Backonja says. Yunxia Wang, M. Wang, a neurologist at the University of Kansas who says that about 15 percent of her practice now involves patients with fibromyalgia. While treating her for MS, I realized that she was using her steroid medication too much.
She told me it was because of pain. I wondered if it was because of the fibromyalgia, so I added her on pregabalin without changing her MS treatment. For over a year and a half, she hasn't had an attack and she's doing much better with her pain. So a patient could have an underlying neurologic disease and also have fibromyalgia.
This is interesting and I don't want to be left out. Not all neurologists are embracing fibromyalgia, however. The patients have chronic pain, they call a lot, and they tend to have a lot of comorbidities," says Dr. Comorbidities are other conditions that exist alongside the main disorder—with fibromyalgia they often include depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, lupus, and rheumatoid arthritis.
Matallana agrees that the interest in fibromyalgia among neurologists at this point is largely among researchers, pain specialists, and those at academic centers. But Dr.
Backonja argues that neurologists, especially those who specialize in pain, have a responsibility to take fibromyalgia on. In addition to pregabalin, which was the first to gain approval, duloxetine and milnacipran can also be prescribed for fibromyalgia.
Duloxetine is also approved for the treatment of depression, anxiety, and painful diabetic neuropathy; and milnacipran for the treatment of depression. Doctors may also prescribe low doses of antidepressants to boost serotonin levels, helping to improve sleep and relieve pain.
None of these are right for everybody, of course. For example, some people prefer exercise therapy to yoga. Physical activity, meditation, and avoidance of symptom triggers have shown to reduce symptoms. Narcotics are not indicated. Patients presenting with signs and symptoms of depression should be screened for suicidal ideation and referred appropriately.
Fibromyalgia cannot be established with an objective laboratory test or imaging. Musculoskeletal fields rely heavily on objective evidence such as radiographs and laboratory tests. Accordingly, to some musculoskeletal practitioners, the lack of such evidence may cast doubt on the validity of the diagnosis.
By taking this unique approach, Dr. Hall presents an objective overview of the fibromyalgia situation today in North America. Patients, family members, and physicians will see themselves reflected in the descriptions and will gain a broader understanding of this challenging illness.
Hall's is a uniquely objective account that surveys diagnosis, treatments, and the controversy surrounding the condition," says Rebecca Raszewski, University of Illinois at Chicago, in a Library Journal review. Despite the uncertainties surrounding fibromyalgia, Leslie Crofford, MD, said the diagnostic criteria are pretty straightforward. When viewed in aggregate, the symptoms can clearly point to fibromyalgia as the diagnosis of patients with chronic widespread or multifocal pain. Once a diagnosis is suspected, internists should next ask themselves whether another disorder could be mimicking fibromyalgia, Dr.
Crofford said. Diseases such as lupus, thyroid disease, seronegative spondyloarthritis, rheumatoid arthritis, and polymyalgia rheumatica can all cause widespread musculoskeletal pain, but they aren't typically common in the primary care setting, she said. Katz said, as an MRI of the back or neck may show something from long ago that may not be clinically relevant and may lead to further unnecessary testing. Katz said, adding that abnormalities in erythrocyte sedimentation rate and C-reactive protein levels can indicate a different illness.
Erythrocyte sedimentation rate or C-reactive protein tests can rule out polymyalgia rheumatica, particularly if a patient is over 50 years old, said Dr. If a patient has joint symptoms, an internist could also check rheumatoid factor and anti-cyclic citrullinated peptide antibody, and if a patient reports weakness which is not particularly characteristic of fibromyalgia , internists could also check creatine phosphokinase, she said.
If any tests come back positive, a rheumatologist could then evaluate the patient for an autoimmune inflammatory musculoskeletal problem and could work together with the internist on management.
The types of treatments that work for peripheral or nociceptive pain, such as nonsteroidal anti-inflammatory drugs, opioids, injections, and surgery, won't work for the centralized pain that occurs in fibromyalgia, Dr. Instead, experts agreed that the first step is educating patients about what fibromyalgia is and what it isn't. Next should be some kind of encouragement or prescription for light exercise to increase heart rate, or referral to physical therapy, experts said.
A Cochrane review of 34 studies found moderate-quality evidence that aerobic-only exercise training has positive effects on global well-being and physical function in fibromyalgia patients.
Evidence suggests that an online form of self-management with cognitive behavioral therapy CBT is helpful, Dr. But Dr. Crofford noted that patients with fibromyalgia often use up their will-power to get through the day with chronic pain and may benefit from the guidance of a professional.
For patients with psycho-social stressors or those who are having difficulty coping with symptoms, another challenge is finding a therapist who is comfortable with CBT approaches and patients with chronic pain, she added. If nonpharmacological treatments are not enough, select medications can be used to tackle patients' most prominent symptoms.
Although the FDA has approved 3 drugs for fibromyalgia—pregabalin Lyrica in , duloxetine hydrochloride Cymbalta in , and milnacipran HCl Savella in —these medications have a relatively low effect size and carry the risk of adverse effects.
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