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I have a 62 year old female patient who was diagnosed by her GP with plantar fasciitis. Her previous podiatrist issued some orthoses to her, and up until about six months ago had successful pain relief. When she presented to me, she was not tolerating the orthoses at all and said the heel pain had returned (more medial over the tubercle) in both feet. She also has fibromyalgia. She takes Lithium and also has trouble with sleeping so also takes various sleeping tablets to help. The patient did not mention she was bipolar when I went through general medical questions, and I am not sure whether Lithium helps the fibro, but observing her, I would say it is a likley possibility that she has bi polar.
I have tried footwear alterations and advice, RICE methods, physiotherapy, silicone heel cups, adjustments to the orthoses, off the shelf insoles, strapping etc etc but nothing seems to help the patient.
I communicate frequently with her physiotherapist as she sees him fairly regularly, and says he finds any treatment he gives her (shoulder, hip, back) has never been able to relieve pain she feels anywhere else in her body.
A key pathophysiological feature of fibromyalgia is an aberrant central pain control mechanism or central hyperexcitability. The most commonly believed hypothesis is that it is due to an aberrant processing of sensory input in CNS. This means that as the tissue mediators of inflammation excite receptors, there are changes in pain sensitivity in those with fibromyalgia that is affected.....so have no real suggestions, just an explanation for what you are seeing .... any pain in fibromyalgia is difficult to manage.
I concur with craig. For people with fibromyalgia the pain is very real, but the aetiology tends to be difficult to pin down, thus making treatment difficult.
Lithium is not usually used for the treatment of fibromyalgia, so I would imagine that it is being used for mood stabilisation in bipolar disorder. The more likely choice for fibromyalgia would be one of the other mood stabilisers such as sodium valproate. None of my reading indicates that bipolar would affect pain directly, other than chanding the individual's ability to 'cope' (in depression it can be the straw that breaks the camels back...)
I would be leaning towards the more supportive and adjunctive therapies, such as myotherapy, TENS, soft covers on orthotics, and a gentle listening ear. Good luck.
I have treated hundreds of patients with FM in earnest as a physical therapist and a few as a DPM over the years- and have drawn three conclusions from this experience:
1) FM is a manifestation of psychological dysfunction and its associated sleep deprivation, and thus treatment must be targeted on these issues
2) Physical treatments fail miserably
3) I do not want to treat people with FM
Fibromyalgia patients can be very challenging and difficult to treat, as no two patients present the same,they also share symptoms with many other condition namely cronic fatigue syndrome , M.E. this is why they cause so much hair pulling from practitioners.
But help is at hand please try this web site http://www.myalgia.com/overveiw2.htm it contains a lot of useful information especially from Dr Robert Bennett. who is reguarded by many with the condition as the foremost expert of this illness
How do you feel about folks with chronic fatigue syndrome? are they imagining it also?
With regards to FM, it depends on your definition of "imagining". In my opinion, I do believe that FM patients are experiencing pain, but it is unknown if they are experiencing true nocioception. This is certainly different from myofascial pain syndrome- which has an identifiable area of nocioception that is treatable. (As far as chronic fatigue syndrome- I have very little experience or knowledge.)
Your comment is quite typical of most FM patients and some clinicians alike. There is a widespread reluctance to accept the mind-body connection for fear of branding the patient a loon and perhaps appearing dismissive to the patient’s complaints. Nothing could be further from the truth. In fact, every ineffective treatment rendered to these patients just feeds the monster. IMHO, these patients need a psychologist, a personal trainer, a good night’s sleep, and more happiness in their lives. Stop sticking them with tiny needles, giving them drugs, and shoving orthotics in their shoes. Of course, I could be wrong.
The classification of a syndrome does untold damage to the patient and often gives them little benefit to expedite recovery. This does not mean their syndrome or symptoms are non existant, just that giving it a 'name' may create a pattern of illness behaviour which slows recovery.
From memory the worst person to send a patient with FM is to a psych professional. If i recall correctly and i'll check later there have been studies done which suggest the most appropriate person to manage these type of 'conditions' is a manual therapist with training in pain based management. This does not deny a team approach may help but we must remember to not overstimulate people who are going through active phases of their symptoms. Thus success can often be achieved by doing less or keeping it below pain threshold levels, which may mean very little physical activity.
