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Fibromyalgia - The Latest Treatments and Evaluation
Tuesday, November 15 - This is Dr. William Shiel from MedicineNet.com reporting from San Diego at the 2005 annual scientific meeting of the American College of Rheumatology and National Arthritis meeting.
Today I'd like to report on the latest in the treatment and evaluation of fibromyalgia. At the national meeting, researchers from University of Cincinnati have shown that duloxetine, which is the generic name for the brand-name product Cymbalta , is effective and safe in the treatment of fibromyalgia whether or not depression is present. This is a very important finding that is, we have used antidepressants in the treatment of fibromyalgia for decades but it's clear that their effects are not dependent on whether or not depression is present. They seem to work in other ways and it may have to do with their secondary pain relieving qualities.
Researchers at Rush University in Chicago showed that low doses of muscle relaxants can be effective in treating fibromyalgia by decreasing pain, decreasing stiffness and fatigue, and also decreasing depression. Now this also is an interesting paper because we've used muscle relaxants, usually at night, in the treatment of fibromyalgia for some time now. But what these researchers showed that was unique was that very low doses of muscle relaxants, much lower than the standard prescribed doses, can be extremely effective in reducing the symptoms of chronic fibromyalgia.
Patients with fibromyalgia often have disorders of sleep. Researchers from West Reading Pennsylvania described that sleep disordered breathing is extremely common in patients with fibromyalgia. Now this includes sleep apnea and this is important as we know as health care givers in the treatment of fibromyalgia, that sleep is essential part of the treatment in improving symptoms of fibromyalgia.
Other researchers at the University of Pennsylvania presented a paper related to acupuncture and fibromyalgia. These researchers in fact found that acupuncture improves sleep disordered breathing in fibromyalgia patients. So look for doctors to be considering acupuncture more as an adjunct of treatment for fibromyalgia.
Researchers from the University of Michigan have noted a very interesting diagnostic test abnormality in patients with fibromyalgia. Using a sophisticated magnetic resonance imaging technique involving spectroscopy, these are big words for a specialized type of an MRI scan, these researchers noted that a particular part of the brain that is generally involved in pain processing showed regional concentration of certain brain metabolites. This is very important, it turns out, because we've known heretofore or suspected that patients with fibromyalgia have an abnormally increased pain perception. And this actually gives us anatomic potential reasons as to why that might be.
Researchers from Mexico reported at the national meeting that using the standard blood-pressure cuff that we all know and recognize in taking a standard physical examination, if the cuff is blown up to 180 mm of mercury or 180, that patients with fibromyalgia reported pain 70% of the time, whereas patients with other forms of arthritis reported it in 5-10% of the time and controls, healthy controls, in 1.5% of the time. This seems to document, which has been known in the past, that patients with fibromyalgia seem to have this increased pain perception. Very interesting data from this year's meeting of the American College of Rheumatology.