Pain Relief: The L.A. Pain Clinic Guideby Sota Omoigui

FIBROMYALGIA PAIN

Fibromyalgia means pain in the muscles, tendons, ligaments and joints. It is a pain disorder that is ten times more common in women than in men. There is wide spread pain of greater than three months duration on both sides of the body (right and left) as well as above and below the waist. There are at least 11 out of 18 tender points which are found on the back of the neck, sternum, lower back, both shoulders, hips, shin, elbows and knees. People with fibromyalgia feel that they ache all over. Their muscles may feel like they have been overworked or strained. The pain in the muscles may be aching, throbbing, burning, shooting and stabbing. In addition, there is a feeling of being totally drained of energy. People who have fibromyalgia have constant interruption of their deep level or Stage 4 sleep. They have difficulty in getting restful sleep and wake up feeling tired. Stage 4 sleep is important for many body functions such as tissue repair, antibody production and regulation of various hormones and neurotransmitters. Fibromyalgia syndrome is closely related to Chronic Fatigue syndrome and both syndromes share many similar symptoms. In some people with fibromyalgia, there is an irritable bowel with abdominal pain, abdominal gas, nausea, constipation and diarrhea. Other complaints can include chronic migraine or tension headache, temporomandibular joint dysfunction, painful menstrual periods and multiple chemical sensitivities to odors, medication and various foods. Fibromyalgia symptoms are aggravated by cold weather, stress, depression, anxiety and over exertion. The cause of fibromyalgia is not really determined but there are several theories. Some believe that it is due to immune system dysfunction or a sleep disorder. Others believe that there are abnormalities in regulation of chemical neurotransmitters like Substance P and serotonin, which play a role in inflammation and pain. Substance P has been found in several studies to be elevated threefold in the spinal fluid of fibromyalgia patients. Fibromyalgia may lie dormant in certain people until it is triggered by certain events. These may include a viral or bacterial infection. a motor vehicle accident or development of one of the autoimmune diseases like rheumatoid arthritis, lupus or hypothyroidism
Practice good muscle and joint protection. Use a cane for a bad knee or hip. Keep common items at counter level – in the kitchen or bathroom. Use lightweight items made from/of plastic rather than metal. Push, pull or roll instead of carrying. Use wide or large grip handles – on doors, cabinets or kitchen utensils. You may take aspirin or other over-the-counter pain relievers such as Tylenol. These medications decrease the production of prostaglandins that cause pain, and should be taken daily even if you have few symptoms. Take the medicines with food to prevent stomach upset. Natural cartilage supplement glucosamine sulfate helps the body to repair damaged or eroded cartilage. This supplement may be taken to reduce pain and joint inflammation. If you are overweight, you need to lose weight to reduce the stress on your joints. For every ten pounds you lose, you save 200 pounds of stress on your joints. Correct posture is important. Use a firm mattress or bed board while you sleep or rest in bed. Whenever possible sit in straight back chairs that have armrests and try not to slump. Warm water aerobics in a swimming pool enable you to exercise your muscle and joints with less discomfort because in water, you weigh only 10% of your body weight. Do not overdo any exercises or activities. Follow the 2-hour pain rule. If exercise induced pain lasts longer than 2 hours, cut back on exercises but do not stop. Do not exercise a joint that is inflamed or “hot”. However you should gently move the joint through the full range of motion twice a day. Pace yourself throughout the day so you do not get too tired. Learn to relax. Books and audiotapes teaching relaxation techniques are available at many bookstores. Maintaining a healthy diet with adequate protein and calcium is important. Vitamin C and Vitamin B5 (pantothenic acid) may be helpful. A herbal medication that may be helpful is pycnogenol, which is an extract of the pine bark. The active ingredients are also found in grape seed extract. Pycnogenol is 50 times more potent as a free radical remover (scavenger) than Vitamin E and 20 times more powerful than Vitamin C. Free radicals are responsible for the breakdown of our bodies, including the joints, skin and organs. Aging, joint, muscle and tissue inflammation, plus poor functioning of the circulatory system, nervous system and immune system often result from free radical damage. Keep your weight down by reducing fats, cholesterol and sugar. Cut back on vegetable oils and oil containing products like salad dressings, fried food and margarine. These contain omega-6 fatty acids that have been shown to worsen inflammation. You may use canola or olive oil that are low in omega-6 fatty acids
