Fibromyalgia: Diagnosis and Treatment
Fibromyalgia can be defined as chronic wide spread pain lasting a minimum of six months. “Wide spread” refers to the upper and lower parts of the body and the left and right sides of the body. It is a centrally mediated pain, and the cause is not known. Tender point counting is not necessary. Patients are polysymptomatic, with marked central nervous system sensitivity (eg, allodynia).
Non-pharmacologic therapies play an important role.
- Good sleep hygiene: caffeine avoidance, quiet place without a snoring partner, regular hours
- Physical activity
- Physical therapy
- Patient education
The goal of therapy is to change the sensitivity of the central nervous system. Many patients with fibromyalgia appear to be deficient in serotonin norepinephrine reuptake inhibitors (eg, fluoxetine, Cymbalta®). Dr. Brown also discusses other types of medications and their use in combination and with non-pharmacologic therapies.
In conclusion, Dr. Brown summarizes some of the fibromyalgia research the United States Department of Defense is conducting. This research is in conjunction with military personnel returning from war with combat stress (“Gulf War Syndrome”) that is now thought to be fibromyalgia.