Loretta Said:

Physio therapist?

We Answered:

No, but I would try to "google" her!

Lynn Said:

Fibromyalgia?

We Answered:

Yes it does sound like fibromaylgia. Congratulatons on making what is a difficult diagnosis for experienced clinicians.

Here's a patient handout that I wrote and will share with you:





FIBROMYALGIA

FIBROMYALGIA [FM] is a condition of the [central] nervous system experienced predominantly as pain, tenderness and stiffness in the bones, joints and muscles.

The cause is unknown. Many afflicted individuals have a history of physical trauma such as a motor vehicle accident. Often there is trauma to the neck and upper shoulder area. In other cases, an infection or hormonal problem has preceded the onset of symptoms. The objective abnormalities that can be found are chemical, and are in the brain and spinal cord. When the tender muscles and joints are examined microscopically, the tissues appear normal. When spinal fluid is tested, abnormalities in serotonin and substance P levels are detectable. Chronic stress, anxiety and insufficient quality sleep factors which may result from the condition and then contribute to its severity by making it worse.

FEATURES WIDESPREAD PAIN and TENDERNESS – Widespread aching, pain and stiffness of the muscles and musculotendinous structures is the dominant problem in fibromyalgia (FM). The pain is symmetrically distributed, always present, and exacerbated by cold, dampness, sleep deprivation, stress and excessive physical activity. Chiefly afflicted are neck, shoulders, hips, low back and buttocks and upper legs. The areas of maximal tenderness tend to remain constant. These tender points are not the same thing as trigger points, and they tend to be resistant to treatment with trigger point injections.

STIFFNESS / sense of SWELLING – stiffness is frequently worst upon arising in the morning or after prolonged sitting, and tends to soften with activity. The sensation of swelling is real, but the swelling itself generally isn’t. Although the joints feel swollen, they look normal - or nearly so.

FATIGUE – may be minimal, or profound and debilitating. The afflicted individual needs frequent breaks and rest periods to accomplish tasks that were previously done without stopping.

CLUMSINESS – some people have trouble gripping and holding. They may drop and break objects more frequently than is common.

NUMBNESS / TINGLING – variably present, usually in the arms and legs.

DISORDERED SLEEP – insomnia is generally present, and makes the condition worse. In addition, because the sleep is disrupted, it is nonrestorative - that is, the individually awakens sleepy and tired in the mornings. Often, there are jerking limb motions - called periodic movements or myoclonic jerks – which occur during sleep.

ANXITEY / mild DEPRESSION – most patients with fibromyalgia have never been correctly diagnosed. Their physicians often have caused them to feel guilty, crazy or in some way at fault. Their frequent complaint for help with pain often leads to accusations of inappropriate drug seeking.

IRRITABLE BOWEL SYMPTOMS [IBS] – diarrhea, constipation, or and alternating of both may frequently be present.

IRRITABLE BLADDER SYMPTOMS – unexplained recurrent bladder pain or burning – called interstitial cystitis [IC] – is frequently present

Laboratory studies:

(a) Normal ESR, RA latex, Lyme serology and CBC. ANA is often moderately and nonspecifically elevated. TFT’s are normal

(b) Serum somatomedin C (the major mediator of the anabolic function of GH) and cerebrospinal substance P levels are low.

(c) Muscle and soft tissue biopsies are normal.

Therapeutics:

(a) SSRIs – in their higher dosing range ( i.e., PROZAC 20-40mg QD or LEXAPRO 10-20mg QD). These are effective for the treatment of both pain and fatigue even if there is no sign of depression. EFFEXOR 150-225mg and CYMBALTA 60mg are also effective

(b) Sleeping medications – these are important, and should be encouraged if necessary. Use only those which preserve normal or near-normal sleep architecture: amitryptiline 25-50 mg, doxepin 25-50 mg, or AMBIEN 10mg hs.

(c) Sedatives – BUSPAR 7.5 – 15mg Q12-24hrs or a benzodiazepine ( XANAX 0.25-0.50 mg Q6 - 12hrs, or ATIVAN 0.5 - 1mg Q6 - 12hrs) is often helpful.

(d) Recently, LYRICA 150-225mg twice daily has been approved for use in fibromyalgia

(e) Aerobic and stretching exercises – beginning slowly and conditioning up to 20-30 mins 3-4 times weekly.

(f) NSAIDs and steroids are ineffective. Opioids relatively useless for bodily symptoms, but may help headaches when severe.

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Hope that helps. Contact me if you like. I'm an Ameican physician who treats a lot of fibromyalgia

Benjamin Said:

Fibromyalgia?

We Answered:

Just to let you know, the term 'fibromyalgia' (FM for short) did not exist some decades ago. The term was coined in 1976 to replace such vague terms such as 'muscular or soft tissue rheumatism'. In 1987, it was made into an illness by the American Medical Association! I suffered many of the same symptoms as you have in my childhood years and into my 20s, long before the term was invented. I had little help for my excruciating pain, even after physiotherapy, a chiropractor and acupuncture.
What helped me most was meditation and learning to relax properly. I came to my own conclusion after years of trying different methods that these symptoms are a result of chronic depletion of energy over time in muscles, connective and other tissues. Proper focused relaxing can, over time, re-energize bodily tissues and alleviate your symptoms.
The easiest way is to spend 10 - 20 minutes, twice a day, lying down, and focusing on each part of the body for about 10 seconds, eg. right foot (count to 10 if that makes it easier), then the left foot, right lower leg, left lower leg etc. Resist the urge to move and turn, just observe and focus, stop if you become too restless. The effect is cumulative but it works.
I am not a doctor but have done extensive research, learned much from my own experience, and wrote a book about self-healing.

Olga Said:

Dear Friends, By profession I am a physiotherapist, but I have good interest in Health insurance, hence I w?

We Answered:

And the question is?

Melvin Said:

Fibromyalgia..?

We Answered:

You may have fms; it often begins to show around puberty. You should definitely speak to your doctor. Make sure that you go to a rheumatologist or other doctor who recognizes fms as a real disorder - many health care professionals think it is a made up name for hypochondriacs to keep them happy but it is a real problem.

You will find much info on the net but not all of it is good info.

I have fms and several sleep disorders as well. The sleep disorder most commonly associated with fms is alpha delta disturbance, which is when you get into deep sleep and your brain kind of yells at you to wake up so you never get rested. This helps lead to the pain levels being high as your muscles don't repair themselves. This particular problem is diagnosed with a sleep lab and is easily treated with a tricyclic antidepressant such as Vivactyl. However, you do not have to have all of the symptoms in order to be diagnosed.

When I was first diagnosed, I was in extreme pain nearly all the time, with migraines that would last for days; at one point I was taking several pain medications, muscle relaxers, and anti depressants. I also was in a wheelchair for a short while.

I went through a pain rehabilitation clinic to manage the pain through things like biofeedback and neutral spine exercises. I still have trouble each winter and February is my worst month historically, but I am a single working mom with an active life. There are physical activities I can't do anymore but overall I lead a fairly normal life. Some of the things that broke the cycle of pain was using first a blood pressure medicine Calan, then herbal feverfew to stop the migraine cycle, using ice and heat, and losing weight.

Good luck!