Fibromyalgia

The exact cause of chronic pain of a nonmalignant nature may or may not be known. This type of pain includes the pain associated with various neuropathic and musculoskeletal disorders such as headaches, fibromyalgia, rheumatoid arthritis, and osteoarthritis. 

Roffman RA, Barnhart R Assessing need for marijuana dependence treatment through an anonymous telephone interview. Int J Addict 22 639-631, 1987 Russo EB Clinical endocannabinoid deficiency (CECD) can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions Neuro Endocrinol Lett 25(1-2) 31—39, 2004... 

Patients with IBS may experience comorbidities outside the gastrointestinal tract such as fibromyalgia, sleep disturbances, headaches, dyspareunia, and temporomandibular joint syndrome. 

Prevalence rates for a variety of different types of pain have been described. The annual incidence of moderate-intensity back pain is 10% to 15% in the adult population with a point prevalence of 15% to 30%.3 Migraine affects more than 25 million Americans, and 90% of Americans report some other types of headaches (e.g., tension or sinus) each year.4 Pain resulting from fibromyalgia affects 4 million Americans.5 Cancer is commonly associated with both acute and chronic pain, and about 70% of those diagnosed with cancer will experience significant pain.6... 

Neuropathic pain is defined as spontaneous pain and hypersensitivity to pain associated with damage to or pathologic changes in the peripheral nervous system as in painful diabetic peripheral neuropathy (DPN), acquired immunodeficiency syndrome (AIDS), polyneuropathy, post-herpetic neuralgia (PHN) or pain originating in the central nervous system (CNS), that which occurs with spinal cord injury, multiple sclerosis, and stroke. Functional pain, a relatively newer concept, is pain sensitivity due to an abnormal processing or function of the central nervous system in response to normal stimuli. Several conditions considered to have this abnormal sensitivity or hyperresponsiveness include fibromyalgia and irritable bowel syndrome. 

Features of central sensitization are pain in response to normally innocuous tactile stimuli, and the spread of pain sensitivity beyond the site of tissue injury. Central sensitization plays a major role in acute post-traumatic pain, and also in migraine, neuropathic pain (see below) and some diffuse chronic pain syndromes, such as fibromyalgia and irritable bowel syndrome. In these conditions, which have no detectable peripheral trigger, an autonomous central sensitization may be the pathology, increasing the gain in neuronal activity in the CNS and thereby producing abnormal responses to normal inputs. 

Neuropathic and functional pain is often described in terms of chronic pain. Neuropathic pain (e.g., postherpetic neuralgia, diabetic neuropathy) is a result of nerve damage, but functional pain (e.g., fibromyalgia, irritable bowel syndrome, tension-type headache) refers to abnormal operation of the nervous system. Pain circuits may rewire themselves and produce spontaneous nerve stimulation. 

As the first SNRI drug approved, venlafaxine has become one of the first-line choices for depression and anxiety disorder [45,46]. An active metabolite, desvenlafaxine (19), is also under clinical development for the treatment of major depressive disorders [47], Preclinical studies also indicate that 19 may be effective in relieving vasomotor symptoms associated with menopause (e.g., hot flushes and night sweats) [47,48]. Desvenlafaxine is reported to be in clinical development for the treatment of fibromyalgia and neuropathic pain, as well as vasomotor symptoms associated with menopause [68]. 

Milnacipran is currently available for use as an antidepressant in several countries outside the U.S. It is also under clinical development to assess its potential role in the treatment of fibromyalgia syndrome [62,63]. In a rat model of neuropathic pain, milnacipran, administered intrathecally, produced dose-dependent anti-allodynic effects at doses between 3 and 100 gg for up to 7h [64], The anti-allodynic effect of 30 gg of milnacipran was attenuated by intrathecal coadministration of a serotonin receptor antagonist or a norepinephrine receptor... 

One of the metabolites of bupropion, radafaxine (GW 353162, 25), is being studied as a treatment for obesity in clinic trials [76]. It is also reported to be in clinical development for restless leg syndrome, neuropathic pain, bipolar disorder and fibromyalgia [68]. 

After I had partially recovered I got board certified in environmental medicine. Now I m certified in both family practice and environmental medicine. I think most people are affected by chemicals. Those of us with MCS are just on one end of the spectrum. I see patients with MS, rheumatoid arthritis, fibromyalgia and other conditions, and there s almost always a chemical link someplace in their complaints. I always keep an eye out for that aspect contributing to these illnesses. 

