Fibromyalgia Questions
Arthritis Today Medical Experts Answer Your Questions About Fibromyalgia
One of the most popular features in Arthritis Today, "On Call" finds answers to your most puzzling arthritis questions by asking a variety of healthcare experts. Just click on the question or title you'd like to see.
Acupuncture for Fibromyalgia
Is Fibromyalgia Inherited
Too Much Ice Cream?
A Fibromyalgia epidemic?
Lyme Disease Mistaken for Fibromyalgia
Cause of Foot and Hand Pain
Help For Weak Muscles
Does Fibromyalgia Drug Cause Weight Gain?
Explaining Fibromyalgia
Fibromyalgia and CFS: What's the Difference?
Fibromyalgia, Lupus -- Or Both
Exercising With Fibromyalgia
Botox Injections for Fibromyalgia?
Fibromyalgia and Numb Feet
Does Anesthesia Cause Fibromyalgia?
The Difference Between Fibromyalgia and Polymyalgia
Methotrexate for Fibromyalgia?
When Fibromyalgia Medicine Causes Pain
Just 'Dealing with' Fibromyalgia Pain
Fibromyalgia and Period Problems
Fibromyalgia Flare Following Dental Visit
Does a Yeast Cause Fibromyalgia?
Q: Does acupuncture help fibromyalgia symptoms? I’ve tried everything else, but still have no relief.
A: Numerous research studies have looked at acupuncture as a treatment for fibromyalgia, and although a few have shown statistically significant improvement of pain, some have not.
In studies that have indicated some benefit, relief was fleeting. In the majority of patients, it lasted from a few days to a few weeks. Some people had pain relief for up to six months, but there are no reports of long-lasting results.
If you are curious about acupuncture, try three treatments. If you think you have benefited from the sessions, continue up to six or eight treatments. By then, you can decide whether acupuncture is cost-effective helpful enough for you to continue further.
Even if acupuncture is helpful, don’t rely on it as your primary treatment. Use it along with other remedies to provide relief. For example, combine acupuncture with other treatments proven to be effective in people with fibromyalgia, such as exercise, tricyclic antidepressants, pain medication, massage therapy, meditation and cognitive behavioral therapy, Keep in mind that you’ll also have to stick with a regular sleep schedule; improve your diet to be based more on vegetables and less on red meats, refined sugar and processed foods; manage stress; and discntinue smoking, alcohol and caffeine.
You say that you’ve tried everything. In my experience, however, many patients have not found relief because, in looking for a quick fix, they haven’t followed treatments exactly as recommended for along enough period of time or at a high enough dose. If you need specific advice about treatments and combinations to try, please talk to a rheumatologist or pain specialist who has experience in treating people with fibromyalgia
James McKoy, MD, Rheumatologist
Back to Top
Is Fibromyalgia Inherited?
Q: I have had fibromyalgia since I was 15. What is the possibility that my daughter will also have this condition? Has there been any research on how teenagers develop fibromyalgia?
A: The origin of fibromyalgia is unknown, but recent studies suggest there may be a relationship between fibromyalgia and depression and other mood disturbances. These mood disorders tend to run in families, and there is evidence of an increased frequency of depression among first-degree relatives of people with fibromyalgia. Although children and teenagers can develop fibromyalgia, it is much more common in people over the age of 20 and it predominantly affects women.
Although fibromyalgia is a very common condition, it is difficult to predict the likelihood that any individual will develop its symptoms, even with a family history. If you have concerns about your daughter's condition, I recommend that you consult a rheumatologist.
David S. Pisetsky, MD, PhD, Rheumatologist
Back to Top
Too Much Ice Cream?
Q: I have had fibromyalgia for 15 years. For many years I ate lots of ice cream. Recently I have begun breaking out in a rash if I eat anything sweet. Do you know why sugar might cause me to break out? Do you think the sugar in the ice cream might have caused my fibromyalgia?
A: It is rare for sugar to cause an allergic skin eruption, so your rash may be completely unrelated to your sugar consumption. Likewise, I have never seen any evidence that sugar or ice cream causes fibromyalgia. I would recommend that you speak to your own physician about both of these issues. He should be able to give you some insight into what's going on in your body.
Doyt Conn, MD, Rheumatologist
Back to Top
A Fibromyalgia Epidemic?
Q: When I first learned eight years ago that I had fibromyalgia I had barely even heard of it. Since then, at least three of my friends have been diagnosed with the condition and I have been reading and hearing more and more about it. Is fibromyalgia reaching epidemic proportions? Could it, like Lyme disease, be caused by an infectious agent that scientists have yet to identify?
