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This video presented by rheumatologist Scott Zashin, MD provides a comprehensive overview of Fibromyalgia (FM), a prevalent neurological condition causing widespread musculoskeletal pain. It details common symptoms like fatigue, non-restful sleep, and cognitive difficulties. The discussion covers diagnostic approaches, potential co-occurring conditions, and current treatment strategies, including FDA-approved and off-label medications, emphasizing the importance of education, exercise, and rest.
Fibromyalgia is a very common and often underdiagnosed cause of muscularkeeletal pain. It affects millions of Americans. It occurs most commonly in women between the ages of 20 and 50, but men and women of all ages may develop fibromyalgia. Patients with fibromyalgia complain of hurting all over, nonrestful sleep, and fatigue.
Even with adequate amounts of sleep, fibromyalgia of patients wake up unrefreshed. Lack of restful stage 4 sleep seems to exacerbate symptoms resulting in a vicious cycle of increasing pain and fatigue. Patients symptoms often have been present for a long time. Many have other associated symptoms including bowel complaints, urinary issues, nerve pain, brain fog, anxiety, and depression. There is no laboratory test that has been commonly used to diagnose fibromyalgia. While it is often considered diagnosis of exclusion, the condition can be confirmed in patients clinically when they complain of fatigue, non-restful sleep, and have widespread pain or tender points on physical exam. The tender areas are typically found over all four quadrants of the body such as above and below the waist and on the right and left side.
Two conditions that should be considered when evaluating patients with suspected fibromyalgia are hypothyroidism and sleep apnea. Patients with low thyroid levels may have similar symptoms and thyroid replacement may take care of their issues. Sleep apnea is also quite common and can increase the likelihood of a patient developing symptoms of fibromyalgia. Treatment of the sleep apnea may improve sleep quality and improve or eliminate chronic fatigue and pain symptoms. There is no cure for fibromyalgia but is not a deforming or life-threatening condition. Education and balancing exercise and rest are main stays of therapy. Many patients who beat clinical criteria for fibromyalgia do not want to believe they have the condition. As they may have heard in quotes, it's all in their head. In the sense they may be right as fibromyalgia is now recognized as a neurological abnormality where patients central nervous system is essentially hyper sensitive. The FDA has accepted the diagnosis as a medical condition and there are several medications that are FDA approved to treat fibromyalgia. These include deluxitine, pregabalin, einosoprine or seella. There are also numerous medications that have been used to treat fibromyalgia for many years but are considered off label as they were FDA approved for other conditions. These include anti-depressants such as trazone and aptylene, muscle relaxers such as cyclloenszoprne and anti-covulsive medicines such as gabapentin.
LDN is another medication that has been used for many years.
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