Fibromyalgia

Many patients have ‘allover’ pain that can sometimes be helped by exploring and trying some effective non-narcotic treatments.
Certainly people have hurt all over for centuries. Most often, the more labor a person does the more pain they will develop. Repetitive motions in work, exercise, sports, and musical instrument practice nearly always produce long term pain symptoms.

For many years, doctors disbelieved patients when they said they had pain in so many different places. If a condition was not accepted by mainstream medicine, it was hard to label it accurately, let alone formulate a treatment plan. Getting insurance to recognize the diagnosis and pay for it was difficult for many years. A diagnosis for multiple areas of muscle pain was not accepted until 1979.

Not until 1979, did a diagnosis relating to fibromyalgia symptoms gain acceptance. “myalgia and myositis, unspecified (729.1)” icd9.

The international classification of disease updated or changed in 2015 to ICD10 from the ICD 9 codes required in 1979. There are 68,000 codes in ICD 10 and there were 13000 codes in ICD 9.

In the past insurers have often denied coverage for ‘fibromyalgia’ and related treatments arguing that the disease was not real or not officially recognized. Now the code, m79.7 identifies this diagnosis.

Fibromyalgia
Fibromyositis
Fibrositis
Myofibrositis

There is a lot involved in a doctor determining a diagnosis, and it is important that fibromyalgia (FM) is officially recognized as a disease that insurance should be paying for. We know it exists and creates a lot of pain.

Fibromyalgia means inflammation of the lining of muscles.

Where does it come from? The medical explanation is “etiology unknown”. Or no one knows why it happens. Unfortunately, too common an explanation for conditions without adequate research. Unfortunately, many patients turned to addicting pain medications.

Finally, in 2007, Pfizer was approved to launch Lyrica as a treatment for fibromyalgia. It is a structural derivative of the inhibitory neurotransmitter Gaba, gamma aminobutyric acid, originally for neuropathic pain. However, this medication was shown to have similar addicting components as benzodiazepines like valium and Xanax. The drug is classified in the controlled substance act in schedule 5, so is not the first drug of choice to prescribe for fibromyalgia. Fortunately, there are other non-addicting options.

In 2008, the pharmaceutical company Eli Lilly was approved to release Cymbalta for fibromyalgia. It works at 2 brain neurotransmitters. This medicine is also approved to treat depression, generalized anxiety, diabetic peripheral neuropathy and musculoskeletal pain.

Savella was approved by the FDA in 2009 for release by forest and cypress pharmaceuticals as the 3rd fibromyalgia medication.

“Fibro” (as it is not affectionately called) does not involve joint pain nor is it the same as osteoarthritis pain.

Early on, fibromyalgia mapping was promoted using a technique where the doctor feels for contracted ligaments and muscles by touching the patient with consistent pressure at 18 tender points. Mapping is subjective and almost all patients will have tenderness if pressure is applied when they don’t feel well.

GUIFENESIN

In the early 1990s Dr. Paul St Amand suggested an officially unapproved treatment, but it was harmless. His protocol involves 3 parts. Titrating the guaifenesin, avoiding salicylates, following a low carb diet if the patient is hypoglycemic (hypoglycemic means that a person needs to eat proteins or complex carbs in small amounts frequently like every 2-4 hours, or the blood sugar will begin to drop. It isn’t a disease, but some people don’t maintain a steady blood glucose unless they eat non sugar and nonfat foods regularly.) Dr. Amand formulated his phosphates theory. He speculated that some mutant gene may be interfering with urinary excretion of phosphates which could allow a retention of phosphates, which could allow a negative effect on the mitochondria, which are the energy producers of each cell. The theory then postulated that the cause of the fatigue would bring on the body wide malfunctions found in fibromyalgia. He proposed that guaifenesin would correct the problem. It is from the guaiac tree, native to the Caribbean and the north coast of South America. This natural product is an expectorant that loosens the mucous in the sinuses and lungs which is helpful for a cold, allergic rhinitis and a cough. It became available in 1952 as the brand Mucinex. Dr. Amand proposed that salicylates would block the Mucinex benefit. The salicylic derivatives are in a vast number of products in topical creams, lotions, hair care, cosmetics so the doctor’s book and web site provide a list of do not use products. The body mapping system was utilized to determine if the Mucinex was helping and possibly toa ‘measured’ subjective method. Many patients have been helped with this plan. It seems it works, or it doesn’t with individual response. Now that the plant product is generic and over the counter, no RX is required unless the extended release 200 and 300 mg doses are used.

ANTIBIOTIC TREATMENT

Using the theory that myalgias (muscle aches) and fatigue is usually present in Lyme disease, some patients with a positive lab antibody titre for Lyme disease have been treated with minocycline to see if it helped those 2 symptoms. Studies suggest that the empirical (treatment without enough research to prove the benefit) use of antibiotics in this case is not worth the risks and cost. Exception is the patient who has anxiety about an untreated lab finding.

NON MEDICATION TREATMENTS

Massage therapists that are trained in FM massage is good. Relaxation and biofeedback are helpful. Along with the pain of fibromyalgia, there is usually associated depression from pain and reduced activities, fatigue almost always accompanies the pain. Behavior therapy helps patients to learn better ways to deal with the problem and to focus on how to participate in improving their health. Stretching, herbal and nutritional supplements are often beneficial.

DIAGNOSTIC TESTS AND CURES

There is no lab test, x ray, or invasive procedure that provides a definitive diagnosis of fibromyalgia. It is not a terminal disease. Unfortunately, currently, there is no known cure. However, at miller health in Oklahoma, many fibromyalgia patients have been treated and they have experienced improvement.

FMS FIBROMYALGIA SYNDROME

A syndrome is a group of symptoms that often occur together Ongoing pain in various muscles, sleep problems, feelings of weakness, memory difficulties, depression, diminished abilities to process stress issues, anxiety about the symptoms, inabilities to function normally, and fatigue.