Written By: Dr. Solitar
Although there are many speculations about what triggers fibromyalgia, its causes have not been definitively identified and confirmed. Recent research has generally found that fibromyalgia is most likely the result of what scientists call the central consciousness or unusual reactions in the nervous system in terms of the perception of pain.
- biochemical triggers of fibromyalgia
“The [current] consensus is that fibromyalgia is not a problem with the muscles, joints or tendons, but a problem with the central nervous system,” says Dr. Bruce Solitar, associate professor of medicine in clinical teacher division rheumatology center medical University of New York / common Diseases Hospital in New York. While it is easy to think that the pain felt by someone who was not physically harmed in the body could be classified as purely psychosomatic sensations that the patient experiences fibromyalgia are as real as any other pain.
This was clearly demonstrated when researchers did MRI scans of patients with fibromyalgia. When pressed in certain areas of the body of the participants, they found dramatic increase in activity in the pain center of the brain. a theory assigns to an increased release of substance P, a chemical that activates nerves when a painful stimulus. “In patients with fibromyalgia, substance P is released even in the absence of a painful stimulus. And there seems to be an amplified version when a painful stimulus, “says Dr. Solitar. Furthermore, the regulatory effect of the brain, which sends “signals down” to turn off the pain also appears to be abnormal in individuals with fibromyalgia – when a pain stimulus, which is amplified rather than wetted occurs.
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- physical and emotional triggers of fibromyalgia
What makes the path malfunction of the nervous system? Scientists are not sure, but a number of conditions have been associated with fibromyalgia development. These include:
Infection. The influenza and Epstein-Barr viruses causing hepatitis B and C have been implicated in the development of fibromyalgia. “These viruses may have [long – term] effects on viral particles inmunológico.También system can bind to glial cells, which are cells of the brain that affects laneurotransmission [and influence the response to pain],” says Dr. Solitar. In addition, there is a relationship well established among Lyme disease (caused by the bacterium Borrelia burgdorferi) and fibromyalgia: Some patients were treated for Lyme – and apparently recover – still face an unusually high frequency of pain without provocation he characterizes fibromyalgia.
Trauma. Sometimes, the development of fibromyalgia is related injury, inparticular in the upper spine (neck). In other cases, it is associated with great emotional stress, such as the death of a family member or loss of a job. The possible relationship between these types of self-injury is that the neurohormonal changes both physical injuries and emotional stress can trigger. Psychological processes may change – and can be modified – change in the function of regulatory hormones centers such as the hypothalamus and pituitary and adrenal lesglandes, which in turn can affect the nervous system.
- Other common Affairs of fibromyalgia
“Fibromyalgia is associated with all age groups, although women between the ages of 30 and 50 have a higher incidence of the disease,” says Dr. Solitar. Although this increase in prevalence in young women suggests a hormonal relationship, he says it is also possible that this is related to the diagnosis. “Women tend to [Natural] contest [or sensitive to pain] than men, so if you base your diagnosis on sensitive points, it is likely that the diagnosis of fibromyalgia with more women than men.”
Furthermore, fibromyalgia often develops in several members of the same family, but it is not clear whether this is the result of genetic or environmental effects. “The relatives of people with fibromyalgia seem to be more sensitive than others,” says Dr. Solitar “but not very conclusive genetic research there.”
In many cases, the ratio reaches fibromyalgia is still largely unknown. “For many patients, not come up with a good explanation for the development of fibromyalgia,” says Dr. Solitar. “We are all exposed to stress regularly. And as injuries and infections seem to be a common theme [fibromyalgia], there are a lot of people gradually develop a sense of discomfort. ”
and its distribution variable area symptoms often baffles, patients and physicians. there is no diagnostic blood test or even widely accepted biomarker of the disease, although people with physical limitations report a change of life. Now, new research from the University of Michigan joins the wide range of symptoms of fibromyalgia in a molecule in the brain called glutamate, opening the door to new treatment options and the most accurate methods of diagnostic tests.
- Fibromyalgia: New evidence could help diagnose
fibromyalgia symptoms are extreme fatigue and flu-like digestive diseases and migraine pain. Due to the absence of a specific quantitative or qualitative evidence, however, clinicians have been forced for a long time to self-assessment of a patient to help diagnose this condition difficult to achieve. For this reason, some doctors do not take seriously the disease.
