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Wednesday, April 27, 2016

A summary of fibromyalgia.

When one talks about alternative medicine one cannot forget conditions like ME/CFS and fibromyalgia. These have both been dismissed by the majority of American doctors, much like they dismissed Celiac disease (discovered in the 1950s) and HIV. Here is a summary of facts.
  1. About 2-5% of US adults have fibromyalgia. 
  2. It can take an average of 5 years for a person to get a diagnosis of fibromyalgia. It is not well understood, so it must be diagnosed by eliminating other possibilities. 
  3. FM is characterized by: pain in at least 11 of 18 points. 
  4. Sleep disturbances. Trouble getting to sleep, feeling tired when they wake up.
  5. Irritable bowel or similar symptoms.
  6. Cognitive problems also called "fibro fog". 
  7. Fibromyalgia often occurs (up to 25-65%) with other rheumatic conditions such as rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.
  8. Fatigue that won't go away.
  9. Widespread stiffness, aching, and burning sensations. (Of course this will lead to sleeping problems and fatigue!)
  10. Many patients report they can't get to sleep, and when they do, they wake up still feeling tired. This might be a lack of proper REM sleep. A sleep study might help determine if they get enough REM sleep but many American insurances do not cover this.
  11. Frequent peeing caused by bladder spasms. 
  12. Researchers have also found abnormalities in the hormone system known as the hypothalamus-pituitary-adrenal gland (HPA) axis. The HPA axis controls important functions, including sleep, the stress response, and depression. Disturbances to the HPA axis is correlated to exposure to BPA. See Chen 2014 below. 
  13. Fibromyalgia can be triggered by infection of Epstein-Barr virus or Lyme disease, chronic physical or emotional stress, hormonal changes, emotional trauma of an accident, "seeing the elephant" (believing you will truly not survive a given situation), or medications.
  14. Abnornally thick vascular walls, which may prevent enough oxygen from getting to the muscle.

For medical coding using ICD9-CM, FM is usually coded as 729.1, "Myositis and Myalgia, unspecified". Overall, many of the symptoms above seem to be inflammatory symptoms.

Treatments
FM is not well understood so not all treatments will work well for all, or even a majority of people. Treatments include:
  1. Aerobic and resistant exercise for the pain. 
  2. Psychological support to deal with the frustration and depression. 
  3. Some medications to address the pain and lack of good sleep. Some medications the FDA has approved for fibromyalgia: Lyrica, Cymbalta, Savella, which all help reduce pain.
  4. Relaxation training. 
  5. Acupuncture, chiropractic treatments help most patients. But again, many American insurances cover neither.
FM can be difficult and expensive to diagnose and patients have to put up with pathological disbelief, but, with much persistence, once diagnosed it can be treated. But not all treatments will work well for all people. 

Sources
  1. Chen F, Zhou L, Bai Y, Zhou R, Chen L. Hypothalamic-pituitary-adrenal axis hyperactivity accounts for anxiety- and depression-like behaviors in rats perinatally exposed to bisphenol A. J Biomed Res. 2015 May;29(3):250-8. doi: 10.7555/JBR.29.20140058. Epub 2014 Nov 12. PMID: 26060449. Link to NIH abstract.
  2. CDC. Fibromyalgia page from the CDC. Last accessed Apr 10, 2016.  
  3. FDA. Living with Fibromyalgia. Last accessed Apr 10, 2016.  
  4. Fibromyalgia center. University of Maryland. Last accessed Apr 10, 2016. 
  5. Fibromyalgia: Maligned, Misunderstood and (Finally) Treatable. Scientific American. May 27, 2014.
  6. Fibromyalgia criteria from American College of Rheumatology. Link to PDF.  
  7. Fibromyalgia on Medscape.
  8. Fibromyalgia treatment on Medscape
  9. JAMA articles on musculoskeletal issues.
  10. National Fibromyalgia Association page. Contains history of FM and latest research and much more info. Last accessed Apr 10, 2016.
  11. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Last accessed Apr 10, 2016.
  12. NIH Pubmed page on fibromyalgia. Lots of links to studies here. Last accessed Apr 13, 2016.
  13. NORML and fibromyalgia and pot. A few small studies show THC reduces pain. Last accessed Apr 10, 2016.
  14. ScienceDaily Fibromyalgia articles. Last accessed Apr 10, 2016.
  15. Understanding Fibromyalgia and Its Related Disorders. (2008). Primary Care Companion to The Journal of Clinical Psychiatry, 10(2), 133–144. Link to NIH study

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