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Treating fibromyalgia | Rheumatology | Oxford Academic - References
The Difference Between Fibromyalgia and Polymyalgia - Ways to Give
Richards, A. Fibromyalgia is a common musculoskeletal disorder, characterized by widespread pain combined with tenderness at multiple tender points. Associated features often include fatigue, unrefreshing sleep, psychological distress, irritable bowel, headaches, paraesthesia and morning stiffness.
Although not universally accepted as a discrete entity [ 1 ], such patients can be readily classified by using the American College of Rheumatology ACR criteria [ 2 ] which require the presence of widespread pain for at least 3 months and pain on palpation of at least 11 of 18 tender points. The syndrome has replaced the label fibrositis and there is a large degree of overlap with other medically unexplained syndromes such as chronic fatigue syndrome.
In all cases, a medical explanation for the pain and fatigue needs to be sought, with appropriate investigations undertaken dependent on the presentation. However, despite being the second commonest syndrome seen in some rheumatology clinics [ 3 ], treatment has been regarded as unsatisfactory, many patients suffering a chronic or rarely remitting course with significant disability and handicap. In general, prognosis is poor. Studies from Denmark, Canada and the USA have all reported similar findings, with high rates of reliance on social security payments or disability pensions.
Many theories about the causation of fibromyalgia have been proposed, although as yet there is neither evidence nor consensus on the importance of these various factors. Proposed aetiological factors include the role of sleep disturbance, loss of fitness, psychiatric disorder, endocrine, traumatic, infective and other factors in the onset of the condition, and also the role of behavioural and cognitive responses in its perpetuation and chronicity.
Most of these elements have been used as a basis for treatment. Interpreting the results of clinical research into fibromyalgia must take account of the many potential confounders, biases and methodological weaknesses. These include studies being under powered or lacking appropriate control groups, selection bias, poor compliance and the potentially confounding Hawthorne effect.
First, the role of sleep disturbance has received much attention. However, randomized controlled trials of zopliclone [ 9 ], temazepam [ 10 ], zolpidem [ 11 ] and melatonin have all shown that, whilst sleep quality can be improved, there is no concomitant improvement in pain or fatigue symptoms. Second, there is some evidence that there is a substantial loss of fitness [ 1213 ] in fibromyalgia patients, although not all studies confirm this [ 14 ].
It is clear, however, that there is decreased muscle strength [ 15 ] and an increase in the perception of fatigue or sense of effort at any given exercise level compared with controls [ 16 ]. It is not clear whether these factors are a primary cause or an effect of fibromyalgia, although Moldofsky et al. This led to the proposal that exercise training might serve as a protective factor against developing fibromyalgia and that, by extrapolation, improving patients' aerobic fitness might improve their symptoms.
Subsequent randomized controlled trials have helped clarify the effects of exercise. Not all exercise studies had a positive outcome: one small study failed to show any improvement in symptoms compared with a control group, despite significantly improving physical fitness [ 21 ]. There are some difficulties with exercise treatment: in particular, compliance is a significant problem and drop out rates are high.
Reasons for this include the initial increase in pain and stiffness in the days following exercise and patients' subsequent beliefs that exercise worsens the condition. This increase in delayed onset muscle soreness is most probably caused by microtrauma induced by unaccustomed exercise and exacerbated by increased eccentric muscle contraction during exercise [ 2223 ]. The third main treatment strategy is of educational programmes including several components: information about the condition; cognitive behavioural therapy and communication skills.
Cognitive behavioural therapy can involve a number of strategies [ 25 ] such as modifying unhelpful coping behaviours e. A variety of programmes have studied the combination of education and exercise treatments compared with a control group [ 182930 ]. The fourth main approach has been to use pharmacological interventions, either directed at a presumed cause or as symptomatic management. Bennett et al. Pain control is an important aim of therapy. Tramadol, which combines analgesic mechanisms mediated via weak opioid and monoaminergic actions, is widely used and anecdotally highly effective in fibromyalgia, but is yet to be adequately evaluated.
