WebMD Live Events Transcript

If the pain of fibromyalgia or chronic fatigue syndrome is taking the joy out of the holidays for you, you'll want to read what pain expert Charles Argoff, MD, had to say. He joined us on Dec. 16, 2004, to answer your questions about managing your pain and making your hoildays brighter.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR
Welcome back to WebMD Live, Dr. Argoff. Thanks for joining us today.

ARGOFF:
Great to be here again.

MEMBER QUESTION:
What do you recommend to help with fibro pain?

ARGOFF:
First there are many non-pharmacological approaches to managing fibro pain, including exercise, proper nutrition, good sleep patterns, controlling stress and anxiety, but if those are being practiced and there's still a need for pain control, there are certainly many medical approaches that can be considered. Among the newest and least likely to cause side effects or more specifically serious side effects, several medical approaches are available that would be likely to help but unlikely to cause serious problems. These medications include the lidocaine patch, which is a prescription anesthetic patch; gabapentin, duloxetine, tizanidine, among others.

MEMBER QUESTION:
What are some good types of treatment for fibro/chronic fatigue in the winter? The cold is causing severe pain.

ARGOFF:
Stay indoors, stay warm, and wear layers of clothing. If cold weather or cold activities greatly aggravate your symptoms, during the cold weather months wear comfortable layered clothing so you can feel as warm and comfortable as possible.

MEMBER QUESTION:
It has been below average cold here in South Carolina. When I have to go outside, I dress in layers. I don't feel cold, but for some reason, within a few minutes or later, my body will start to ache; mainly my hands, feet, sternum and ribs, lasting from minutes to hours.

ARGOFF:
This kind of experience that you describe confirms that in people who have fibromyalgia, there are difficulties with the central nervous system, control of sensations and more specifically, pain. There really have not been any studies which I am aware of which have addressed the situation that you have described. But some advice I might give you, regardless, is if you're not already using an anti-inflammatory drug, consider taking an over the counter anti-inflammatory like ibuprofen just before going out in hopes of reducing discomfort. Also, any of the medications which I just mentioned in my last response, and even others, might be helpful if you're not using them already to help your nervous system become less sensitive to changes in weather. You bring up a very challenging situation, but it probably is worth a try to use some of the suggestions that I've made.

"A suggestion would be to consider cognitive and behavior approaches to pain management, including biofeedback, relaxation therapy, the use of imagery, acupuncture, and maybe aqua therapy. Maybe if you are exercising in the water, that can be very helpful, especially warm water. "

MEMBER QUESTION:
I am newly diagnosed with FMS in October, but started probably in 2001 or earlier. The problem is that I have a 10-month-old that I am breastfeeding and cannot take the medications. I am in the midst of a flare. I have trouble concentrating, am more exhausted than I've ever been, my muscles are so tight they ache and I have acute diffuse pain everywhere. I am in PT/OT, chiropractic, and massage therapy. Most are suggesting I wean my baby so I can take the medications, but that is something I really don't want to do. I have already given up most everything I enjoyed previously and now am rarely outside of the house except therapy appointments and don't want to lose this special bond with my daughter. Any ideas?

ARGOFF:
First of all, it's absolutely your choice to decide how you want to handle the flare. You have to weigh the discomfort you're having and the likely length of your flare against the potential benefit that you might have from using medications recognizing, of course, that you do not want to use medications because it would mean you would have to stop nursing your 10- month-old. If you've carefully weighed those issues and have elected to continue nursing your child, then one other suggestion would be to consider cognitive and behavior approaches to pain management, including biofeedback, relaxation therapy, the use of imagery, acupuncture, and maybe aqua therapy. Maybe if you are exercising in the water, that can be very helpful, especially warm water. Hopefully a number of these will be available to you and you'll be comfortable, and comfortable enough to continue breastfeeding your baby.

MEMBER QUESTION:
Does regular intake of calcium and magnesium help the pain of FM?

ARGOFF:
The regular intake of magnesium and calcium, or more accurately, proper intake of magnesium and calcium together, will promote overall health; not specifically more helpful to people who have fibromyalgia, and certainly are not associated with pain relief, per se, for patients who have fibromyalgia. I will say, however, that in order for your muscles and nervous system to work well, you must have the right amount of calcium and in order for calcium to be utilized well, you must have the right amount of magnesium, so these substances are clearly very important to us and to our health.

MEMBER QUESTION:
How effective is acupuncture for pain from FM?

ARGOFF:
The benefits of acupuncture vary from person to person. So first you should know that acupuncture, it's certainly a scientifically sound approach to reduction of pain. Second, you should know that no two individuals are the same, so one person who responds to one treatment may not necessarily respond to the same treatment. So really what it comes down to is that acupuncture can be performed competently and safely by qualified people who are trained to do acupuncture, so make sure your acupuncturist is licensed and fully trained. Done properly, it's harmless, so go into it, perhaps, with an open mind and if you are among the people whom it helps, that's wonderful, but don't consider yourself unfit if it doesn't help you, because it doesn't help everybody.