There are significant gains being made in the understanding of pain patterns and the mind/body connection. The cortisol pathway is a must read to understand how stress can mediate as musculoskeletal pain. Moseley would be a good author to read for most people who treat from manaul therapy/podiatric base. His book with Butler is a great reference.
DaFlip not just bad on the inside
Here are my notes I give students on fibromyalgia:
Common painful non-inflammatory disorder characterised by chronic generalised diffuse musculoskeletal pain/aching and fatigue with tenderness at specific points. Fibromyalgia is at the severe end of the spectrum of widespread pain. Affects up to 2-4% of population (however prevalence may depend on definition used in studies – could be up to 11%). F>M. Average age of onset is around 35-40yrs. As a diagnosis, it is being made with increasing frequency, buts its validity as a diagnostic entity has been somewhat controversial in the recent past – some consider it as a variant of an anxiety disorder.
Many theories – largely unknown. There seems to be a genetic predisposition (more common in females; first degree relatives have a higher incidence) with a trigger by stress, trauma, infection or inflammation. Also there appears to be an aberrant central pain control mechanism or central hyperexcitability. Suggestions also include it being a disorder of muscle energy metabolism, an immunopathologic disorder of muscle, due to non-restorative deep sleep, a neuroendocrine imbalance (especially involving the thyroid and/or hypophyseal hormones), a disorder of serotonin or somatomedin-C metabolism, a pain modulation disorder. No pattern of inheritance has been identified – but it may require a predisposing factor that is genetic and a triggering factor (eg trauma, sleep disturbance, infection, stress) for the syndrome to develop. Most commonly believed hypothesis is that it is due to an aberrant processing of sensory input in CNS. The tissue mediators of inflammation excite receptors--> changes in pain sensitivity.
Generally have chronic widespread ‘muscle’ pain – predominantly neck and back, fatigue, headaches, poor sleep, morning stiffness, Raynaud’s phenomenon and tender points.
Clues to diagnosis: “I hurt all over”; “tests show nothing” symptoms (fatigue, pain, headaches, sleep problems); “nothing works”; “doctors don’t know what I have”.
Pain is diffuse, persistent, deep, aching, throbbing – sometimes stabbing; usually bilateral;
Physical examination and investigations will show no evidence of joint, osseous or soft tissue pathology, but fibromyalgia may be associated with other conditions – irritable bowel syndrome, tension & migraine headaches, dysmenorrhoea, chronic fatigue syndrome, Lyme disease, hypothyroidism, exposure syndromes (eg Gulf war syndrome).
Criteria --> chronic diffuse aching with tenderness in at least 11/18 characteristic locations.
Characteristics locations bilaterally --> suboccipital muscle insertions at occiput; lower cervical paraspinals; trapezius at midpoint of the upper border; suspraspinatus at its origin above the medial sacpular spine; 2nd costochondral junction; 2cm distal to lateral epicondyle in forearm; upper outer quadrant of buttock; greater trochanter; knee just proximal to medial joint line.
Many autoimmune rheumatological conditions may initially present with features that are indicative of fibromyalgia.
Schneider & Brady (2001) suggest a reconsideration of the diagnosis and classification of fibromyalgia as they consider the criteria for diagnosis to be two strict. They suggest that those who present with widespread tenderness and fatigue be divided into ‘classic fibromyalgia syndrome’ (sleep disorder, anxiety syndrome, depression, alteration of CNS chemistry) and ‘pseudo fibromyalgia’ (various disorders – organic diseases eg anaemia, hypothyroidism, multiple sclerosis; functional disorders eg improper diets; musculoskeletal disorders eg postural problems).
Involvement of foot:
Occasionally get tender trigger points; feet can be “painful all over” – non-specific pain; increased sensitivity to pain.
Raynauds’ phenomenon is more common in those with fibromyalgia.
Paresthesia’s can occur.
Quality of life is generally “miserable”--> need to listen to the patient’s “struggle” --> attempt to lesson the effects of the symptoms on the quality of life. No single treatment is effective --> need multiple modes of management.
Health professional and patient need to have an accepting attitude.
Patient education and reassurance (“it’s a real disease”) – patient support groups helpful
Percent of patients that respond to each intervention is generally small.
Thyroid hormone levels and regulation may need to be assessed.
