From: mrl@nerus.pfc.mit.edu
Subject: Fibromyalgia patient guide.
Organization: MIT PLASMA FUSION CENTER
Date: Wed, 30 Dec 1992 01:22:39 GMT

From: "David A. Nye MD" <NYEDA@cnsvax.uwec.edu>
Subject: Fibromyalgia patient information handout

        Fibromyalgia -- a guide for patients


        Fibromyalgia is a common and disabling disorder affecting one in
        20 people, women more often than men.  Despite the condition's
        frequency, the diagnosis is often missed.  Patients with
        fibromyalgia usually ache all over, sleep poorly, are stiff on
        waking and feel tired all day.  They are prone to headaches,
        dizziness, numbness and tingling, itching, facial rashes, fluid
        retention, crampy diarrhea and other symptoms.  Fibromyalgia may
        be closely related to the chronic fatigue and irritable bowel
        syndromes.  There are no reliable lab or x-ray abnormalities,
        but a physician can confirm the diagnosis by finding multiple
        tender points in characteristic locations.

        Fibromyalgia was originally thought to be a form of joint,
        muscle or tendon inflammation, but no evidence of inflammation
        or arthritis could be found.  When it was noted to worsen with
        depression and stress, it was thought perhaps to be a
        psychiatric disorder.  Many patients are still told that their
        symptoms are stress-related, but this appears not to be the
        true.  Patients with fibromyalgia have been found to be no
        more depressed than patients with other chronic, painful,
        debilitating conditions.  It is now believed to be due to an
        imbalance of chemicals in the brain associated with
        malfunctioning deep sleep.  Abnormal brain waveforms have been
        found in deep sleep in some patients with fibromyalgia.  The
        symptoms of fibromyalgia can be produced in normal volunteers by
        preventing them from getting any deep sleep for a few days.

        The cause of fibromyalgia is unknown, but a predisposition to it
        may be inherited.  It often runs in families.  It may lie
        dormant until something happens to disrupt sleep, such as
        increased stress, pain, swinging shifts, or having to get up
        with children.  Sometimes just getting regular, adequate sleep
        again is enough to make the symptoms disappear.  Usually
        however, additional treatment is needed.

        Amitriptyline (Elavil), a medication commonly used to treat
        depression, also helps fibromyalgia.  It probably works by
        improving the quality and depth of deep sleep rather than by any
        effect on mood.  When sleep is normalized, all of the other
        associated symptoms of fibromyalgia begin to improve.  Patients
        taking amitriptyline usually don't note significant improvement
        until they are on enough to make them sleep through the night.

        Amitriptyline frequently produces mild side effects.  An
        increase in sleepiness or dizziness should be expected when it
        is first taken.  Starting at a low dose taken an hour or more
        before bedtime and increasing gradually helps minimize these
        initial side effects.  Those patients who notice an initial
        stimulant effect of amitriptyline, perhaps with a rapid
        heartbeat, should take it earlier in the evening, so that this
        effect has given way to sedation by bedtime.  By the end of two
        weeks, most patients are noticing that the side effects are
        settling down and the medication is beginning to help their
        fibromyalgia symptoms.

        Almost everyone on enough amitriptyline to help fibromyalgia
        gets a dry mouth and often some constipation.  If these side
        effects are severe, another medication called Mestinon can be
        added to block them, generally with no other side effects of its
        own.  Amitriptyline may cause a craving for sweets, although
        usually not for calories in other forms.  I recommend you avoid
        sweets entirely while on amitriptyline to avoid weight gain.

        Daily, vigorous exercise is also important in the treatment of
        fibromyalgia.  Exercise is more effective if done in the
        evening.  Fifteen to thirty minutes of exercise is usually
        sufficient.  The exercise seems not to work through conditioning
        of muscles but rather through a direct, possibly hormonal effect
        on sleep.  Patients who have been exercising regularly and then
        miss a day usually find that their fibromyalgia symptoms are
        significantly worse the next day.

        The kind of exercise is unimportant as long as it is vigorous.
        Just make sure to pick something that doesn't increase your
        pain.  The exercise should get your heart rate up and and make
        you get a little short of breath.  Less than vigorous exercise
        provides no benefit and may actually make you feel worse.  Be
        sure to warm up adequately with some stretches before starting
        to exercise to avoid injury.

        It is important to maintain a regular schedule of sufficient
        sleep.  Avoid caffeine and alcohol in the evenings, both of
        which may disrupt sleep.  Try not to exercise just before bed,
        as this may make it harder to fall asleep.

        Even with good results from treatment, brief relapses are common,
        often caused by temporary sleep disturbances, such as staying up
        as little as one hour late one evening, or skipping exercise.
        You will do best if you "give in to it" when this happens and
        try to get extra rest.

        Feel free to call us here at the office if problems develop,
        particularly if you are having significant problems with
        medication side effects.

                                                        David A. Nye MD
                                                        Midelfort Clinic

Mark London
MRL@NERUS.PFC.MIT.EDU
Newsgroups: sci.med