| The American College of Rheumatology meeting | | | | since they were kids. The rest say something |
| held in Boston from November 6-12 provided a | | | | happened" to trigger it. |
| platform for experts in the field of fibromyalgia | | | | Dr. Clauw agreed noting that a wide range of |
| (FM) to present information that updates our | | | | events appear to trigger fibromyalgia, such as |
| notions as to what this disorder really is. | | | | infections and injuries. A small subset of people |
| Legitimacy as a medical condition has been | | | | experiencing these events will go on to develop |
| supported by the FDA approval of a drug, | | | | regional or widespread pain syndromes as a result |
| pregabalin (Lyrica), for the treatment of | | | | of their particular genetic makeup. |
| fibromyalgia. | | | | He also said, "Getting effective treatment to |
| Unfortunately there are still skeptics including | | | | fibromyalgia patients is important because when |
| many physicians. | | | | they have had uncontrolled symptoms for too |
| Dr. Daniel Clauw, of the University of Michigan in | | | | long, they become resistant to treatment." |
| Ann Arbor, and one of the foremost authorities | | | | "They're upset because they can't function |
| on FM, told attendees "it has now been proven | | | | normally in their societal roles. They become |
| convincingly that FM is primarily a disorder of pain | | | | depressed because of what the pain and fatigue |
| signaling, arising in the central nervous system." | | | | has done to their life. They develop ways of |
| He went on to say though, that "many physicians, | | | | thinking, which has been confirmed by brain |
| including specialists, still regard the local | | | | imaging, that can actually increase their pain levels |
| manifestations, such as tender points, as | | | | by changing the way pain is transmitted in the |
| important," creating what he called "a circular | | | | brain. And... they develop bad habits that are called |
| problem" in treatment. | | | | 'maladaptive illness behaviors' where they make |
| What Dr. Clauw was alluding to were the | | | | their condition worse," Dr. Clauw added. |
| diagnostic criteria formulated a few years ago, | | | | Fortunately, many therapies are available to make |
| which stated that among the classic symptoms of | | | | fibromyalgia sufferers more comfortable. |
| fibromyalgia is abnormal pain in some or all of 18 | | | | Among them are exercise, certain analgesics, |
| points in the body when touched. The American | | | | some classes of antidepressants and, most |
| College of Rheumatology was the group that | | | | recently, drugs classified as anticonvulsants. |
| developed criteria for diagnosing the condition that | | | | Fibromyalgia pain can be reduced with moderate |
| includes a finding that at least 11 of these points | | | | and regular aerobic exercise. |
| are tender. | | | | Opioid narcotics and most over-the-counter |
| But, a key point that Dr. Clauw stressed is that | | | | analgesics are not effective in fibromyalgia. One |
| "the longer we keep publishing review articles | | | | analgesic, tramadol (Ultram) may be useful. |
| [with illustrations of] a woman with 18 dots, the | | | | Amitryptyline (Elavil) and cyclobenzaprine (Flexeril) |
| longer people are going to think there's something | | | | are two other drugs that have proven to be |
| wrong in (just) those 18 areas of the body, even | | | | effective in placebo-controlled trials. |
| though we know that's not the case." | | | | Equivocal results have come out of studies of |
| Dr. Clauw went on to say that it was better to | | | | selective serotonin reuptake inhibitors including |
| think of fibromyalgia as a "disorder of the | | | | fluoxetine (Prozac). |
| pain-sensation system's "volume control" that | | | | But antidepressants that affect both serotonin |
| determines how the brain processes... stimuli." | | | | and norepinephrine have demonstrated good |
| "This is likely set by the genes we are born with, | | | | results. Duloxetine (Cymbalta) and milnacipran |
| and modified by the environment," he added. | | | | (Ixel) both show promise in this condition. |
| Those with a high volume control setting will feel | | | | Anticonvulsant drugs like gabapentin (Neurontin) |
| more pain for a given level of stimulus. | | | | and pregabalin (Lyrica) have been used to treat |
| As a result, he said, one can test for fibromyalgia | | | | fibromyalgia. The latter drug is now the only |
| with stimuli in areas other than the classical 18 | | | | medication approved in the United States to treat |
| points, such as the thumbnail. He said fibromyalgia | | | | fibromyalgia. |
| can also be diagnosed without touching patients at | | | | Editor's note: Another important modality that |
| all. | | | | wasn't mentioned is cognitive behavioral therapy. |
| Don Goldenberg, M.D., of Tufts University School | | | | This type of treatment uses devices such as |
| of Medicine in Boston, another FM expert, | | | | guided imagery, visualization, time management, |
| commented on the important dual role of genetics | | | | etc. to help FM patients cope better. While not |
| and environment in the disorder. "Fifty percent of | | | | effective as a lone treatment modality, it is crucial |
| my patients say they were born with it, had it | | | | as an adjunctive method for FM management. |