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Dx Fibromyalgia Treatment:

Fibromyalgia, Myofascial Pain Syndrome

The Merck Manual Home Edition
"Fibromyalgia is characterized by poor sleep, fatigue, and widespread aching and stiffness in soft tissues, including muscles, tendons, and ligaments.
Poor sleep, stress, strains, injury, and possibly certain personality characteristics may increase the risk of fibromyalgia. Pain is widespread, and certain parts of the body are tender to touch. Fibromyalgia is diagnosed when people feel pain in specific areas of the body and have typical symptoms.
*Improving sleep, exercising, applying heat, and getting massages usually help.

This disorder used to be called fibrositis or fibromyositis syndrome. But because inflammation (indicated by the “itis” suffix) is not present, the suffix was dropped, and the name became fibromyalgia.
Fibromyalgia is about 7 times more common among women. It usually occurs in young or middle-aged women but can also occur in men, children, and adolescents.
Fibromyalgia is not dangerous or life threatening. Nonetheless, persistent symptoms can be very disruptive.

People with fibromyalgia seem to have a heightened sensitivity to pain. That is, areas in their brain that process pain interpret painful sensations as being more intense than seems to occur in people who do not have fibromyalgia. Usually, the cause of fibromyalgia is unknown. However, certain conditions may contribute to developing the disorder. They include poor sleep, repetitive strains, an injury, and repeated exposure to dampness and cold. Mental stress may also contribute. However, stress per se may not be the problem. Rather it may be how people react to the stress. Many affected people are perfectionists or have a type A personality.
Some affected people may also have a connective tissue disorder, such as rheumatoid arthritis or systemic lupus erythematosus (lupus). ...

Most people feel a general achiness, stiffness, and pain. Symptoms can occur throughout the body. Any soft tissue (muscles, tendons, and ligaments) may be affected. But soft tissue of the neck, upper shoulders, chest, rib cage, lower back, thighs, arms, and areas around certain joints are especially likely to be painful. Less often, the lower legs, hands, and feet are painful and stiff. Symptoms may occur periodically (in flare-ups) or most of the time (chronically).
Pain may be intense. It usually worsens with fatigue, straining, or overuse. Specific areas of muscle may be tender when firm fingertip pressure is applied. These areas are called tender points. During flare-ups, muscles become tight, or spasms may occur.
Many affected people do not sleep well and feel anxious, depressed, and tired. They may also have migraine or tension headaches, interstitial cystitis (a type of bladder inflammation that causes pain when urinating), and irritable bowel syndrome (with some combination of constipation, diarrhea, abdominal discomfort, and bloating—see see Irritable Bowel Syndrome (IBS)).
The same conditions that may contribute to the development of fibromyalgia can make symptoms worse. They include emotional stress, poor sleep, injury, exposure to damp or cold, and fatigue. Fearing that symptoms represent a serious illness can also make symptoms worse.
Fibromyalgia tends to be chronic but may resolve on its own if stress decreases. Even with appropriate treatment, most people continue to have symptoms to some degree.

The diagnosis is based on the pattern and location of the pain. Some parts of the body have tender points. To detect tender points, doctors firmly press specific areas of the body to determine whether the person feels pain in one spot (a tender point). In the past, doctors based the diagnosis on the presence of tenderness at 11 or more of the 18 designated tender points. Now, however, the number of tender points is not considered as important as the presence of a few tender points along with typical symptoms, especially widespread pain.
Doctors want to be sure that another disorder (such as hypothyroidism, polymyalgia rheumatica, or another muscle disorder) is not causing the symptoms, often by doing blood tests. But no test can confirm the diagnosis of fibromyalgia.
Fibromyalgia may not be recognized in people who also have rheumatoid arthritis or lupus because these disorders cause some similar symptoms, such as fatigue and pain in the muscles, joints, or both."