Pioneering research conducted in 2002 by Daniel Clauw, MD, professor of medicine and associate director of the University of Michigan Medical School, provided the first biological evidence and strong physical that fibromyalgia patients actually feel intense pain when they said they did. One way to images of the brain called functional magnetic resonance imaging (fMRI) showed that people with fibromyalgia are more sensitive to pain than those of a control group; Similar levels of pain also caused different brain areas with group light studies FM than the control group.
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The widespread nature of chronic pain associated with fibromyalgia – pain is not specific to a whole group of muscles or joints – is currently under review. “Most doctors believe that fibromyalgia is a secondary issue, which involves the muscles and joints, as patients experienced and informed,” said Richard Harris, Ph.D., research investigator in the Division of rheumatology department of internal medicine at the University of Michigan Medical School and a researcher with the University chronic pain and fatigue research center; and a colleague of Dr. Clauw. “The results of this study suggest that fibromyalgia may be a condition of the nervous system central.Cela makes it harder for critics to explain the results, patients can not fake the results of an MRI test.”
- Fibromyalia: Glutamate pain Linked
Dr. Harris and other researchers at the University of Michigan found that pain levels in fibromyalgia patients were positively correlated with the levels of glutamate, an amino acid and neurotransmitter (brain chemical) responsible for stimulating nerve cells. “When patients have received treatments to reduce pain, glutamate levels have been reduced accordingly,” says Harris.
Previous research has shown a link between activity in a part of the brain called the insula (insular cortex) and pain in people with fibromialgia.Em around the island is also involved with muscles and skin stimulation, and internal sensations, such as the intestine . This association may help explain the increased incidence of digestive problems such as irritable bowel syndrome, fibromyalgia. Other related conditions such as anxiety, fibromyalgia and migraine, may also be related to the involvement of the central nervous system, according to Andrew Holman, MD, a rheumatologist and Clinical Assistant Professor of Medicine at the University of Washington.
- fibromyalgia research leads to new drugs
new drugs are now available for use in the treatment defibromyalgiasymptoms through this research. “The Food and Drug Administration recently approved pregabalin (Lyrica) and duloxetine (Cymbalta), two drugs that both work in the center as a direct result of new research,” says Dr. Holman. “Fibromyalgia has its own process, but the problems of the autonomic nervous system causing stage 4 sleep deprivation [one fibromyalgia symptom] come in the same areas of the brain that are responsible for issues such as intestinal lamotilité [which relates to SII] and the fight Basic or flight syndrome [on anxiety symptoms]. ”
Despite these results validate the more subtle symptoms experienced by patients with fibromyalgia, further investigation before the fMRI screening test becomes part of a Harris diagnostic routine is required, he said. Until then, Harris emphasizes the importance of being aware of their symptoms and manage appropriately. “Fibromyalgia is not one of those situations where you can do one thing and done,” he says. “It’s a matter of controlling the symptoms through a multifaceted approach.”
- or MedicaFibromyalgia
The exact cause of fibromyalgia is still a matter of speculation, so that current treatments even FDA approved are not specific at best. Many pharmaceutical options, however, are available for the treatment of various symptoms of fibromyalgia, which may vary from muscle pain and sleep disorders, depression and anxiety.
To date, the antidepressant duloxetine (Cymbalta) and milnacipran (Savella) and pregabalin (Lyrica), an anticonvulsant drug, which is also used for certain types of pain are the only prescription drug approved by the FDA specifically for the treatment of fibromyalgia. However, doctors use drugs approved for other conditions related to treat specific symptoms fibromyalgie.Plusieurs these drugs treat more than one problem associated with fibromyalgia. As with all drugs, most drugs listed here have significant side effects and interactions side. You should discuss all prescription medications with your doctor and pharmacist before taking. This will help you know what to expect and when you need to report a problem or find a substitute drug.
Pain relief and improved sleep are the main objectives of the treatment of fibromyalgia and drugs, but doctors also prescribe various medications to treat depression and fatigue.