A: To chat with friends and read the latest health magazines, you certainly would think that fibromyalgia is becoming increasingly common. But many physicians and researchers, including myself, suspect it's the diagnosis of fibromyalgia -- not necessarily the condition itself -- that's becoming more common.
Most adults will experience fibromyalgia symptoms at some point in their lives. For most, the symptoms -- widespread muscle pain, often accompanied by fatigue -- are short lived. Symptoms may appear during a time of prolonged stress or after a period of sleep deprivation or unaccustomed physical activity, and then subside. But for reasons not completely understood, these symptoms can become chronic in some people.
Although such symptoms have probably existed since the beginning of time, it has been only in recent years that doctors have connected this specific collection of symptoms, given the condition a name, and developed the criteria to diagnose it. As more doctors become familiar with fibromyalgia, more and more are diagnosing the syndrome. And savvy consumers, armed with information from medical journals and popular magazines, are making their own diagnoses and then asking their doctors for confirmation and help with management. As a result of this increased awareness, people who previously might have suffered in silence or accepted muscle pain as an unfortunate part of life are probably now seeing their doctors and wanting diagnosis, relief and sometimes disability benefits. Others -- who might have had to travel from doctor to doctor years ago to find out what was wrong -- are getting a diagnosis earlier. Those factors, more than an increase in the incidence of the syndrome itself, are probably why you're discovering more people with fibromyalgia.
To answer your second question, I very seriously doubt that fibromyalgia is caused by an infectious agent. Lyme disease, which you mentioned, is certainly a success story. Scientists have found a single bacterium that causes Lyme disease, which can be cured if treated with antibiotics. Unfortunately, the understanding and treatment of most chronic, painful conditions are much more complicated. fibromyalgia is likely to be the result of many factors, and the factors probably vary among different people. Some of the numerous theories about the cause of fibromyalgia pain include: abnormalities in the muscles, an imbalance of chemicals in the body that control our sensation of and response to pain, or an imbalance in the natural body hormone called cortisol.
But actually proving any of these physiologic factors to be a cause of fibromyalgia is difficult; instead, it is likely that some of these factors are associated with, or are a result of chronic pain.
In addition to these physiologic factors, many studies have shown an association between psychological factors and fibromyalgia. As an extreme example, at least a couple of studies have shown an association in some people between fibromyalgia and sexual abuse. The theory is that psychological trauma somehow may lower the pain threshold and allow painful conditions to persist.
While you may never know exactly what caused your fibromyalgia, you can take heart in the fact that the condition won't result in damage to joints or other organs, and it certainly isn't fatal. The good news about fibromyalgia is that it can be treated and managed, and the person in the best situation to help your condition is you.
Although certain medications (for example, antidepressants to promote more healthful sleep patterns) can be helpful for fibromyalgia, perhaps the best ways to manage the syndrome are those things you can do yourself. These include getting an appropriate balance of rest and exercise and maintaining a positive attitude. Exercise boosts the production of natural body chemicals called endorphins that help ease pain and promote an improved sense of well- being. Your physician or physical therapist can tailor an exercise program for you. Initially, you will start with mild exercise, but will build to increasingly vigorous exercises to improve physical conditioning. Although any new level of exercise may be difficult or unpleasant at first, with time, repetition and perseverance, you will feel better.
Keeping focused on what's positive in your life and the things that you can do will help, too. No matter how difficult it may seem now, you can live with a certain amount of pain and fatigue. Remember that you always have some control -- control over what you are doing and thinking. Change these two components of your behavior in a positive way and you'll indirectly improve how you feel.
Doyt Conn, MD, Rheumatologist
Back to Top
Lyme Disease Mistaken for Fibromyalgia
Q: I have read that Lyme disease is highly treatable with antibiotics. I was diagnosed with Lyme disease three years ago, yet despite several rounds of antibiotics, I still suffer from muscle aches and fatigue on a daily basis. Why isn't the treatment helping me?
A: Without personally examining you or evaluating your medical records, I can only suspect one of two things: You have a stubborn case of Lyme disease that isn't responding to standard treatment; or, more likely, you don't have Lyme disease at all.
