chemical in the brain called
serotonin. Examples of tricyclic antidepressants commonly used in treating
fibromyalgia include amitriptyline (Elavil)
and doxepin (Sinequan).
Studies have shown that adding fluoxetine (Prozac), or
related medications, to low-dose amitriptyline further reduces muscle
pain, anxiety, and depression in patients with fibromyalgia. The combination is
also more effective in promoting restful sleep and improving an overall sense
of well-being. These two medications also tend to cancel out certain side
effects each can have. Tricyclic medications can cause tiredness and fatigue,
while Prozac can make patients more cheerful and awake. A
study of patients with resistant fibromyalgia found that lorazepam
(Ativan) was helpful in relieving symptoms. Prozac has also been shown to be effective when used alone for some patients with fibromyalgia.
Trazodone can be taken at bedtime to improve sleep when tricyclic antidepressants are not tolerated.
In 2007, pregabalin (Lyrica) became the first medication approved specifically for treating fibromyalgia. Lyrica may work by blocking nerve pain in patients with fibromyalgia. Lyrica has advantages of flexible dosing that can be adjusted according to persisting symptoms. A related medication, gabapentin (Neurontin), is also used to treat fibromyalgia.
More recently, drugs that simultaneously increase the amount of two brain nerve transmitters, serotonin and norepinephrine, have been approved to treat fibromyalgia in adults. These drugs include duloxetine (Cymbalta) and milnacipran (Savella). Research studies have shown significant effectiveness in decreasing pain and improving function in patients with fibromyalgia with these drugs. Cymbalta has been effective in treating depression and relieving pain in people with depression and is also used to treat anxiety.
Other fibromyalgia treatments
Local injections of analgesics and/or cortisone medication
into the tender point areas can also be helpful in relieving painful
soft tissues, while breaking cycles of pain and muscle spasm. Some studies indicate that the pain reliever tramadol (Ultram) and tramadol/acetaminophen (Ultracet) may be helpful for the treatment of fibromyalgia pains. The muscle relaxant cyclobenzaprine
(Flexeril) has been helpful for reducing pain symptoms and improving sleep.
The nonsteroidal anti-inflammatory
drugs (NSAIDs), while very
helpful in treating other rheumatic conditions, have only a limited value in
treating fibromyalgia pain. Narcotic pain relievers and cortisone medications
have not been shown to be beneficial in this condition. Narcotics
and cortisone medications are avoided because they have not been shown
to be beneficial, and they have potential adverse side effects,
including dependency, when used long term.
Both biofeedback and electroacupuncture have been used for
relief of symptoms with some success. Standard acupuncture has also been reported to be effective in treating some patients with fibromyalgia. Massage therapy is beneficial for some.
Of note, there are many other modalities and medications that are touted to be helpful for patients with this chronic condition. Unfortunately, most have no scientific basis for their usage. This includes guaifenesin (Humibid, Humibid LA, Robitussin, Organidin NR, Fenesin), copper bracelets, and magnets. Consumers should be especially cautious when products come with marketing claims such as "will cure," "ancient remedy," "has no side effects," and "revolutionary new scientific breakthrough."
Fibromyalgia - Symptoms at Onset of DiseaseQuestion: The symptoms of fibromyalgia can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Neck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
IBS (irritable bowel syndrome) is a common gastrointestinal disorder involving abnormal gut contractions (motility) characterized by abdominal pain,
bloating, mucous in stools, and irregular bowel habits with alternating diarrhea
and constipation, symptoms that tend to be chronic and to wax and wane over the
years. Treatment options include medication and lifestyle changes such as diet, exercise, and stress management to control symptoms. Also called spastic colitis, mucus colitis, nervous colon syndrome.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Chronic fatigue syndrome is a debilitating and complex disorder characterized by profound fatigue that lasts 6 months or longer, is not improved by bed rest, and may be worsened by physical or mental activity.
Myofascial pain syndrome is muscle pain in the body's soft tissues due to injury or strain. Symptoms include muscle pain with tender points and fatigue. Treatment usually involves physical therapy, massage therapy, or trigger point injection.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Stress may be considered as any physical, chemical, or emotional factor that causes bodily or mental unrest and that may be a factor in disease causation. An important goal for those under stress is the management of stress in our lives. Elimination of stress is unrealistic, since stress is a part of normal life. We can however, learn to manage stress through techniques such as exercise, relaxation, meditation, time management, and support systems so that we have control over our stress and its effects on our physical and mental health.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
Natural menopause is the permanent ending of menstruation that is not brought on by any type of medical treatment. For women undergoing natural menopause, the process is described in three stages: perimenopause, menopause, and postmenopause.
However, not all women undergo natural menopause. Some women experience induced menopause as a result of surgery or medical treatments, such as chemotherapy and pelvic radiation therapy.
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