NSAID’s (may help some local pain); amitriptyline, cyclobenzaprine, alprazolam help some; improved posture; local injection of tender points; aerobic exercise (has been shown to be beneficial for symptoms and general well being) (Richards & Scott, 2002); adequate sleep/regular sleep schedule; EMG biofeedback; acupuncture; cognitive/behaviour therapy; TENS; chiropractic/osteopathy (some patients have benefited)
Prognosis often poor; 3% free of all pain at 3 year follow up (Felson & Goldenberg, 1986).
One thing I would add, is check around the plantar intrinsic muscles for trigger points - I have seen some with "plantar fasciitis" get better with foot orthoses, but the change in mechanics initiated trigger points in the intrinsic muscles that resulted in the pain remaining the same .... given the trigger point isssue in fibromyalgia, its worth looking.
I have had some tremendous successes (and some failures too) with very soft, more accommodating orthotics with FM patients. I have had better luck doing foam box and weight bearing casts than with the plaster slipper casts. I do believe these folks are wading through deep water which really don't ask about, however, I hear more than my share of what I don't need to know from them. So I listen a bit, encourage them to walk and work out. When in doubt, under correct and go softer. I never use rigid materials for them because I see them back saying they can't tolerate them.
I can't say that that seeing FM on the patient info sheet fills me great cheer, but I always give them my very best efforts and hope.
I was recently talking to a musculoskeletal physician about fibromyalgia. He gives his patients some dry needling/accupuncture at irritable trigger points but he seems to think that kinesiology is the best thing for fibromyalgia.
Having read some of the above comments I agree with most of the points made. I have encountered some patients who suffer with Fibromylagia and chronic fatigue who have tried a form of psychotherapy called Mickel Reverse Therapy. They have found this the only form of treatment that actually gets to the source of their problem. For example, one patient of mine with fibromyalgia leads an extrordinary life - mother of 5 children, works night shifts only, single parent... She claims that the firbromyalgia started around 4-6 months after starting to work the night shifts. No wonder!
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ScienceDaily are reporting: Acupuncture Relieves Symptoms Of Fibromyalgia, Mayo Clinic Study Finds
Evidence suggests acupuncture reduces the symptoms of fibromyalgia, according to a Mayo Clinic study.
Fibromyalgia is a disorder considered disabling by many, and is characterized by chronic, widespread musculoskeletal pain and symptoms such as fatigue, joint stiffness and sleep disturbance. No cure is known and available treatments are only partially effective.
Mayo's study involved 50 fibromyalgia patients enrolled in a randomized, controlled trial to determine if acupuncture improved their symptoms. Symptoms of patients who received acupuncture significantly improved compared with the control group, according to the study published in the June issue of Mayo Clinic Proceedings.
"The results of the study convince me there is something more than the placebo effect to acupuncture," says David Martin, M.D., Ph.D., lead author of the acupuncture article and a Mayo Clinic anesthesiologist. "It affirms a lot of clinical impressions that this complementary medical technique is helpful for patients."
Increasingly, patients are interested in pursuing complementary medicine techniques in conjunction with their mainstream medical care, Dr. Martin says. But often, such techniques lack scientific evidence to justify a patient's expense and time.
The study lends credence to patients' belief that nontraditional methods may improve their health. In Mayo's trial, patients who received acupuncture to counter their fibromyalgia symptoms reported improvement in fatigue and anxiety, among other symptoms. Acupuncture was well tolerated, with minimal side effects.
Mayo's acupuncture study is one of only three randomized and controlled studies involving fibromyalgia patients. Of the other studies, one found acupuncture to be helpful, while the other reported it was ineffective for pain relief.
Dr. Martin says Mayo's study demonstrates that acupuncture is helpful, and also proves physicians can conduct a rigorous, controlled acupuncture study. Future research could help physicians understand which medical conditions respond best to acupuncture, how to apply it to best relieve symptoms, and how long patients can expect to their symptoms to decrease after each treatment.
According to the principles of Chinese Medicine, acupuncture is said to open up channels that are clogged.This may proveide a clue into the treatment of this disease.Maybe fibromyalgia is a short circuiting of an electrical impulse(s) in the body,in much the same way MS is said to be.
