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Pain Fibromyalgia

Cooling Painful Hot Spots in Fibromyalgia

When the hypothalamus goes offline, Teitelbaum says, the body loses energy and the muscles become short and stiff, causing pain that ultimately leads to pain in other parts of the body as you try to compensate for the discomfort. In other words, the hypothalamus is forcing the body to shut down.

Stress is believed to trigger the blown fuse in many cases. That stress can be emotional, such as job or relationship stress, or physical, such as trauma from an infection or from sleep deprivation. Both types of stress lead to the "fight or flight" reaction in the brain that involves the release of certain chemicals and hormones.

"There are two ways that stress seems to be involved in this illness," Clauw says. "One is that certain types of stress, such as a motor vehicle accident, seem to be capable of triggering this illness. The other thing that stress can do is exacerbate symptoms if someone already has this condition."

Treatment Tips
Besides minimizing their exposure to stress, there are a number of treatments available to people. Some people, however, may opt not to treat their fibromyalgia. According to Clauw, these men and women just "want to make sure there is nothing ’bad’ going on." Most patients, however, will opt for treatment. And according to a New England Journal of Medicine review, the ideal approach involves a combination of therapies that in some way or another get the brain chemistry charged.

While the Food and Drug Administration (FDA) has not approved any drugs specifically for fibromyalgia, tricyclic antidepressants such as Elavil (amitriptyline), and muscle relaxants such as Flexeril (cyclobenzaprine), have been well studied and shown to be effective. Other, newer forms of antidepressants, including dual serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Effexor (venlafaxine) have also been shown to be helpful. Also a drug called milnacipran is awaiting FDA approval for fibromyalgia.

Exercise, particularly aerobic exercise such as biking, dance or walking, can also improve pain and energy levels, as well as sleep. Clauw explains that exercise raises levels of serotonin and norpinephrine just as medication does, "so the way I explain the value of exercise to my patient is that exercise is, in fact, a drug that you get your body to produce." According to Clauw, about 15 to 25 minutes of exercise every day is probably more valuable to people with fibromyalgia than 45-minute periods of exercise three days a week.

"Just like with drugs." he continues, "I tell people to start at a low dose and go up slowly." But patients shouldn’t worry that exercise will simply cause more pain. A study conducted by Clauw that was published in Arthritis and Rheumatism showed that increased physical activity in people with fibromyalgia was not necessarily associated with more pain.

Studies have also shown that cognitive behavioral therapy, which involves psychological and behavioral therapy, can also be used to lessen pain and improve function. Such techniques can help people feel like they have more control over their illness and help them cope with pain by teaching relaxation skills, distraction strategies, better scheduling and goal setting. People can get cognitive therapy through a trained counselor, and research groups are working on developing Web-based programs so people can work on these techniques on their own time.

Other approaches that may also help are meditation, acupuncture, hypnotherapy, better sleep habits, improved nutrition and regulating hormone levels.

You Don’t Have to Feel Sick
If you think you may have fibromyalgia, it’s best to find a physician who is familiar with its treatment. That doctor may be an internist or family physician or a rheumatologist, though Teitelbaum recommends seeking out a pain specialist through the American Academy of Pain Specialists.

"If you are exhausted and you hurt all over, the good news is that fibromyalgia is a very treatable disease," Teitelbaum says. "You don’t have to feel sick anymore."

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