FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

EXERCISE, MEDICATION AND WORK CAN HELP TREAT FIBROMYALGIA

Question: I would like to know more about fibromyalgia. What are its symptoms? What causes it? How can it be treated? Who can treat this properly? Can it be cured?

Answer: Fibromyalgia is a condition characterized by chronic, diffuse pain. It is much more common in women than in men and is found in about 2 percent of the general population. People with many chronic conditions -- for example, rheumatoid arthritis, osteoarthritis, Lyme disease and sleep apnea -- are more likely to also have fibromyalgia. Similar associations have been noted with chronic fatigue syndrome, irritable bowel syndrome, migraine headache, and temperomandibular joint (TMJ) syndrome.
Before a diagnosis of fibromyalgia can be made, your doctor will ask you questions about the pain you're experiencing. Fibromyalgia may be considered a possibility if pain is present in each of the four body quadrants -- that is, on the left and right sides of the body both above and below the waist. There is also usually pain throughout the entire spine. Typically, the pain is worse in the morning and at the end of the day. The pain must persist for at least three months.

In addition, to this generalized pattern of pain, your physician will examine you for specific tender and non-tender points. Diagnosis of fibromyalgia requires a finding of pain and tenderness in at least 11 of 18 specific tender-point sites. Combining the information gathered in this physical examination with a carefully taken history can enable a qualified practitioner to make an accurate diagnosis.

There are no lab tests or X-rays that can confirm a diagnosis of fibromyalgia. However, your doctor may ask you to undergo certain tests to see if your symptoms might have another cause. These would probably include blood tests to determine your blood count, sedimentation rate, thyroid hormone levels, and creatinine phosphokinase (CPK)levels as well as tests to rule out rheumatoid arthritis and systemic lupus erythematosis.

Treatment for this non-life threatening condition starts with a positive relationship between the patient and physician. Regular low-impact exercise that begins gradually and increases as patient tolerance grows can be beneficial. It's usually a good idea for a sufferer to continue working. This enhances self-esteem and helps the person learn to live with his or her condition. While at work, walking and stretching breaks every two or three hours are helpful. Also, it's been found that getting a good night's sleep can help to manage daytime pain.

Medications can helpful as well. Tricyclic antidepressants like amitryptline have been very useful in chronic pain conditions. Some SSRI anti-depressant medications also bring relief. Non-steroidal anti-inflammatories, such as ibuprofen -- and analgesics, like acetaminophen -- can be used to help control the pain. Other useful treatments include physical therapy, TENS units and acupuncture.

A study reported last year in the Journal of the American Osteopathic Association, found that using osteopathic manipulative treatment (OMT) in conjunction with medication or other forms of standard treatment was more effective than any standard treatment by itself. So, if your physician is a D.O., you might ask whether OMT might be helpful in your case. Unfortunately, at this time, there is no “cure” for this problem.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.