Half of women with FM have low vit D (2 studies) and Vitamin D deficiency (Osteomalacia = bone pain and muscle weakness) is often misdiagnosed as FM. It is very difficult to get enough sunlight to make enough vitamin D when working shift work and sleeping during the day. The other main causes of FM include thyroid deficiency (see John C Lowe's work, incl book 'The metabolic Treatment of FM')Magnesium and B vitamin deficiencies, food intolerance, mercury overload and lastly, multiple ligamentous lesions, treatable by prolotherapy - see article by Reeves on treatment of 31 severe FM patients http://www.kalindra.com/prolo_reeves.PDF
ScienceDaily are reporting: Pain From Fibromyalgia Is Real, Researchers Say
Many people with fibromyalgia -- a debilitating pain syndrome that affects 2 to 4 percent of the population -- have faced the question of whether the condition is real.
Fibromyalgia often has been misdiagnosed as arthritis or even a psychological issue. Increasingly, though, the scientific knowledge about fibromyalgia is growing, and a new paper from the University of Michigan Health System says there are "overwhelming data" that the condition is real, is characterized by a lower pain threshold and is associated with genetic factors that can make some people more likely to develop fibromyalgia.
The review paper, in the December issue of the journal Current Pain and Headache Reports, cites recent studies involving pain, genetics, brain activity and more. The paper's authors hope these findings will lead to a better understanding and acceptance of fibromyalgia and related conditions.
"It is time for us to move past the rhetoric about whether these conditions are real, and take these patients seriously as we endeavor to learn more about the causes and most effective treatments for these disorders," says Richard E. Harris, Ph.D., research investigator in the Division of Rheumatology at the U-M Medical School's Department of Internal Medicine and a researcher at the U-M Health System's Chronic Pain and Fatigue Research Center.
A growing amount of research related to the neurobiology of the condition supports the notion that the pain of fibromyalgia is real. Studies at U-M and elsewhere using two neuroimaging techniques -- functional magnetic resonance imaging (fMRI) and single photon emission computed tomography (SPECT) -- indicate there is a difference between patients with and without fibromyalgia.
"In people without pain, these structures encode pain sensations normally. In people with fibromyalgia, the neural activity increased," says Daniel J. Clauw, M.D., director of the U-M Chronic Pain and Fatigue Research Center and professor of rheumatology at the U-M Medical School, and an author of the new paper. "These studies indicate that fibromyalgia patients have abnormalities within their central brain structures."
In a 2003 paper in the journal Science, a U-M team reported that a small variation in the gene that encodes the enzyme called catechol-O-methyl transferase, or COMT, made a significant difference in the pain tolerance, and pain-related emotions and feelings, of healthy volunteers. Researchers also have found that individual mutations in the COMT gene are related to the future development of temporomandibular joint disorder, also known as TMD or TMJ, a condition related to fibromyalgia.
Together, these studies about COMT and numerous studies with animals suggest that pain sensitivity is determined at least in part by a person's genetic makeup, Clauw says.
The authors note that there are some legitimate areas of debate regarding fibromyalgia, including disagreements about how precisely it should be defined and whether people with the condition deserve compensation. But none of those disagreements should detract from the acceptance of it as a condition causing real pain, they say.
Reference: Current Pain and Headache Reports, Dec. 2006, pp. 403-7.
The July issue of American Family Physician out today has a review of Fibromyalgia
Fibromyalgia is an idiopathic, chronic, nonarticular pain syndrome with generalized tender points. It is a multisystem disease characterized by sleep disturbance, fatigue, headache, morning stiffness, paresthesias, and anxiety. Nearly 2 percent of the general population in the United States suffers from fibromyalgia, with females of middle age being at increased risk. The diagnosis is primarily based on the presence of widespread pain for a period of at least three months and the presence of 11 tender points among 18 specific anatomic sites. There are certain comorbid conditions that overlap with, and also may be confused with, fibromyalgia. Recently there has been improved recognition and understanding of fibromyalgia. Although there are no guidelines for treatment, there is evidence that a multidimensional approach with patient education, cognitive behavior therapy, exercise, physical therapy, and pharmacologic therapy can be effective
How depressing! Pity the poor patients who are treated with this paradigm - Count your 11 tender points and learn how to ignore the pain with CBT, gradually increase exercise even though it hurts and take drugs to suppress everything into a fog to reduce your misery. How could a senior author who is board certified in both occupational medicine and general preventive medicine and public health, not be aware of the evidence of vitamin D and fibromyalgia or undiagnosed coeliac disease for a start. Surely the fact that it is a multi-system condition should make one look for a connecting cause before prescribing treatment. Thank goodness podiatrists have access to a chat room like this where people can share websites that have more practical options.