The following medications are commonly used in the treatment of fibromyalgia.
more over-the-counter pain medications do not work very well for fibromyalgia because the disorder does not have a lot of swelling. desinjections located opiates and can sometimes be useful, depending on the specific symptoms.
- counter painkillers. Tylenol (acetaminophen) and anti-inflammatories (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Anaprox) may help some patients. However, it is generally recommended for patients with peripheral pain (involving the muscles and connective tissue and / or peripheral nervous system as opposed to fibromyalgia, a central nervous system disorder), and more than lafibromyalgie syndrome.
- . opioid therapies some relief reported pain with opioids such as tramadol (Ultram), and the combination of tramadol and paracetamol (Utracet) – both of which can also alleviate sleep disorders. While effective for acute and severe pain, opiates such as hydrocodone / acetaminophen (Vicodin), propoxyphene / acetaminophen (Darvocet), oxycodone / acetaminophen (Percocet) and oxycodone (OxyContin) do not work as well Lelong in-have chronic, generales pain. Además conditions speaking, carry the risk of dependency and have been associated with other side effects – for example by increasing the body’s sensitivity to pain and constipation and drowsiness.
- injections into trigger points. Injections of local anesthetics (such as lidocaine and laprocaine) and / or cortisone (a steroid medicine) can help treat aching muscles, tendons, ligaments, I break the cycle of pain and muscle spasms.
These medications help regulate certain chemicals in the brain called neurotransmitters, which are involved in various symptoms of fibromyalgia, including muscle desdouleurs, sleep disturbances and fatigue. For best results, they are sometimes used in combination. Among the most commonly prescribed include:
- Tricyclic antidepressants. Amitriptyline (Elavil), nortriptyline (Pamelor) , and doxepin (Sinequan) and trazodone tetracyclic antidepressant (Desyrel), which increases the levels of serotonin and noradrenaline, the brain neurotransmitters which affect the signals and pain depression, and often a sedative, induces desommeil.
- selective reuptake inhibitors (SSRIs). Included in this group are citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil).
- Selective serotonin reuptake inhibitor norepinephrine inhibitors (SSNRI). This new class of antidepressants, known also by absorption inhibitors adouble name, helps regulate the neurotransmitters serotonin and norepinephrine. They include venlafaxine (Effexor), desvenlafaxine (Pristiq), duloxetine (Cymbalta) and Savella (milnacipran).
such as cyclobenzaprine drugs (and Flexeril Cycloflex Flexib), carisoprodol (Soma) and methocarbamol (Skelex) are often prescribed to treat painful muscle spasms, but is commonly used for short – term relief.
These drugs are used for fibromyalgia, because these drugs also help treat neuropathic pain that occurs when nerves are excited and should be insensitive. Drugs in this category include pregabalin (Lyrica) and carbamazepine (Carbatrol, Epitol, EQUETRO, Tegretol, Tegretol XR-y) and lagabapentine (Gaborone, Neurontin).
Sedatives / hypnotics
of restful sleep is essential to alleviate the symptoms of fibromyalgia. If other medicines (especially muscle relaxants and antidepressants) are not effective, lesmédecins may prescribe sleeping pills short term, as zolpidem (Ambien) and zaleplon (Sonata) , and eszopiclone (Lunesta), working for the activity slowing the brain to allow sleep . These drugs often lose their effectiveness over the long term, however.
Some doctors already prescribe drugs used for attention deficit hyperactivity disorder and deficit as methylphenidate (Ritalin), sulfate, dextroamphetamine (Dexedrine) and modafinil (Provigil) to alleviate the symptoms of fatigue and “brain fog” (difficulty of thinking and concentration) the fibromyalgia patients often experience.
On the horizon
Among the new drugs for the treatment of fibromyalgia is provided sodium oxybate (Xyrem), also known as GHB. This depress the central nervous system is currently approved for the treatment of narcolepsy, but showed résultatsprometteurs for the relief of pain and improved function lespatients fibromyalgia. The application for approval was submitted to the FDA December 15, 2015.
Finally, in addition to prescription drugs, doctors often recommend thatother pain treatment therapies are exploring. Among the most effective are the therapeutic massage and myofascial release therapy, a specialized technician used to relieve tension in the body that can help relieve discomfort and reduce muscle spasms.