Tender point injection is widely practised as part of a treatment package but is yet to be subject to a randomized blind controlled trial, although an open study found significant relief from combined lignocaine and triamcinolone [ 35 ].
In conclusion, the overall degree of benefit of tricyclics is modest although for a minority of patients there is evidence for a persistent benefit in many aspects of their condition. In an open study of 23 patients taking fluoxetine there was no benefit in pain scores or tender point scores [ 41 ]. In a randomized controlled trial Wolfe et al. These findings parallel similarly disappointing results in chronic fatigue syndrome [ 43 ].
Citalopram another SSRI has also failed to show any significant benefit [ 4445 ]. However, this result should be viewed with caution as fluoxetine can markedly increase plasma levels of tricyclics; therefore, the improved efficacy could represent a dose—response effect of tricyclics.
Two small studies suggest that two other drugs acting on the serotonin system might be efficacious. Many patients turn to alternative therapies. What, then, can we conclude? It is important not to overlook concomitant psychiatric disorders and to treat them appropriately. Pharmacological treatments also have an important role, primarily in the symptomatic treatment of pain and sleep disorder in combination with sleep hygiene advice.
Finally, we need to acknowledge that treatments based on current ideas regarding aetiology are of only limited effectiveness. This necessitates the need for the development and testing of new hypotheses of pathogenesis and treatment. Bohr TW. Fibromyalgia syndrome and myofascial pain syndrome do they really exist?
Neurol Clin ; 13 : — The American College of Rheumatology criteria for the classification of fibromyalgia. Arthritis Rheum ; 33 : — The present and future adequacy of rheumatology manpower: a study of healthcare needs and physician supply. Arthritis Rheum ; 34 : — Estimated prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum ; 41 : — Chronic widespread pain in the community: the influence of psychological symptoms and mental disorders on healthcare seeking behaviour.
J Rheumatol ; 26 : —9. Primary fibromyalgia syndrome—an outcome study. Br J Rheumatol ; 32 : — Psychosomatic Med ; 37 : — Moldofsky H, Scarisbrick P. Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation.
Psychosomatic Med ; 38 : 35 — Effect of zopiclone on sleep quality, morning stiffness, widespread tenderness and pain and general discomfort in primary fibromyalgia patients. Clin Rheumatol ; 12 : — Fibromyalgia: Effects of amitriptyline, temazepam and placebo on pain and sleep abstract. Arthritis Rheum ; Suppl. The effect of Zolpidem in patients with fibromyalgia: a dose ranging, double blind, placebo controlled modified crossover study.
J Rheumatol ; 23 : — Assessing physical fitness in women with rheumatic diseases. Arthritis Care Res ; 1 : 38 — Aerobic fitness in the fibrositis syndrome: a controlled study of respiratory gas exchange and Xe clearance from exercising muscle.
Arthritis Rheum ; 32 : — Pain and fatigue induced by exercise in fibromyalgia patients and sedentary healthy subjects. Clin Exp Rheumatol ; 13 : — Br J Rheumatol ; 34 : — Muscle strength and aerobic capacity in primary fibromyalgia.
Clin Exp Rheumatol ; 8 : —9. A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia. Arthritis Rheum ; : — A randomised controlled clinical trial of education and physical training for women with fibromyalgia. J Rheumatol ; 21 : — Effects of aerobic exercise versus stress management treatment in fibromyalgia.
Scand J Rheumatol ; 25 : 77 — An exercise program in the treatment of fibromyalgia. J Rheumatol ; 23 : —3. The effect of 20 weeks physical fitness training in female patients with fibromyalgia. Clin Exp Rheumatol ; 10 : —9. Increased EMG activity during short pauses in patients with primary fibromyalgia. Scand J Rheumatol ; 18 : —3. Pain and fatigue after concentric and eccentric muscle contraction. Clin Sci ; 64 : 55 — Low levels of somatomedin C in patients with fibromyalgia syndrome.