There may finally be an explanation for the pain fibromyalgia patients feel.
A new report from the United Kingdom finds the unexplained pain is caused by a mismatch between sensory and motor systems.
Researchers asked 29 patients to look at the reflection of one of their arms while they moved the other one - which was hidden behind the mirror - in a different direction. This created a mismatch between what the brain sees through sensory input and what it feels through the motor system.
26 of the patients said they felt a transient increase in pain, temperature change, or heaviness in their hidden limb – all symptoms of a “flare up” of their condition. Researchers say this suggests a mismatch between sensory and motor neurons could cause fibromyalgia.
“Nearly all of the group reported an increase in the sensations connected with their condition in the hidden limb,” researcher Dr. Candy McCabe, University of Bath, United Kingdom, was quoted as saying. “This provides strong evidence that sensory-motor conflict is at the heart of this condition.”
McCabe adds as researchers begin to understand more about fibromyalgia they can take steps towards how to treat it in the future.
Fibromyalgia patients complain of widespread pain, multiple tender points, stiffness, problems sleeping, and fatigue. Most patients are women. The condition usually develops between the ages of 30 and 60, but it can strike at any age.
Looks like the above is an important study, as ScienceDaily have also picked up on the story: Fibromyalgia Pain Caused By Neuron Mismatch, Suggests Study
The unexplained pain experienced by patients with fibromyalgia is the result of a mismatch between sensory and motor systems, new research suggests.
In a study published in the journal Rheumatology, researchers asked patients to look at a reflection of one arm whilst moving their other in a different direction which was hidden behind the mirror.
This created a mismatch between what the brain sees via sensory input and what it feels through the motor system that controls movement.
Of the 29 patients involved in the study, 26 reported feeling a transient increase in pain, temperature change or heaviness in their hidden limb - all symptoms of a ‘flare up’ of their condition. This suggests that a mismatch between sensory and motor neurons could be at the root of the fibromyalgia – a condition affecting one in 100 people in the UK at some stage of their lives.
“The chronic pain experienced by people with fibromyalgia is hard to understand because there are no obvious clinical signs that pain should be experienced,” said Dr Candy McCabe, one of the researchers involved in the University of Bath and Royal National Hospital for Rheumatic Diseases study. We have shown that by confusing the motor and sensory systems we can exacerbate the symptoms felt by people diagnosed with the condition.
“This adds to a growing body of evidence that many of the symptoms of this common disorder may be perpetuated, or even triggered, by this sensory-motor conflict.
“We have had some success to date in using a similar technique to help alleviate the symptoms of this kind of chronic pain. This works by helping the brain to see a limb moving freely without pain – although in reality it is a reflection of their pain-free limb.”...
An article published by Robert M Bennett, Jessie Jones, Dennis C Turk, I Jon Russell and Lynne Matallana: An internet survey of 2,596 people with fibromyalgia, BMC Musculoskeletal Disorders 2007,8:27, which is available from: http://www.biomedcentral.com/1471-2474/8/27
This article gives you an idea how patients respond to various treatment .
Pity the poor professional who has to deal with it! I imagine that there are a great deal of 'hypochondriac' patients who are wrongly diagnosed with said condition just so that the practitioner can offer an explanation. No matter what form of treatment is offered this type of patient is impossible to satisfy. This is immensely frustrating and unfair to those who genuinely have the condition which, in my opinion, may be treated succesfully with any of the above options or combination of (yes, even including psychological assistance in some cases!).
Last edited by greatwhite : 6th January 2008 at 11:04 AM.
ScienceDaily are reporting: Fibromyalgia Pain Linked With Central Nervous System Disorder
Fibromyalgia is a chronic pain condition that causes widespread pain and tenderness throughout the body. A University of Michigan study, published in The Journal of Pain, shows that fibromyalgia is associated with central nervous system abnormalities evidenced by patients’ elevated sensitivity to auditory and pressure sensations.
The Michigan researchers studied 31 subjects to determine if there is a global central nervous system problem underlying sensory processing in fibromyalgia patients. They noted that few studies have employed different stimuli in consistent ways and levels of intensity to measure pain sensitivities in this patient group. In this study, fibromyalgia patients and normal subjects were exposed to random auditory and pressure stimuli.
