Fibromyalgia is a chronic muscular condition characterized by widespread muscular pain, fatigue, and tenderness. Pain associated with fibromyalgia can worsen and improve over time. The cause of fibromyalgia is unknown; however, people with fibromyalgia are known to have increased amounts of Substance P in their spinal fluid. Substance P is a chemical that helps to transmit and amplify pain signals to and from the brain. In people with fibromyalgia, it is as if the "volume control" for pain signals is turned up way too high in the brain’s pain processing centers. Genetics seems to play a role in the disease as there is a familial tendency for the disease. Everyday exposure to physical, emotional, or environmental stressors may trigger fibromyalgia symptoms. Fibromyalgia affects between 2 and 4 percent of the population, most of them women. There is no laboratory test for fibromyalgia, so the diagnosis is made from the patient’s symptoms and physical examination. Patients are often frustrated by difficulty in diagnosis, as the symptoms are general and difficult to differentiate from other painful conditions. Other symptoms of fibromyalgia include cloudy thinking, morning stiffness, and overall inability to function in daily life.

Prevention of symptoms includes life-style modifications including regular relaxation to help reduce stress, adequate amounts of rest and sleep, regular exercise (start low and go slow as it may seem difficult at first because of the pain), and education as the disease is poorly understood. Treatment includes both medication and manipulation therapies. Low doses of tricylic and other anti-depressants seem to work best for controlling fibromyalgia pain. Opioid pain relievers are not recommended for fibromyalgia, as they appear to have limited effectiveness. Recent evidence shows that anti-epileptic medications such as gabapentin and pregabalin also show promise as treatments. Therapeutic massage may help to alleviate pain, discomfort, muscle spasms and stress by manipulating muscle and soft tissues. Likewise, myofascial release therapy can help to release connective tissue tension.

Recent evidence suggests that patients treated with 60 mg to 120 mg of Cymbalta experienced greater pain reduction than compared to placebo. Cymbalta is an anti-depressant mediation called duloxetine. Between 34 and 62 percent of patients with fibromyalgia develop depression. Cymbalta offers pain relief in patients with or without depression. Eli Lilly, the manufacturer of Cymbalta, has submitted a supplemental new drug application for the management of fibromyalgia. The proposed mechanism of action for Cymbalta involves the roles of serotonin and norepinephrine in the spinal cord and brain in the perception of pain. Researchers are hopeful that Cymbalta and other related medications can offer relief to sufferers of this chronic, painful condition.

References: http://www.rheumatology.org/public/factsheets/fibromya_new.asp?

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