Improving the quality of sleep is a priority. Your doctor may prescribe medications such as Xanax, Klonopin, Elavil and Trazodone to do just that. Your doctor may also prescribe strong pain medications such as Vicodin ES, MS Contin or Oxycontin. One of the ways these medications give you pain relief is by decreasing the level of Substance P in your tissues, joints and spinal fluid. In some recent studies, injection or oral administration of the serotonin-3 antagonist medication Tropisetron significantly reduced pain symptoms in patients with fibromyalgia. Medications in the same family as Tropisetron such as Dolasetron (Anzemet) and Ondansetron (Zofran) are normally used for treatment of chemotherapy induced nausea and vomiting. These medications bind to serotonin receptors and diminish serotonin induced release of substance P from nerve fibers. In other studies, injection of steroid (methyl prednisolone acetate) in the spinal fluid reduced the levels of a pain transmitter called interleukin-8 and produced dramatic and long lasting pain relief in patients with nerve pain from shingles. It is not yet known if this type of treatment may also help patients with fibromyalgia. Anti-inflammatory drugs such as Tolmetin may be helpful by reducing pain and inflammation but sometimes can irritate the stomach and cause heartburn or ulcers. An alternative therapy that has helped some patients is Guaifenesin, which is an ingredient in many over-the-counter cough medications. However do not use Guaifenesin in combination with the other ingredients that are found in cough mixtures, as these can produce side effects. Guaifenesin must be used as a 200 mg pure tablet, which is available over the counter or a 600 mg tablet available by prescription. Alternative therapy practitioners believe that Guaifenesin may help by increasing body levels of serotonin and decreasing body levels of phosphate. Excess phosphate results in cellular overactivity followed by fatigue. There is reported to be an initial worsening of symptoms with the onset of Guaifenesin treatment and it may take a few months to see an improvement. When you have a flare-up, use common sense and do not fight the pain. Put ice or heat on your painful joints and muscles and wear your brace if you have one. You may rub over-the-counter ointments, rubs and sprays such as Eucalypta Mint, Ben-Gay or Flex-all 454. A new ointment called Zostrix (Capsaicin) may also help painful joints by decreasing the amount of substance P, which sends pain signals to the brain. Zostrix is the burning ingredient in red-hot chili peppers. The ointment itself may give you a funny burning sensation that lasts the initial couple of days. Wear rubber gloves when you apply it and keep it out of your eyes. Rest is important because fatigue can make the pain worse. Your doctor may sometimes recommend injections of steroid into the painful joints. Pantothenic acid (also called Vitamin B5) has been found to decrease inflammation and relieve pain in some people. Take 1000 mg daily for one month and then reduce to 500 mg daily. Your doctor may use biofeedback or meditation to help you learn to relax. If you are depressed you may need a higher dose of antidepressant medication and counseling.
Take pain relievers, such as Tylenol. Take herbal supplements such as Quercetin, Rutin, Curcumin, Red Wine tablets, Cinnamon and Ground Clove Extracts. These contain polyphenols which are the best anti-inflammatory agents that nature has provided to us. A new ointment called Zostrix (Capsaicin) may also help painful areas by decreasing the amount of substance P that sends pain signals to the brain. Zostrix is the burning ingredient in red-hot chili peppers. The ointment itself may give you a funny burning sensation that lasts the initial couple of days. Wear rubber gloves when you apply it and keep it out of your eyes. Specially compounded ointments containing the medication combination gabapentin/DMSO/clonidine/ketoprofen may help relieve the burning pain. Local treatment with DMSO ointment promotes healing in diabetic ulcers. DMSO is a free radical scavenger. Oxygen derived free radicals or neuropeptides are responsible for the breakdown of our bodies, including the joints, skin and organs. Aging, joint, muscle and tissue inflammation, plus poor functioning of the circulatory system, nervous system and immune system often result from free radical damage. A herbal pill that is a free radical scavenger is pycnogenol, which is an extract of the pine bark. The active ingredients are also found in grape seed extract. Pycnogenol is 50 times more potent as a free radical remover (scavenger) than Vitamin E and 20 times more powerful than Vitamin C. Your doctor may need to examine you and make sure your diabetes is under control. Your doctor may prescribe the blood thinner medication Trental (pentoxifylline). Trental used alone is effective in most diabetics in relieving the burning and numbing pain. Doctors sometimes prescribe strong anti-inflammatory drugs such as Tolmetin or strong pain medications such as Vicodin ES or Norco 10/325, which may be given for short periods. The strong pain medications should be used carefully so that they do not produce drug dependency. Antidepressants like Lexapro, Vivactil, Elavil, St. John’s Wort help ease the burning pain. They work by blocking pain messages traveling through the spinal cord and may act directly on injured nerves, stopping painful spasms or decreasing their sensitivity. These pain relieving actions are separate from their mood lifting effects. Anesthetic ointments such as Lidocaine or an anti-itch cream called Zonalon (Doxepin) may be used to numb the area of pain. Anti-seizure medication e.g. Trileptal, Lyrica, Topamax or Neurontin may be added to help prevent and treat the pain. Take the medications regularly. An intravenous (IV) infusion of the anti-seizure drug Depacon combined with IV infusion of magnesium sulfate and IV mini bolus doses of Ketamine can also be effective. Some of these medications may decrease the production of blood cells so your physician may have to check your blood every few weeks. Occasionally some of these medications may produce a skin rash. Acupuncture, hypnosis, electrical nerve stimulation and psychotherapy are helpful in some people.

Call your Doctor: if your pain is severe or you have difficulty controlling your diabetes.