As many as half of the people who believe they have Lyme disease -- even those in whom Lyme was diagnosed by their doctors -- probably don't have the disease. The reason for misdiagnosis, in large part, is that blood tests used to diagnose Lyme disease are prone to false positives. Relying on results of the blood test alone can lead you and your doctor to believe you have a disease that you really don't have. In fact, in a 1993 study of 788 patients referred to a university Lyme disease clinic, researchers found that 452 -- more than half -- of those people did not have, and had probably never had, Lyme disease at all. Their diagnosis, instead, was fibromyalgia or a similar condition called chronic fatigue syndrome (CFS). An additional 156 patients, who had experienced Lyme disease in the past (which, in fact, might have been cured by the antibiotics), currently had fibromyalgia or CFS. Active Lyme disease was found in only 180 -- or 23 percent -- of the patients.
Because of the potential for misdiagnosis, most doctors rely on several factors in addition to blood tests to diagnose the disease. These include: the probability of exposure to disease-carrying ticks; your medical history; your symptoms; and physical examination results. Lyme disease generally begins with a localized circular red rash where the bacterium from the infection-bearing tick enters the skin. Later symptoms, occurring after the infection has spread, can include joint pain and swelling, heart inflammation, and nerve involvement with associated muscle pain and fatigue. Some of these symptoms are similar to those of other forms of arthritis and even to unrelated diseases. For example, muscle pain and fatigue are also common in fibromyalgia. Your physician should be knowledgeable about Lyme disease and know what criteria are necessary for its diagnosis.
Unlike Lyme disease, fibromyalgia, CFS and other related conditions cannot be cured with anti- biotics. Consequently, if a person has both fibromyalgia and a positive blood test for Lyme disease, antibiotics will probably not relieve all of the symptoms. If there is reasonable doubt that you actually have Lyme disease or if you haven't had characteristic symptoms of Lyme disease other than the positive blood test, your doctor will probably choose not to prescribe antibiotics again.
If you actually have fibromyalgia or something similar, your treatment will differ significantly. Fibromyalgia can be managed effectively through a number of measures, including exercise to promote muscle conditioning, medications to promote deep sleep, relaxation techniques and maintaining a positive attitude.
Discuss your concerns and these various issues with your doctor. He should be able to help you sort out the actual cause of your pain and fatigue -- be it Lyme disease or something different -- and prescribe an effective treatment plan for you.
Doyt Conn, MD, Rheumatologist
Back to Top
Cause of Foot and Hand Pain
Q: Is it possible to have fibromyalgia in your feet and hands? My thumb hurts so much that it's difficult for me to write, and both my feet hurt when I put any weight on them. My hands and feet used to be the only parts of my body that didn't hurt. Now this. Can you explain?
A: Fibromyalgia is a condition characterized by persistent pain throughout the body. The pain is usually felt in the muscles and soft tissues. The joints themselves do not show signs of arthritis such as pain and swelling. Fibromyalgia can occur together with another form of arthritis such as rheumatoid arthritis or osteoarthritis.
The prominence of symptoms in your hands and feet suggests that arthritis, rather than fibromyalgia, may be -- but is not necessarily -- the cause of your pain. Foot pain can be caused by a condition called plantar fasciitis, which is the irritation of a band of soft connective tissue that spans the sole of the foot. Planter fasciitis can be associated with fibromyalgia. It is important that you get a full medical evaluation to determine the precise cause of your pain and to begin treatment, because treatment for other arthritis- related diseases is different from that for fibromyalgia.
David Pisetsky, MD, PhD, Rheumatologist
Back to Top
Help For Weak Muscles
Q: I am a 48-year-old woman with fibromyalgia. Among my most troublesome problems are fatigue and muscle weakness, which my doctor attributes to lack of physical activity. Are these common in fibromyalgia? Can anything help?
A: The problem you describe is common in people with fibromyalgia, but feelings of fatigue and weakness can occur in anyone who is inactive -- whatever the reason. While a program of aerobic activity -- brisk walking, jogging, swimming -- may boost your energy level, the only way to strengthen muscles is through strength training or "resistance" exercise (in other words, weight lifting). And be prepared to work pretty hard at it.
To do resistance training properly, start with moderate weights, and slowly and progressively increase the amount of weight you lift. You should never work out more than three times per week; twice a week is probably best in your case. It's also important that you take time to warm up before lifting, cool down when you stop and stretch plenty in-between. The program I recommend in cases like yours is three sets of eight to 10 repetitions per muscle group, working at 60 to 80 percent of the most weight you are able to lift at once. This means you should find the last few repetitions you do to be quite difficult. This may aggravate your fibromyalgia at first, so you have to listen to your body. It's OK to be a bit stiff and achy in the muscles the day after training, but persistent pain or pain in the joints is a warning sign that you're overdoing it.
