Fibromyalgia Pain

There is a condition, more prevalent among women, in which there are chronic musculoskeletal pains associated with various trigger points located regional parts of the body. Two things come to mind: first of all fibromyalgia occurs in ten times as many women as men; secondly, the diagnosis specifies that tenderness must be present in over eleven of the eighteen trigger points specified over the body. The trigger points are about the size of a penny and occur over the neck, back, elbows, buttocks, and knees. It is interesting and exciting that medical researchers and clinicians are discovering more and more about the disorder of fibromyalgia. It seems to be a dysfunction of the mind and body interface of the entire nervous system. The peripheral nerves become more sensitive to pain and consequently send more signals to the brain. This process can actually cause changes in the brain where there is a loss of brain volume and a decrease in cognition (the ability to think and remember.) The finding of pain alone is seldom found, i.e. there is usually accompanying sleep disturbance, mood disorder such as anxiety or depression, fatigue, or morning stiffness. Another diagnostic point is that the disorder more commonly starts after the age of thirty-five. It is not unusual to discover that the fibromyalgia sufferer underwent a severe physical or emotional injury earlier in life.

The disorder of fibromyalgia was once thought to be a form of hypochondria, but now more and more dysfunctions are being found in markers of inflammation, neuroendocrine functions, and other body systems. Fortunately, the consensus now is that it is a true disease process which can and does become worse over time if not treated. There are several forms of treatment now utilized to improve the condition. One is simply low impact and regular exercise. This tends to down-regulate the volume of sensory signals being sent to the brain. A second type of non-pharmacologic treatment is cognitive behavioral therapy which can bring about significant improvement.

There are three drugs that have been FDA approved for the treatment of fibromyalgia. One is pregabalin (Lyrica) which seems to down-regulate impulses to the brain like exercise does. A second medicine is Duloxetine (Cymbalta) which has effects that are not totally understood, but it seems to have brain protective properties and also down regulates the number of nerve impulses being sent to the brain. It is called an SNRI drug. The third medicine, which is also an SNRI, is called milnaciprin, and has many of the same properties as Duloxetine.