If I m having a bad day I sometimes still write, unless a reaction to a chemical is affecting my brain. When I can t think clearly, I can t write. And sometimes I feel so apathetic that I can t write. But I m thankful that I have the skill. I think education is so important to prevent others from getting this illness. I believe that chronic fatigue syndrome, fibromyalgia, sick building syndrome and similar conditions with other names are all forms of MCS. They ll find that out with more studies. People just don t know what s wrong with them. They think they ve got asthma, depression, attention deficit disorder and a lot of other problems that can be related to chemical exposures. 

Frequently, MCS involves imbalances in one s nervous, immune, and endocrine systems, and impaired detoxification abilities. Conditions such as CFIDS (Chronic Fatigue Immune Dysfunction Syndrome), fibromyalgia, and Candida Syndrome are frequently found in people with MCS. It is not yet known whether these are separate diseases or whether they represent different manifestations of a common underlying problem. 

Sometimes, a medical illness prodnces insomnia in a more immediate fashion. Pain, shormess of breath, congh, and the nrge to nrinate or defecate are just a few of the medical symptoms that can interfere with sleep. Fibromyalgia and several neurological conditions can directly interfere with sleep quality (see Table 9.3). 

Fibromyalgia, accounting for 2-4% of the general population, is a common cause of chronic pain. It has been estimated that 20-40% of such patients have co-morbid depression with a lifetime prevalence of about 70%. This raises the question whether there is a common mechanism linking pain and depression. 

Neuroanatomically both the locus coeruleus and the raphe nuclei project to the spinal cord where they gate sensory pathways from the skeletomuscular areas. As there is evidence that both noradrenaline and 5-HT are dysfunctional in depression, it is perhaps not surprising to find that the pain threshold is often reduced in patients with depression. Conversely, different types of antidepressants have been shown to have an antinociceptive effect in both rodent models of neuropathic pain, and clinically in fibromyalgia, chronic fatigue syndrome, postherpetic neuralgia and diabetic neuropathy. In general, it would appear that the dual action antidepressants (such as the TCAs and SNRIs) are more effective than the SSRIs. 

Soft tissue rheumatism can be one of the many manifestations of an underlying specific autoimmune disease. Secondary fibromyalgia and enthesitis are the consequences of long-term inadequately treated autoimmune diseases. When no specific underlying causes can be detected, the disorder is called nonspecific soft tissue rheumatism. The major manifestations of soft tissue rheumatism are non-specific... 

PA is defined when concomitant weekly polyarticular corticosteroids injections together with corticosteroids injections into trigger points of secondary fibromyalgia and inflammation of attachments of skeletal muscles to bone (enthesitis) are administered. 

The pool of upstream systemic IL-1, IL-6, TNF-a and IgG, IgM, including autoantibodies is bigger than the pool of local down-stream ones in early disease. In late disease the pool of local cytokines, TNF-a, and autoantibodies is bigger than the pool of the upstream ones. This happens when symmetrical poly-arthritis, trigger points of enthesitis, and secondary fibromyalgia have developed. That is why weekly PA is as important as IVT in late stages of the disease. 

The idea of reduced adrenal capacity as a possible model for PTSD has also been recently raised by Heim et ah, who concluded that low cortisol may not be a unique feature of PTSD, but may represent a more universal phenomenon related to bodily disorders, having an etiology related to chronic stress (Heim et al. 2000). There are numerous stress-related disorders such as chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis, chronic pain syndromes, and other disorders that are characterized by hypocortisolism. In one study, Heim et al. showed decreased cortisol responses to low-dose DEX, but failed to observe blunted ACTH responses to CRF in women with chronic pelvic pain, some of whom had PTSD, compared to women with infertility (Heim et al. 1998). Since the data were not analyzed on the basis of the subgroup with and without trauma and/or PTSD, it is not possible to directly compare results of that study to other reports examining PTSD directly. 

The special difficulty of using psychiatric medications is illustrated by another feature of Rachel s life. She had the double misfortune of suffering from fibromyalgia as well as depression. Although some researchers have linked fibromyalgia with psychiatric problems, Rachel is... 

Unlabeled Uses Treatment of chronic pain syndromes, fibromyalgia, stress incontinence, urinary incontinence... 

I Unlabeled Uses Treatment of body dysmorphic disorder, fibromyalgia, hot flashes, post-traumatic stress duisorder, Raynaud s phenomena... 

Unlabeled Uses Depression (due to bipolar disorder), fibromyalgia, restless legs syndrome... 

Sodium oxybate is effective and indicated for the treatment of cataplexy in patients with narcolepsy it could also be effective for general anesthesia, narcolepsy, fibromyalgia syndrome, insomnia, alcoholism and opiate withdrawal, but its potential for abuse is unacceptable... 

---