The level of exercise I'm recommending is intensive, but such activity is the only known way to bulk up your muscles, and more important, to increase your strength. It is strength that makes people functional and independent. When you exercise, don't worry about your arms too much -- concentrate on your legs, buttocks, back and chest. It doesn't matter if you work out in a gym or use fancy equipment, but if you have arthritis or other medical conditions in addition tofibromyalgia, ideally you should find a trainer who has experience with people who have those problems. (Ask your rheumatologist or physical therapist for a recommendation.) If you don't have access to or can't afford a trainer, consider an excellent book called Strong Women Stay Young (Bantam Books, 1998) by Miriam Nelson, PhD. It's not specifically about fibromyalgia, but the principles are applicable to everyone. A sample exercise you might find helpful is featured here. Foremost, I recommend you go slowly at first, listen to your body and be patient. You'll see results in about eight weeks, so hang in there!
Ronenn Roubenoff, MD, Rheumatologist
Back to Top
Does Fibromyalgia Drug Cause Weight Gain?
Q. Two years ago, my doctor prescribed the drug Pamelor to ease the pain and sleep disturbances associated with my fibromyalgia. Although I exercise regularly and eat sensibly, I have gained 25 pounds since I started taking Pamelor. Could this drug be causing my weight gain and, if so, is there another drug I could take instead?
Pamelor (nortriptyline) very well could be responsible for the higher number you're seeing on your bathroom scale. A member of the tricyclic class of antidepressants, Pamelor is frequently used to treat fibromyalgia symptoms.
While people with fibromyalgia often find the tricyclics effective in promoting sleep, they may also discover the drugs promoting something they don't want — weight gain. The cause for this isn't clear, but tricyclics appear to increase appetite, especially for carbohydrates.
Fortunately, there are alternatives to taking Pamelor and the other tricyclics. Serotonin-selective reuptake inhibitors (SSRIs), a newer group of antidepressants that includes drugs such as fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil), cause little weight gain and may even contribute to weight loss.
I recommend you speak to your doctor who might consider changing your medications.
Don Miller, PharmD, Pharmacist
Back to Top
Explaining Fibromyalgia
Q. What is the best way to describe severe fibromyalgia pain to people who have never had it? When I describe my condition to friends and family members, they often respond with a wrinkled brow as if to say "So what's really wrong with you?"
A: Before I answer this question directly, allow me to say that you are not alone in your distress. Many people with fibromyalgia have experienced doubting looks or comments from family members and friends about the pain and symptoms of this disorder.
There are even a few doctors who continue to question the "realness" of fibromyalgia pain. This skepticism arises from the fact that the health-care community is not yet able to fully explain what causes or perpetuates the pain. Of course, that doesn't make the pain and other symptoms of fibromyalgia less real for you.
In general, your explanation to others about fibromyalgia should be straightforward and uncomplicated. You might say something like, "Fibromyalgia is a rheumatic disorder that causes muscle tenderness, pain and fatigue." If the other person doesn't understand, you might make your explanation simpler, such as "Fibromyalgia is like arthritis in the muscles." Of course, this explanation is not entirely accurate, but it should be readily understood. You might also obtain some literature on fibromyalgia to share with family and friends who would like more information.
The Arthritis Foundation has several brochures and books that address many of the concerns of people with fibromyalgia. (For more information, contact your local chapter.)
Additionally, you might help others understand fibromyalgia better by explaining in clear language how it affects you. Be careful to avoid complaining, but be honest and open about the symptoms and how they affect your daily function. If friends or family members offer, you can then tell them how they may be able to help you (or not help you). In the end, honesty is the best approach.
Kristofer Hagglund, PhD, Psychologist
Back to Top
Fibromyalgia and CFS: What's the Difference?
Q. What is the difference between fibromyalgia and chronic fatigue syndrome?
A: There are wide differences of opinions on the two conditions, even among medical experts. Most would agree that fibromyalgia and chronic fatigue syndrome (CFS) are similar, and probably related, disorders. However, there are some who believe that these are simply two different names for the same thing, others who think they are completely different and still others (although their numbers are small and diminishing) who contend that neither condition exists at all.
My opinion is that the conditions are similar and probably related. Pain, fatigue and a host of other problems are seen in both fibromyalgia and chronic fatigue syndrome. However, a practical way to differentiate the disorders is that pain is the predominant problem in people with fibromyalgia, whereas fatigue is the major complaint in people with CFS.
The pain of fibromyalgia is typically chronic and widespread, and is often associated with stiffness. On examination, many patients have specific sites (called tender points) that are extremely tender to touch. The detection of these tender points is helpful in making a diagnosis of fibromyalgia.