Arthritis Rheum ; 35 : —6. Bandura A. Self efficacy mechanism in physiological activation and health promotion. Adaption learning and affect. New York: Raven Press. Development and evaluation of a scale to measure perceived self efficacy in people with arthritis.
❾-50%}Prednisone fibromyalgia. Fibromyalgia: Is Prednisone a Good Choice for Care?
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Understand the similarities and differences between polymyalgia and fibromyalgia. Get involved with the arthritis community. Every gift to the Arthritis Foundation will help people with arthritis across the U. Join us and become a Champion of Yes. There are many volunteer opportunities available. Take part to be among those changing lives today and changing the future of arthritis.
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Our Signature partners make their mark by helping us identify new and meaningful resources for people with arthritis. Our Supporting partners are active champions who provide encouragement and assistance to the arthritis community. What is the Difference Between Fibromyalgia and Polymyalgia? What is the distinction between polymyalgia and fibromyalgia? What is the treatment for polymyalgia?
Answer: I can certainly understand the confusion between fibromyalgia and polymyalgia; the names and, to an extent, the symptoms of both conditions are similar. The word myalgia means pain within the muscles. Both fibromyalgia and polymyalgia are characterized by muscle pain, but many other aspects of the two conditions differ.
Polymyalgia, or polymyalgia rheumatica, is an inflammatory disease of muscle. The primary symptoms are severe stiffness and pain in the muscles of the neck, shoulder and hip areas. People with this condition also may have flu-like symptoms, including fever, weakness and weight loss. Fibromyalgia is not an inflammatory condition.
It is caused by abnormal sensory processing in the central nervous system. People with fibromyalgia may be extremely sensitive to pain and other unpleasant sensations.
To be diagnosed with fibromyalgia, you must experience pain on both sides of the body and in both the upper and lower half of the body. You also will typically have tender points throughout your body.
Other common symptoms of fibromyalgia include fatigue, difficulty sleeping and concentrating, irritable bowel syndrome and headaches. Both fibromyalgia and polymyalgia are more common in women than men. Fibromyalgia can occur at any age, but polymyalgia rarely occurs before age The average age of onset is And whereas fibromyalgia is chronic, often lasting a lifetime, polymyalgia usually resolves itself within two years.
Treatment differs, too. Fibromyalgia is treated with exercise, relaxation techniques, analgesic medications and antidepressants to relieve pain and promote sleep. Treatment for polymyalgia is targeted at relieving inflammation. For some people, daily doses of NSAIDs, such as ibuprofen Advil, Motrinare sufficient, but more often corticosteroids, such as prednisone, are required to control inflammation.
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Volunteer Join us and become a Champion of Yes. Live Yes! Make a Donation Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease. Gift Planning I want information on ways to remember the AF in my will, trust or other financial planning vehicles.
Volunteer Volunteer Opportunities The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. Tell us what matters most to you. Change the future of arthritis. How are you changing the future? Partner Meet Our Partners As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability.
Trailblazer Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. Pioneer Our Pioneers are always ready to explore and find new weapons in the fight against arthritis. Pacesetter Our Pacesetters ensure that we can chart the course for a cure for those who live with arthritis.
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Prolonged use of prednisone for fibromyalgia can cause adrenal glands to atrophy and. Prednisone has an average rating of out of 10 from a total of 54 ratings for the treatment of Fibromyalgia. 72% of reviewers reported a positive. Drugs such as NSAIDs, opioids and corticosteroids have not been found to be effective for fibromyalgia pain. Common Medications for Fibromyalgia. Her response to prednisone, 10 mg/day, was prompt and marked but, A diagnosis of fibromyalgia is made when there is widespread pain lasting for at least. Fibromyalgia is a common musculoskeletal disorder, no benefit derived from 2 weeks of treatment with 15 mg of prednisolone daily [31]. Especially if it is a drug as dangerous as Prednisone. The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. Arthritis Rheum ; : — Make a Donation Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease. Scand J Rheumatol. Kurt Sherwood, D. Accessibility Contact us Advertising Media enquiries Legal and policy.The key to finding a suitable treatment option for fibromyalgia is understanding the condition and why it happens. Fibromyalgia is the most common musculoskeletal condition next to osteoarthritis. The condition is a long-term and chronic experience of widespread pain in the bones and muscles, extreme exhaustion, and areas of tenderness.