MEMBER QUESTION:
What tests can confirm a diagnosis of fibromyalgia?

ARGOFF:
First of all, there are currently no tests which are available that confirm the diagnosis of fibromyalgia. Tests are done to confirm the presence of other conditions which can cause pain as well, and it is the absence of those tests being positive when a patient has the other features of fibromyalgia that helps confirm the diagnosis. The challenge or a challenge for all of us, practitioner, the person with the problem and so on, even if you are correctly diagnosed with fibromyalgia, five years from now it doesn't mean that that exacerbation or worsening of your pain might not be related to a totally unrelated problem.

In other words, we don't stay the same, we do, unfortunately develop other problems as we get older. So if you are concerned that the discomfort is different that you're experiencing, is different from the discomfort than when you were first diagnosed with fibro, or if it's been a really long time since someone has looked at you from a diagnostic point of view and you're really not responding to treatment, the wisest thing to do might be to be reevaluated. Every year we do get better and better tests that do help us to pinpoint more and more disorders that can cause pain. So it is best not only to manage the pain, but to also reevaluate the cause of the pain periodically.

MEMBER QUESTION:
Thanks for your input on the acupuncture! Back to what you were saying about the calcium and magnesium. What dosages do you recommend? Also, I have been taking coral calcium and that seems to help me with my sleeping.

ARGOFF:
That's very interesting about your sleeping. Dosages are usually 400 mg to 800 mg magnesium a day and 600 mg to 1200 mg calcium per day. The other thing that many of you may consider is have your vitamin D levels measured. Vitamin D is required for proper metabolism and use, and several studies have suggested that chronic pain can be associated with vitamin D deficiency.

MEMBER QUESTION:
Also I have heard that malic acid is a good supplement to take as well.

ARGOFF:
Malic acid is an important component or chemical that is utilized to help give us energy. I'm not aware of any well done study, though, that supports the use of this supplement for fibro patients.

MEMBER QUESTION:
I have post polio and Guillain-Barre symptoms and have a lot of muscular and nerve pain.

ARGOFF:
First, post-polio syndrome and Guillain-Barre syndrome are very different syndromes. Polio affects only motor cells, whereas Guillain-Barre affects the myelin that covers the axons of our nervous system in our arms and legs. Post-polio syndrome may be painful in part because of the weakness that people may experience and the effect on joints and other structures this weakness may have. Pain in Guillain-Barre is more likely to occur because of injury to sensory nerves themselves. The pain of Guillain-Barre is more often caused by nerve injury, and not muscular causes, as in post polio. The reason I'm making this distinction is that it is likely that they're very different and they won't respond to the same therapy.

"For many years doctors, patients and everyone did not recognize how messed up the central nervous system can become in terms of processing information in patients with FMS."

MEMBER QUESTION:
Dr Argoff, is FMS actually a short-circuit problem with one's brain, or do we actually have a higher intensity of pain due to the FMS? Can you explain what your definition of FMS is?

ARGOFF:
FMS is defined by the American College of Rheumatology. Again see the links as to how it's defined. What scientists have been trying to do is figure out why people are getting FMS. It does appear that when a person develops FMS, their central nervous system, meaning their spinal cord, and especially their brain, becomes more sensitive to all sensations; that it actually becomes easier for someone to experience pain. So someone with FMS basically has an overly excitable nervous system. Being overly excitable is not consistent with being normal. And so people with FMS, because of this central nervous system abnormality, experience a wide range of painful symptoms and other symptoms.

This kind of thinking has been confirmed by very detailed studies of brain activity in patients who have FMS. For many years doctors, patients and everyone did not recognize how messed up the central nervous system can become in terms of processing information in patients with FMS, and instead, FMS was thought to be a rheumatological disorder.

Just to summarize very briefly, FMS ultimately reflects abnormal wiring of the central nervous system and the symptoms derive from that.

MEMBER QUESTION:
Is any specialty better than others to go for evaluation? Should I see a pain expert?

ARGOFF:
First of all, the person who sees you has to truly be aware of what fibromyalgia is. That person also should not be trying to become rich by taking care of fibro patients; they have to be seriously dedicated to this disorder. And they have to be open-minded and willing to listen to you. And finally, it doesn't matter if they're a neurologist or physical medicine specialist, rheumatologist, family doctor or internist; they have to meet the criteria I just talked about, because they have to be truly interested in helping you.

MODERATOR
We are almost out of time. Before we wrap things up for today, do you have any final words for us, Dr. Argoff?

ARGOFF:
I hope these responses have been helpful. Please keep on searching for people you need to get your questions answered and your problems helped. Thank you.

MODERATOR
Our thanks to Charles Argoff, MD, for joining us today. And thanks to you, members for your great questions.

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