The fatigue seen in people with CFS is generally profound, and can be completely incapacitating. Criteria for CFS established by the Centers for Disease Control and Prevention (CDC) are fatigue that has been present for more than six months and is accompanied by the following:
- a sore throat;
- enlarged or tender lymph nodes;
- muscle or joint pain;
- other signs of systemic illness.
Signs and symptoms that are commonly present in botfh fibromyalgia and CFS include the following:
- sleep disturbances;
- headaches;
- impaired memory or concentration;
- dizziness;
- bowel complaints (such as bloating, diarrhea and/or constipation);
- anxiety or depression.
Despite the differences between fibromyalgia and CFS, the approaches to treatment of the two disorders are, in fact, quite similar. Most patients benefit from education about the conditions, participation in local and national support groups such as the Arthritis Foundation Self-Help Course, the use of low-dose antidepressant drugs at bedtime to improve sleep, as well as low-impact aerobic exercises.
For more information on fibromyalgia, contact your local Arthritis Foundation office and ask about fibromyalgia resources.
John Klippel, MD, Rheumatologist
Back to Top
Fibromyalgia, Lupus -- Or Both
Q: My family doctor, suspecting I might have lupus, referred me to a rheumatologist, who diagnosed fibromyalgia. Is it possible to have symptoms of lupus, but actually have fibromyalgia?
A: Figuring out whether a patient has lupus, fibromyalgia or both -- which is entirely possible -- requires a thorough medical history, physical examination and laboratory tests. Diagnosing lupus and fibromyalgia can be difficult because the conditions share some symptoms.
During the medical history, fibromyalgia patients usually describe fatigue and a generalized muscle pain or soreness of the muscles that often is made worse by lack of quality sleep. Lupus patients may also have fatigue and muscle soreness, but initial symptoms may include a rash across the cheeks and nose that gets worse in sunlight, kidney problems, difficulty breathing or a blood clot, stroke or heart attack.
Physical examination of a person with fibromyalgia shows joints that move normally and are not swollen. However, people with fibromyalgia usually have tender areas over muscles, and pressing those areas causes discomfort. The examination of a person with lupus may reveal joint pain, stiffness, swelling or abnormal movement.
In most cases, a patient's history and physical examination lead to a diagnosis; lab tests usually confirm the diagnosis. A blood test that measures the level of antinuclear antibody (ANA) usually is positive in people who have lupus, but it also can be positive in those with mixed connective tissue disease, rheumatoid arthritis (RA), scleroderma and Sjögren's syndrome. Therefore, a rheumatologist will run several other special tests to confirm lupus. In people with fibromyalgia, all blood tests usually are normal.
A proper diagnosis is important because the treatments for lupus and fibromyalgia are different. When a person has both fibromyalgia and lupus, corticosteroids or disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, should be prescribed to prevent lupus-related damage to the internal organs. Physical therapy, counseling and antidepressant medications can help improve muscle aches, sleep and mood changes associated with fibromyalgia
Robert Shaw, MD, Rheumatologist
Back to Top
Exercising With Fibromyalgia
Q: I have fibromyalgia as well as osteoarthritis (OA). I would like to do some exercises to regain muscle mass and improve flexibility, but weight-training leaves me with worse pain. What do you recommend?
A: any of my fibromyalgia patients tell me their pain worsens when they exercise - particularly if they are just starting an exercise program. The truth is that you will have to stick with an exercise program for about six weeks, exercising two or three times per week, to start feeling or seeing any benefit.
Don't start a program while your fibromyalgia is flaring - wait until you're at your usual baseline. Then start slowly, giving yourself a day or two between workouts. If you can stick it out, I think you'll find the benefits of exercise worth the temporary increase in discomfort.
Start with lots of range of motion work, taking each joint through its full range of motion five to eight times. Continue your exercise session by walking in a warm pool, if you have access to one. If you don't have access to a pool, walking on land is acceptable, as is using an exercise bicycle or elliptical trainer. I don't recommend stairclimbers or running at this stage. The goal is to get your heart and lungs in shape and get the blood flowing to your muscles and joints.
After three to four weeks, add weight training, but instead of doing a lot of repetitions (reps) with a low weight, consider doing fewer reps (no more than six to eight at a time) with a higher weight. Aim for three sets of reps two to three times a week for each muscle group. How fast you progress depends on how you feel, and you have to judge for yourself if you feel you've overdone it.
In general, if it hurts when you do the exercise, you should back off on the intensity or the number of reps. However, feeling sore a day or two after exercise is often the normal response to muscles being challenged; as your muscles become conditioned to exercise, the soreness should diminish. A prolonged increase in pain, however, could be a sign you've done too much too soon and you should cut back to just range-of-motion and stretching exercises.