Consistent with prior research, the fibromyalgia subjects in the study showed greater sensitivity to auditory tones and reported higher sensitivity to daily sounds. Further, significant associations were observed between the auditory and pressure responses and support the claim that such abnormalities maybe related to a common pathophysiological mechanism. They also noted that fibromyalgia subjects perceived auditory stimuli to be of the same intensity as felt by control subjects, even though their actual intensity levels were lower.
The authors concluded their findings show that fibromyalgia is associated with a central nervous deficit in sensory processing. Further research is needed to examine mechanisms governing these perceptual abnormalities.
Fibromyalgia (FM) is characterized by widespread tenderness. Studies have also reported that persons with FM are sensitive to other stimuli, such as auditory tones. We hypothesized that subjects with FM would display greater sensitivity to both pressure and auditory tones and report greater sensitivity to sounds encountered in daily activities. FM subjects (n = 30) and healthy control subjects (n = 28) were administered auditory tones and pressure using the same psychophysical methods to deliver the stimuli and a common way of scaling responses. Subjects were also administered a self-report questionnaire regarding sensitivity to everyday sounds. Participants with FM displayed significantly greater sensitivity to all levels of auditory stimulation (Ps < .05). The magnitude of difference between FM patients' lowered auditory sensitivity (relative to control subjects) was similar to that seen with pressure, and pressure and auditory ratings were significantly correlated in both control subjects and subjects with FM. FM patients also were more sensitive to everyday sounds (t = 8.65, P < .001). These findings support that FM is associated with a global central nervous system augmentation in sensory processing. Further research is needed to examine the neural substrates associated with this abnormality and its role in the etiology and maintenance of FM.
Muscle tenderness is the hallmark of FM, but the findings of this study and others suggest that persons with FM display sensitivity to a number of sensory stimuli. These findings suggest that FM is associated with a global central nervous system augmentation of sensory information. These findings may also help to explain why persons with FM display a number of comorbid physical symptoms other than pain.
The frequent use of chiropractic, naturopathic, and physical and occupational therapy by patients with fibromyalgia has been emphasized repeatedly, but little is known about the attitudes of these therapists towards this challenging condition.
We administered a cross-sectional survey to 385 senior Canadian chiropractic, naturopathic, physical and occupational therapy students in their final year of studies, that inquired about attitudes towards the diagnosis and management of fibromyalgia.
336 students completed the survey (response rate 87%). While they disagreed about the etiology (primarily psychological 28%, physiolgical 23%, psychological and physiological 15%, unsure 34%), the majority (58%) reported that fibromyalgia was difficult to manage. Respondants were also conflicted in whether treatment should prioritize symptom relief (65%) or funcitonal gains (85%), with the majority (58%) wanting to do both. The majority of respondents (57%) agreed that there was effective treatment for fibromyalgia and that they possessed the required clinical skills to manage patients (55%). Chiropractic students were most skeptical in regards to fibromyalgia as a useful diagnostic entity, and most likely to endorse a psychological etiology. In our regression model, only training in naturopathic medicine (beta=0.33; 95% confidence interval=0.11 to 0.56) and the belief that effective therapies existed (beta=0.42; 95% confidence interval=0.30 to 0.54) were associated with greater confidence in managing patients with fibromyalgia.
The majority of senior Canadian chiropractic, naturopathic, physical and opccupational therapy students, and in particular those with naturopathic training, believe that effective treatment for fibromyalgia exists and that they possess the clinical skillset to effectively manage this disorder. The majority place high priority on both symptom relief and functional gains when treating fibromyalgia.
Press Release: First treatment for Fibromyalgia pain now available in Canada
KIRKLAND, QC, May 12 /CNW/ - Pfizer Canada Inc. announced today that
LYRICA(R) (pregabalin) is now indicated for the management of pain associated
with fibromyalgia, giving the approximately one million Canadians who suffer
from this debilitating condition a key component towards managing their
This new indication announcement, made on International Fibromyalgia
Awareness Day, represents positive news for fibromyalgia sufferers since pain
associated with the condition previously had no approved treatment options in
"Fibromyalgia is a life altering and complex condition that has been and
continues to be under-treated in the medical community," said Dr. Gordon D.
