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Medical Edge Newspaper Column from Mayo Clinic
MANAGING FIBROMYALGIA MAY REQUIRE HOLISTIC APPROACH
DEAR MAYO CLINIC: I have fibromyalgia and have tried just about
everything there is to try, without success. I understand that there is
no cure for this condition, but surely there must be something that will
relieve my pain. I am 32 years old and have two active teenage boys to
keep up with. Is there anything else I can try? — Waskom, Texas
ANSWER: Not knowing what you have tried, I’ll offer you some treatment
options that have helped others who suffer from fibromyalgia.
Fibromyalgia is a condition characterized by pain and tenderness in muscles,
ligaments and tendons. The pain can range from regional discomfort to
widespread soreness. Additional symptoms often include disrupted sleep,
fatigue and a variety of other disturbances.
The cause of fibromyalgia is unknown, but it’s thought to be triggered
by events such as injury, infection or chemical changes in the brain.
The good news is that fibromyalgia is not progressive, doesn’t lead to
other conditions and can usually be managed. The bad news is that it may
never completely disappear; some of the body’s tissues, in effect, have
now learned a different way of acting and have become more sensitive to
pain.
When the patient is able to function fairly normally, my approach is threefold.
Because sleep disruption is not only a symptom but possibly a trigger
of fibromyalgia, the first priority is to re-establish normal sleep patterns.
Even if you seem to be sleeping reasonably well, it’s likely that you’re
getting too little of the deep stages of “restorative sleep,” without
which other symptoms cannot improve.
The goal is to feel rested when you awake in the morning. Treatments include
behavior-modification techniques or the use of antidepressants such as
nortriptyline (Pamelor) or trazodone (Desyrel) at doses well below those
taken by clinically depressed individuals. You should avoid sleeping pills,
however, which can be habit forming and do not restore normal sleep patterns.
The second priority is to become more physically fit. Though you are in
pain, it pays to gently persist: regular and moderate exercise can reduce
your fibromyalgia symptoms, including sleep disruptions. This exercise
need not be intense, and can include moderate activities such as stretching
and walking.
Finally, because stress always accompanies fibromyalgia (or any type of
chronic pain), we encourage the routine use of stress management techniques
such as meditation and other relaxation methods. If clinical depression
is present (as it often is), we may prescribe an additional antidepressant,
such as Prozac or Zoloft, in therapeutic doses. The reason is that depression,
if left unrelieved, can confound efforts to deal with the pain of fibromyalgia
and can itself disrupt sleep.
For advanced cases — when long-term and widespread pain essentially precludes
the patient’s normal functioning — a more comprehensive approach, called
pain management or pain rehabilitation, is employed.
A centerpiece of this approach at Mayo Clinic is a three-week program,
for six-plus hours a day, that is led by an interdisciplinary team. It
offers groups of patients a set of methods for coping with their fibromyalgia
and restoring normal function to the greatest possible degree. This program
includes physical therapy, occupational therapy, cognitive/behavioral
therapy, biofeedback and other elements.
For most patients, a combination of approaches that gets to the sources
of the problem — or at least, to sensible ways of managing it — is much
more promising than using one modality (taking a painkiller such as Tylenol,
for example) at a time.
When you say you’ve tried everything, it may well be that you’ve done
a long series of things but have not addressed the problem more holistically.
Thus I would suggest working with your physician to develop a multifaceted
program that’s customized for you.
— Jeffrey M. Thompson, M.D., Physical Medicine and Rehabilitation,
Mayo Clinic, Rochester, Minn.
Additional Resources:
Treatment of
Fibromyalgia
Appointment
Information
More Informationon
Fibromyalgia
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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