| #ffffff;" /> | | | | were kids. The rest say something happened" to |
| The American College of Rheumatology meeting held | | | | trigger it. |
| in Boston from November 6-12 provided a platform | | | | Dr. Clauw agreed noting that a wide range of events |
| for experts in the field of fibromyalgia (FM) to | | | | appear to trigger fibromyalgia, such as infections and |
| present information that updates our notions as to | | | | injuries. A small subset of people experiencing these |
| what this disorder really is. | | | | events will go on to develop regional or widespread |
| Legitimacy as a medical condition has been supported | | | | pain syndromes as a result of their particular genetic |
| by the FDA approval of a drug, pregabalin (Lyrica), | | | | makeup. |
| for the treatment of fibromyalgia. | | | | He also said, “Getting effective treatment to |
| Unfortunately there are still skeptics including many | | | | fibromyalgia patients is important because when they |
| physicians. | | | | have had uncontrolled symptoms for too long, they |
| Dr. Daniel Clauw, of the University of Michigan in Ann | | | | become resistant to treatment.” |
| Arbor, and one of the foremost authorities on FM, | | | | "They're upset because they can't function normally |
| told attendees “it has now been proven | | | | in their societal roles. They become depressed |
| convincingly that FM is primarily a disorder of pain | | | | because of what the pain and fatigue has done to |
| signaling, arising in the central nervous | | | | their life. They develop ways of thinking, which has |
| system.” | | | | been confirmed by brain imaging, that can actually |
| He went on to say though, that “many | | | | increase their pain levels by changing the way pain is |
| physicians, including specialists, still regard the local | | | | transmitted in the brain. And... they develop bad |
| manifestations, such as tender points, as | | | | habits that are called 'maladaptive illness behaviors' |
| important,” creating what he called "a circular | | | | where they make their condition worse," Dr. Clauw |
| problem" in treatment. | | | | added. |
| What Dr. Clauw was alluding to were the diagnostic | | | | Fortunately, many therapies are available to make |
| criteria formulated a few years ago, which stated | | | | fibromyalgia sufferers more comfortable. |
| that among the classic symptoms of fibromyalgia is | | | | Among them are exercise, certain analgesics, some |
| abnormal pain in some or all of 18 points in the body | | | | classes of antidepressants and, most recently, drugs |
| when touched. The American College of | | | | classified as anticonvulsants. |
| Rheumatology was the group that developed criteria | | | | Fibromyalgia pain can be reduced with moderate and |
| for diagnosing the condition that includes a finding | | | | regular aerobic exercise. |
| that at least 11 of these points are tender. | | | | Opioid narcotics and most over-the-counter analgesics |
| But, a key point that Dr. Clauw stressed is that "the | | | | are not effective in fibromyalgia. One analgesic, |
| longer we keep publishing review articles [with | | | | tramadol (Ultram) may be useful. |
| illustrations of] a woman with 18 dots, the longer | | | | Amitryptyline (Elavil) and cyclobenzaprine (Flexeril) are |
| people are going to think there's something wrong in | | | | two other drugs that have proven to be effective in |
| (just) those 18 areas of the body, even though we | | | | placebo-controlled trials. |
| know that's not the case." | | | | Equivocal results have come out of studies of |
| Dr. Clauw went on to say that it was better to think | | | | selective serotonin reuptake inhibitors including |
| of fibromyalgia as a “disorder of the | | | | fluoxetine (Prozac). |
| pain-sensation system's "volume control" that | | | | But antidepressants that affect both serotonin and |
| determines how the brain processes... stimuli.” | | | | norepinephrine have demonstrated good results. |
| "This is likely set by the genes we are born with, and | | | | Duloxetine (Cymbalta) and milnacipran (Ixel) both |
| modified by the environment," he added. Those with | | | | show promise in this condition. |
| a high volume control setting will feel more pain for a | | | | Anticonvulsant drugs like gabapentin (Neurontin) and |
| given level of stimulus. | | | | pregabalin (Lyrica) have been used to treat |
| As a result, he said, one can test for fibromyalgia | | | | fibromyalgia. The latter drug is now the only |
| with stimuli in areas other than the classical 18 points, | | | | medication approved in the United States to treat |
| such as the thumbnail. He said fibromyalgia can also | | | | fibromyalgia. |
| be diagnosed without touching patients at all. | | | | Editor’s note: Another important modality |
| Don Goldenberg, M.D., of Tufts University School of | | | | that wasn’t mentioned is cognitive behavioral |
| Medicine in Boston, another FM expert, commented | | | | therapy. This type of treatment uses devices such |
| on the important dual role of genetics and | | | | as guided imagery, visualization, time management, |
| environment in the disorder. "Fifty percent of my | | | | etc. to help FM patients cope better. |
| patients say they were born with it, had it since they | | | | |