Ronenn Roubenoff, MD, Rheumatologist
Back to Top
Botox Injections for Fibromyalgia?
Q: Have you heard of Botox injections for fibromyalgia? If so, what are they and how do they work?
A: ABotulinum toxin type A (Botox) is produced by a bacterium called clostridium botulinum. The U.S. military originally purified the toxin about 30 years ago as a potential nerve agent. More recently, the toxin, which blocks neuromuscular transmission, has been used for medicinal purposes.
When injected in small quantities, Botox causes selective weakening and paralysis of muscles, thereby alleviating spasms and pain. Although the drug is approved only for certain problems involving the muscles of the eyes, doctors have used it to treat the muscular rigidity seen in various medical conditions including cerebral palsy, strokes, multiple sclerosis and some esophageal disorders, and for the pain of a muscular condition called myofascial pain syndrome. In fact, it was the successful use of Botox in some people with severe myofascial pain syndrome that led doctors to try it for fibromyalgia.
Although its use in fibromyalgia is not well studied, it is being pushed over the Internet and in the news media as the new “miracle cure” for Fibromyalgia. There are reports of patients with fibromyalgia getting some relief of their tender points (from injections) that lasts up to three to four months. Even though muscle pain is one of the major features of fibromyalgia, there are many other symptoms of the condition not helped by Botox.
If you decide to try Botox, be prepared to wait about eight days before you see any effects. The most relief occurs at about three weeks, and the injections can be repeated every three to four months. But be careful not to get them more often. Too frequent injections may cause you to develop immunity to the injections. Some patients who have received too much Botox, depending on the location of the injections, have developed facial and eyelid drooping, bruising, jaw weakness, headache, neck or back pain, and back weakness. Such symptoms last until the injections wear off.
When administered correctly, Botox appears to be safe. But the drug is expensive, costing $400 per injection.
James McKoy, MD, Rheumatologist
Back to Top
Fibromyalgia and Numb Feet
Q: I have fibromyalgia. One of my most bothersome symptoms is numbness and tingling in my feet, and nothing my rheumatologist prescribes seems to help. Do you know what causes this? Should I see another type of doctor?
If numbness and tingling are chronic and confined to your feet, I would suspect a condition besides fibromyalgia might be involved. Fibromyalgia is a syndrome characterized by diffuse widespread pain associated with at least 11 discrete tender areas of the body. Fibromyalgia can also include fatigue, headaches, restless sleep, irritable bowel syndrome, memory changes and, as you are experiencing, numbness and tingling.
The cause for numbness and tingling in fibromyalgia is unknown. These symptoms don't follow any anatomic or nerve pattern and they tend to come and go in different parts of the body.
Other conditions that might cause numbness are diabetes, alcohol use, obesity with fluid retention around the ankles (which causes the compression of nerves in the tarsal tunnel of the lower extremities) and compression of nerves in the low back.
Your rheumatologist should be able to help you sort this out by your history, physical exam, lab tests and X-rays. Depending on what he finds from these tests, your rheumatologist can arrange to test the nerves in your feet (nerve conduction test) and refer you to a specialist for additional treatment if needed.
James McKoy, MD, Rheumatologist
Back to Top
Does Anesthesia Cause Fibromyalgia?
Q: I know more than 20 people who had undergone surgery with general anesthesia before developing fibromyalgia. Could this be a coincidence?
A: No studies have uncovered a link between surgery with general anesthesia and the development of fibromyalgia. It’s understandable that you want to know what caused your condition, but it usually is not possible to confirm a “cause-and-effect” relationship between two relatively common occurrences such as undergoing surgery and developing fibromyalgia. I often use the analogy that fibromyalgia could be caused by exposure to brown carpet; that is, nearly everyone who has the disease was in a room or building with brown carpet sometime before developing it. Exact triggers of most diseases, including fibromyalgia, remain unknown.
Fortunately, doctors don’t need to know how or why someone develops fibromyalgia to treat it. Researchers are the ones looking for causes and triggers of these diseases to find the best treatment and to prevent them from occurring in other people. Someday we’ll have a better understanding of what causes fibromyalgia and other rheumatic conditions.
Keep in mind that the cause of your fibromyalgia is much less important than what you are doing about it now. I recommend working with your doctor to find the most effective ways to control your pain and other symptoms. Treatments that might help you include regular physical exercise, relaxation techniques, and antidepressant and analgesic medications to promote deep sleep and ease muscle pain.
