A PRACTICAL APPROACH TO FIBROMYALGIA – part 3

fibromyalgia treatmentTREATMENT-NONPHARMACOLOGIC MODALITIES
Education-Patients with fibromyalgia seem to be comforted once the diagnosis is confirmed by a healthcare professional. Much of what we can do is to “witness” the disease along with the patient. Even though we do not have successful treatments we can help people understand the disease process, what will worsen it, and how long the exacerbations will last. People also do better when they are given some part in their recovery. Relaxation and breathing exercises can be used to help a person maintain their functional ability at work. There also is benefit in “uncoupling” of the sensory component of the pain and the cognitive appraisal of the pain. Celebrex arthritis

Exercise-As muscles atrophy, the pain worsens and prospects for full recovery diminish. Maintaining muscle tone needs to be a priority in treating fibromyalgia. Exercise programs need to start off with stretching. Exercises should be low load, low repetition and focus on strengthening. If aerobics are done they should be low impact. Pain limits should not be exceeded, and when pain develops exercise should stop. Water aerobics are particularly well tolerated. Buy canadian Sumatriptan

Biofeedback-There are a number of studies that show biofeedback successfully lessening the number of tender points, decreasing overall pain and decreasing morning stiffness. Effects of biofeedback have been shown to last up to six months after treatment has been instituted.

Hypnosis-Hypnosis has shown promise in relieving pain symptoms. Hypnosis was shown to be more effective than physical therapy in re lieving pain in a controlled study of 40 patients with fibromyalgia. canadian pharmacy Levaquin

Physical Therapy Modalities-Heat, stretching, massage, meditation, body work, can all be used to maintain the functional ability of a person with fibromyalgia. It does not help in curing the condition or alleviate the return of symptoms. The goal of these treatments is to minimize fatigue and maintain functional ability.

Manipulation-People with fibromyalgia both subjectively and objectively have been shown to benefit from manipulation. Counterstrain is the technique of choice. Specific goals need to be set. In my practice if, after an initial weekly treatment for three weeks, the positive response does not last at least two weeks, I discontinue manipulation. Almost all patients feel better for some short period of time ranging from 3 hours to 3 days. If the response does not last, then the effect is not alleviating the underlying pathology of the disorder. buy Omnicef 300 mg

Cognitive Behavioral Therapy-Focuses mainly on relaxation and coping strategies. There are strong positive reinforcements for healthy behaviors. Compliance with this therapy has been poor.

TREATMENT-PHARMACOLOGIC MODALITIES
Tricyclic antidepressants – have been shown to help with sleep, but have minimal effect of the pain symptoms. Initial dose of given at bedtime. Patients should be warned that these medications do cause a “hungover” feeling particularly for the first week of use. Symptom improval may take 4-6 weeks and a course of at least three months should be tried before a full evaluation of the therapy can be done.

It is the most widely studied and has some benefit in treatment. An adequate trial of this medication is a minimum of two months.

Seratonin/Norepi Reuptake Inhibitor-Ven-lafaxine is the only medication in this class and at high doses it does increase norepi and do pamine levels in the serum. Anecdotally it has been very successful, but no double blind trials have been conducted yet. generic Imitrex online

Benzodiazepines-When used in combination with NSAIDS have shown benefit in reducing pain. The chronic nature of fibromyalgia makes benzodiazepines a difficult medication to choose. Dependence to benzodiazepines and withdrawal syndromes need to be taken into consideration before instituting treatment.

Analgesics-Tramadol in injectable form has been shown to be as effective as acetaminophen with codeine for treatment of pain without the side effect and abuse problem. Goal oriented and time limited therapies can be of tremendous benefit and need to be included in the treatment algorithms.

Calcitonin-nasal administration of calcitonin has been shown to decrease pain. Calcitonin is a seratonin precursor.

Muscle Relaxants-Cyclobenzaprine (flexeril) has been shown to help a person maintain stage four sleep and wake up more rested. A five mg dose 1-2 hours before bedtime. It has also been shown to reduce pain particularly in the late evening. buy Carisoprodol 350 mg

Opiods-Effective pain relievers but potentially dangerous medications to be using in fibromyalgia. When used they need to be given for a specific time period and with the use of them directed at achieving a specific goal. May increase fibrofog.

Steroid injections into trigger points-This therapy has been shown to increase a persons functional ability by increasing range of motion. There are also small decreases in pain perception after the injection. Skelaxin 400 mg online

CONCLUSION
Fibromyalgia is a disease based on self-reported symptoms and without any objective measurable findings. This has led many practitioners to question its existence. A problem that is difficult to diagnose, and oftentimes takes years to be diagnosed, any real or perceived obstacles to the diagnosis can strain the physician patient relationship. Compounding the problem of this disease is that the effectiveness of treatments range from mediocre to poor, with the best modality we have available to us being the therapeutic relationship we forge with our patients. By providing support, helping people develop coping mechanisms, and accepting the complaints presented to us, we can provide patients with what they need from us most, and that is showing them that we understand what they are experiencing.

About

So Many Advances in Medicine, So Many Yet to Come