These symptoms cannot be identified or evaluated by using tests, making it a common situation for fibromyalgia to be misdiagnosed as another illness. This is what has led some doctors to question whether the disease actually exists. Although this condition has grown in recognition, still there are many who do not validate FM as being a real thing. This can be a very hopeless experience for patients and make it more difficult for them to find answers.
As researchers learn more about fibromyalgia, the stigma that envelops it is decreasing. One of the concerns that some doctors have is that patients will use this undetectable pain as a guise to obtain pain medication for personal use. This has motivated many doctors to encourage lifestyle changes instead of medicating their FM patients.
As more doctors confirm the validity of fibromyalgia, research will continue to increase in order to find effective ways to bring relief to sufferers.
One of the well-known characteristics of fibromyalgia is that it causes areas of tenderness called trigger points. There are 18 spots on the body that become painful with just a slight application of pressure, and at one period of time, this was used as an indicator for diagnosing fibromyalgia.
However, eventually they learned that not everyone feels pain in these areas every day. Currently this is still one way that doctors narrow down their list of possible diagnoses.
Patients describe the pain associated with these pressure points as a constant dull ache. If the person endures this pain for longer than 3 months, they will most likely be diagnosed with FM. The areas of trigger points are:. Researchers and the medical community still do not have an answer for what exactly causes fibromyalgia. However, there are a few factors that can lead to or trigger this condition that are now being agreed upon:.
Some theories exist, such as the following:. Prednisone is an anti-inflammatory drug that is usually prescribed for fibromyalgia relief. While it does help reduce inflammation and could help you feel better, it includes a long list of serious side effects.
If you are considering taking this drug, it would be a very good idea to do your research before deciding. Here is list of possible side effects from taking Prednisone:. Another additional side effect to be wary of is adrenal fatigue, which can happen as a result of using this drug for the long-term.
The adrenal glands could actually stop working, which is extremely serious. Usually doctors recommend taking a break from using prednisone so that the body can recover, but they will encourage you to begin taking it again as soon as possible. In situations where the body is not provided a break and a recovery period, adrenal crisis is possible.
The symptoms that would follow due to adrenal issues are nausea, vomiting, and going into shock. After hearing about these dangerous side effects, the pressing question is whether there is an alternative to taking any medication. We have good news up ahead. Among the list of theories describing why fibromyalgia happens, there is one that has been proven. There is clear evidence that a misalignment in the bones of the upper neck can be a cause.
Understanding how the brain and the body work together will help you see the way that this contributes to fibromyalgia. The neck bones of the upper cervical spine, specifically the C1 and C2 vertebrae, have the important role of protecting the fragile brainstem. The brainstem functions as the communication highway between the brain and the body. However, the unique shape and position of these bones make them particularly susceptible to misaligning. Just a minor blow to the head or overextending the muscles can cause these bones to misalign.
Unfortunately, in these types of situations, instead of protecting the brainstem, the bones now are putting pressure on the brainstem, interfering with its ability to send accurate signals to the brain.
Fibromyalgia is a result of the brain getting pain signals in the body when there is no pain. Here at Evoke Spinal Care in Pleasant Hill, California, we use a gentle method to return these bones to their properly aligned position without popping or cracking the spine. Give us a call to see how we help make it go away and not return. View Larger Image. Table of Contents. Share This Post With Others!
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