Symptoms
Fibromyalgia is a chronic, noninflammatory disorder that manifests as pain throughout the body and is characterized by numerous other complaints. It is much more common in women than in men and usually first appears in middle age.
- Chronic, bilateral, diffuse pain.
- Muscle pain, pain in the limbs, back pain, joint pain, neck pain, headaches, migraines
- Muscle tension, morning stiffness
- Calf cramps
- Neuropathic disorders such as numbness, paresthesias.
- Increased sensitivity to cold, noise, odors and light.
- Restless Legs
- Fatigue, sleep disturbances, exhaustion, lack of concentration, sleep is not restful
- Digestive problems, irritable bowel syndrome.
- Psychosomatic complaints such as palpitations, anxiety, nervousness.
- Depression
Causes
The exact causes are unknown. A common theory considers the cause to be a disorder of central pain perception with an increased sensitivity to pain. In addition to external factors, heredity plays an important role. Inflammatory processes, on the other hand, are not involved in the development.
Nonpharmacologic treatment
The various causes and the diverse clinical picture require a heterogeneous therapeutic approach that is individually adapted to each patient. A single drug or method usually cannot alleviate all symptoms. Therefore, various non-drug and drug measures are combined. The non-drug treatments used include good patient education, cognitive behavioral therapy, psychotherapy, physical therapy, bath therapy, exercise, training, sports, acupuncture, and support groups. Numerous other methods are used.
Drug treatment
Pain medication:
- Anti-inflammatory agents such as the NSAIDs and glucocorticoids are considered by most authors to be ineffective or even harmful. Pure analgesics such as acetaminophen and the opioids, especially tramadol, on the other hand, seem to be able to relieve pain. Tramadol is not only an opioid, but also inhibits the reuptake of neurotransmitters like the antidepressants.
Antidepressants:
- The selective serotonin and norepinephrine reuptake inhibitors SSNRI duloxetine and milnacipran are FDA approved for this indication and appear to be more effective than the SSRIs. The tricyclic antidepressant amitriptyline may also relieve symptoms, but potentially has numerous adverse effects.
Antiepileptic drugs:
- Pregabalin, in addition to the two SSNRIs, was also recently approved by the FDA for this indication. Gabapentin is another alternative.
Sleep aids:
- Sleeping pills such as the benzodiazepines, zolpidem or zopiclone can promote sleep and some are muscle relaxants. Disadvantages include the development of dependence.
Other options:
- Tropisetron and pramipexole have been studied in small trials. Numerous other agents and alternative medicine therapeutics can be used depending on the symptoms.
Herbal medications:
- Numerous herbal remedies are also available for the treatment of individual complaints. Thus, St. John’s wort can be used for mood disorders, peppermint and fiber against irritable bowel syndrome. Meadowsweet and willow bark are said to be effective in relieving pain. Cannabis and its ingredients may be suitable for treatment as analgesics and muscle relaxants.