Daniel Clauw, MD, Rheumatologist
The Difference Between Fibromyalgia and Polymyalgia
Q: I’ve been diagnosed with polymyalgia. What is the distinction between polymyalgia and fibromyalgia? What is the treatment for polymyalgia?
A: I can certainly understand the confusion between fibromyalgia and polymyalgia; the names and, to an extent, the symptoms of both conditions are similar.
The word myalgia means pain within the muscles. Both fibromyalgia and polymyalgia are characterized by muscle pain, but many other aspects of the two conditions differ.
Polymyalgia, or polymyalgia rheumatica, is an inflammatory disease of muscle. The cause is uncertain but it is believed to be an autoimmune disease in which the body’s own immune system attacks the connective tissues. The primary symptoms are severe stiffness and pain in the muscles of the neck, shoulder and hip areas. People with this condition also may have flu-like symptoms, including fever, weakness and weight loss, and approximately 15 percent develop a potentially dangerous condition called giant cell arteritis – an inflammation of the arteries that supply the head.
Fibromyalgia is not an inflammatory condition. It is caused by abnormal sensory processing in the central nervous system. People with fibromyalgia may be extremely sensitive to pain and other unpleasant sensations. To be diagnosed with fibromyalgia, one must experience pain on both sides of the body and in both the upper and lower half of the body. They are also typically tender throughout their body. Other common symptoms of fibromyalgia include fatigue, difficulty sleeping and concentrating, irritable bowel syndrome and headaches.
Both fibromyalgia and polymyalgia are more common in women than men. Fibromyalgia can occur at any age, but polymyalgia rarely occurs before age 50. The average age of onset is 70. And whereas fibromyalgia is chronic, often lasting a lifetime, polymyalgia usually resolves itself within two years.
Treatment differs, too. Fibromyalgia is treated with exercise, relaxation techniques, analgesic medications and antidepressants to relieve pain and promote sleep. Treatment for polymyalgia is targeted at relieving inflammation. For some people, daily doses of NSAIDs, such as ibuprofen (Advil, Motrin), are sufficient, but more often corticosteroids, such as prednisone, are required to control inflammation.
Although your polymyalgia will eventually go away completely, it’s important that you be mindful – both now and after your disease resolves – of symptoms such as headaches and blurred vision, which could mean giant cell arteritis. If you develop arteritis, high doses of corticosteroids may be necessary to control the condition and prevent vision loss.
Daniel Clauw, MD, Rheumatologist
Methotrexate for Fibromyalgia?
Q: I have fibromyalgia, which causes a lot of fatigue and stiffness. After reading that rheumatoid arthritis (RA) causes those same symptoms and can be treated with methotrexate, I purchased a six-month supply of the drug over the counter in
A: Methotrexate is certainly available in the
When Fibromyalgia Medicine Causes Pain
Q: I finally found a medication (piroxicam) that helped my fibromyalgia pain and allowed me to be active again. However, after taking it for a while, I started having heartburn and stomach pain. My doctor had me stop the medicine. The stomach problems are better now, but my fibromyalgia pain is back. Is there any way I can ease the side effects so I can still take piroxicam? If not, can you recommend another similar drug that might help me?
A: Piroxicam (Feldene) is a nonsteroidal anti-inflammatory drug (NSAID), much like ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn). NSAIDs are notorious for causing gastrointestinal side effects, including the heartburn and stomach pain you experience. Many people find those side effects can be reduced or eliminated by taking other types of drugs that protect the stomach and intestine.
The two types of drugs that have proven to be most effective are misoprostol (Cytotec), a synthetic prostaglandin that replaces the normal stomach-protective prostaglandins that NSAIDs wipe out, and the proton-pump inhibitors (PPIs), which include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex). PPIs block the production of stomach acid but may increase fracture risk.
If these protective drugs don’t help, another option is to try celecoxib (Celebrex) – a type of NSAID called a COX-2 inhibitor, which is designed to be safer for the stomach than traditional NSAIDs, such as piroxicam. However, be aware that Celebrex is not appropriate if you have a sensitivity to sulfonamides, a type of sulfa drug. Every drug carries some potential risks, but not treating medical problems can be risky, too. Before beginning any new drug, it is important to review your medical history with your doctor, who can weigh the risks of the medication against the problems you are trying to ease or prevent.
Dan Clauw, MD, Rheumatologist
Q: With both fibromyalgia and osteoarthritis, I have constant pain. Even with treatment, it never goes away completely. I’ve just been “dealing with it.” Is that OK?