Ko, Medical Director, Canadian Centre for Integrative Medicine and Consultant
in the Department of Rehabilitation Medicine at Sunnybrook Health Sciences
Centre, University of Toronto. "Now that there is a viable and effective
treatment option available, there is hope that this will change and those who
suffer from fibromyalgia will find relief from their pain."
Characterized by a chronic widespread pain that can be relentless,
fibromyalgia is usually accompanied by poor sleep, stiffness and fatigue;
sufferers also report experiencing deep tenderness, soreness and flu-like
aching. There is not one specific cause of fibromyalgia. Some of the
associations that have been identified include heredity, physical trauma,
emotional trauma, infection or autoimmune disorders such as rheumatoid
arthritis or lupus.
Fibromyalgia has baffled and frustrated the health care profession for
years. Often difficult to diagnose, fibromyalgia cannot be detected through a
blood test or x-ray. Diagnostic criteria were developed in 1990 by the
American College of Rheumatology to help patients and their physicians
recognize the condition, learn to manage the disease, and define treatment
plans to provide relief for symptoms. Women are much more likely to report
suffering from fibromyalgia than men, although the condition affects both
"Fibromyalgia sufferers are often stigmatized as chronic complainers,"
said Dr. Ko. "However, the ambiguity of the symptoms that they experience
doesn't diminish their pain. Patients with fibromyalgia report pain at much
lower levels of stimulus than those without the condition, which has been
confirmed in several studies, including technology with advanced functional
MRI scanning of the brain. It is as if the "volume control" for pain is turned
Fibromyalgia can be debilitating and can have devastating effects on a
sufferer's life, impacting one's ability to work and engage in everyday
activities, as well as their relationships with family, friends and employers.
Because it often results in lost work days, lost income and disability
payments, fibromyalgia exerts a substantial health and economic burden in
Canada due to lost productivity, psychological damage and disability.
Sandra Gartz, diagnosed with fibromyalgia in 1985, knows all too well the
devastating impact that the disorder can have on one's quality of life. She
managed to work as a nurse through two work related accidents while suffering
from leg cramps, headaches and severe pain in different parts of her body.
Unfortunately in 1995, a third accident delivered the final blow: she tripped
while walking upstairs when she was working as a home care nurse and hasn't
been able to work since.
"I tell people to imagine having the flu. You hurt from head to toe and
just want to lie on the couch all day," said Sandra. "The flu is something
people can relate to. But with fibromyalgia, you can't stay in bed for the
rest of your life. You have to get up, move around and carry on."
Now the leader of her local fibromyalgia support group for 10 years,
Sandra has her family doctor, massage therapist, pharmacist, family and good
friends for support. "Sometimes I think that living with fibromyalgia is like
living with an invisible illness. The pain I feel is very real, but through
the eyes of others, I don't look sick," said Sandra. "Having an actual medical
treatment become available to manage some symptoms of my illness has now made
my pain real to others."
LYRICA is an analgesic agent that selectively binds to a specific
sub-unit of calcium channels that modulates nerve transmission in the brain
and spinal cord, thereby reducing the activity of hyperexcited nerve cells
involved in pain. This mechanism restores nerve cell function to more normal
levels. The safety of LYRICA for fibromyalgia has been established in 3,446
patients (controlled and uncontrolled studies) and has a favourable safety
profile. The most common treatment-related adverse events ((greater than or
equal to) 5% and twice the rate of that seen in placebo) in controlled
clinical studies in fibromyalgia were: dizziness, somnolence, weight gain, dry
mouth, blurred vision, peripheral edema, constipation, and disturbance in
attention. Adverse events were usually mild to moderate in intensity. LYRICA
is also indicated for the management of neuropathic pain associated with
diabetic peripheral neuropathy (DPN) and postherpetic neuralgia (PHN). It is
approved, with conditions, for the use in management of central neuropathic
pain (CNeP). This includes nerve pain associated with conditions such as
spinal cord injury, stroke, multiple sclerosis, and Parkinson's disease.
One thing I would add, is check around the plantar intrinsic muscles for trigger points - I have seen some with "plantar fasciitis" get better with foot orthoses, but the change in mechanics initiated trigger points in the intrinsic muscles that resulted in the pain remaining the same .... given the trigger point isssue in fibromyalgia, its worth looking.
So in this instance would you still use orthotic therapy?
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