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