A: Chronic pain is not a problem you should just put up with; in fact, you should make every effort to reduce it because an increasing number of studies are showing serious consequences of having chronic pain. It may cause damage to certain areas of the brain, just as chronic stress does. It also may lead to psychological problems, such as depression; social problems, such as isolation or decreased earning potential; and functional problems, such as decreased activity or disability.
Overall, people do far better if they take an active role in aggressively managing their chronic pain-inducing condition(s). You should treat pain, as long as the treatments you use do not have side effects that exceed the benefits. Practicing relaxation techniques and sticking with a regular exercise plan may reduce pain in some of the same ways as pain medications. Massage and some supplements also may provide similar benefits, but these therapies have had less research documenting the benefits.
For moderate-to-severe knee osteoarthritis (OA), the supplement glucosamine may provide some relief, as may the right combination of analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs). The analgesic tramadol (Ultram), four antidepressant medications – amitriptyline (Endep), cyclobenzaprine (Cycloflex), duloxetine (Cymbalta) and fluoxetine (Prozac) – and two anti-seizure medications – gabapentin (Neurontin) and pregabalin (Lyrica) – have been studied in people with fibromyalgia. In fact, Lyrica, which eases pain, promotes sleep and reduces fatigue, has just been approved by the FDA to treat fibromyalgia.
Tell your doctor that the treatments you tried previously are not resolving your chronic pain, and then work with him to find the right combination of treatments for you. It may take some time, but the end result will be worth the effort.
Daniel Clauw, MD, Rheumatologist
Fibromyalgia and Period Problems
Q: Can fibromyalgia be the cause of my irregular menstrual cycles?
A Your question is one I hear often. Although a number of patients have told me they associate the development of fibromyalgia with the beginning of irregular menstrual periods, research thus far has not proven a connection between the two. Nevertheless, I wouldn’t be surprised if such a connection is eventually found. It is well known that most chronic illnesses can cause irregular menses. The portions of the nervous system that control menstruation are very sensitive to any slight changes in the body, such as those that occur with conditions like fibromyalgia.
Daniel Clauw, MD, Rheumatologist
Fibromyalgia Flare Following Dental Visit
Q: I have RA and fibromyalgia. Every time I get my teeth cleaned, I have a flare of both conditions a few days later. Do you know why this might happen?
A: We know any type of stress – whether physical stress, such as an infection, or emotional stress, such as fear – can make fibromyalgia and perhaps RA worse, too. In the scenario you describe, I can think of at least three potential stressors that may contribute to your flares: the release of bacteria from the mouth into the bloodstream during cleaning, which stimulates the immune system just enough to increase the level of cytokines in the bloodstream and tissue; the discomfort associated with the procedure, and the anxiety caused by anticipating another flare. Once you know this has happened in the past, it would not be unreasonable to assume it might happen again.
Theoretically each of these three stressors could be dealt with to help reduce your risk of future dental-cleaning-related flares. Antibiotics could be used before and during the procedure to control the bacteria, and deep-breathing or relaxation techniques could be used to help reduce your anxiety, and therefore flares. Analgesics could be used after the procedure, if necessary, to relieve pain. Speak to your doctor or dentist about pre-cleaning medications and about specific techniques that might be helpful.
Daniel Clauw, MD, Rheumatologist
Does Yeast Cause Fibromyalgia?
Q: A friend passed along an article that said the symptoms of fibromyalgia (including fatigue, achiness, bloating, depression and irritability) may be from having systemic candida overgrowth. After eight years with fibromyalgia, I have never heard of this. Is it possible there’s something to it?
A: There is no scientific evidence that fibromyalgia or any of its symptoms are caused by candida overgrowth. Candida is a type of yeast that most people have living in their gastrointestinal tract, such as the mouth and intestines. In some situations – such as when the immune system is weakened by immunosuppressive drugs, like the disease-modifying antirheumatic drug cyclosporine (Neoral) or long-term use of the corticosteroid prednisone – naturally occurring organisms such as candida increase in number because the normal immune system activity that keeps them in check is reduced. A decade or two ago, it became popular to blame candida overgrowth for problems ranging from hyperactivity to infertility. It’s not surprising that people have connected fibromyalgia with excessive yeast as well.
The yeast-overgrowth theory is just one of many untested theories about the cause of fibromyalgia. It is possible that one or more of these theories may be true – at least for some people with fibromyalgia.
For now, until a theory is confirmed, it is best to pursue tested treatments, including exercise, relaxation therapies and a variety of prescription medications.
Daniel Clauw, MD,Rheumatologist