Medications Used in Treatment:
1. SNRIs: Cymbalta® /duloxetine, Savella® /milnacipran
2. Anti-epileptics: Lyrica® /pregabalin
3. Central Alpha Agonists: Zanaflex®/tizanidine
4. Anabolic Steroids: testosterone cypionate, oxandrolone, nandrolone, stanozolol, Danocrine®/danazol
5. Adrenocortical Steroids: DHEA,
  Corticosteroids: Cortef®/hydrocortisone,
  Aldosterone Antagonists: Aldactone®/spirolactone
6. Human Growth Hormone: Tev-Tropin® Humitrope®, Omnitrope®, Norditroopin® Genotropin®, human Growth Hormone
7. IV Vitamin's: Myer's cocktail
8. Aldosterone Inhibitors: Spirolactone reference article

Suggested Links:
*N.H.S. Choices

*[Editor] The Editor has treated women with fibromyalgia, fibromyositis and chronic fatigue for more than 30 years. Anti-depressants are not part of his treatment plan the French author states "many of the abnormalities may be the consequence of psychological disturbances." Even though up to 70% of women report being psychologically and/ or physically abused, the evaluation and treatment of hormonal imbalance should not be ignored. Psychological changes effect hormones and hormone effect the brain chemistry-- so treat both.

The Editor's holistic treatment plan is based on correcting imbalances in the endocrine system with temporary treatment using anxiety and insomnia medication. That is why the first step is the H.I.S. or H.E.R. Comprehensive Blood Profile that is available On-Line.

The laboratory tests are designed to focus on disruptions in the endocrine system.
1. Sleep disturbances originate in the Hypothalamus. The lack of REM sleep is the first key. After the H.E.R. laboratory profile, treatment begins with small amounts of sex hormones (estradiol and testosterone) in women. Men are treated with testosterone. Progesterone is not part of the first phase of treatment.
2. Pituitary (human growth hormone). RM Bennett, M.D., professor of Lupus and Fibromyalgia at Oregon University, established in 1992 that fibromyaglia patients had low levels of Somatomedin-C (IGF-1) the marker for human growth hormone. The laboratory test of IGF-1 will increase if she can get into REM sleep. Human growth hormone is not part of the first treatments, even though Bennett found 75% responded to daily human growth hormone for 9 months.
3. Thyroid replacement is evaluated in the blood profile. Small doses of bio-identical thyroid are started routinely as most individuals have been exposured to envronmental toxins that down-regulate the thyroid.
4. Small doses of hydrocortisone are given before and after breakfast and at noon. If needed, a half dose in repeated at 3:00PM. Parker found evidence of disturbances of the hypothalamic-pituitary-axis (HPA) leaving cortisol levels low in one-third of reviewed studies.
5.Dihydroepiandrosterone (DHEA) is supplemented in tangent with cortisol.
6. A major component of treatment has been to use anabolic steroids such as oxandrolone, danazol, nandrolone and stanozolol. The increase in energy and presumed increase in cellular ATP seems to be pivotal to the patient's recovery.
7. Supplements are proved based specifically on laboratory assessment. Daily oral include high dose B vitamins, liquid vitamins suspension and L-methylfolate 15mg. Weekly methylcolbamin 1000mcg or more is added to twice weekly infusions of ascorbic acid, mangnesium and trace minerals called the Myer's cocktail. The high dose magnesium is the best at initially releasing the muscle pain. The other hormones (this includes Vitamin D3, iodothyronine (T3), DHEA, pregnenolone, oxytocin and if necessary human Growth Hormone) increase the absorption and utilization of minerals, supplements and hormones.

8. Ben Lynch ND recommends the following:
Methylfolate will push the mitochondria hard. Fibromyalgia – your mitochondria are tired. You need instead: – Optimal Electrolytes – 1 scoop once to twice daily in a liter of filtered water
– Adrenal Cortex – 1 in AM after breakfast
– NADH + CoQ10 – 1 upon rising and possibly another around afternoon
– Optimal Start – as directed on the bottle.
– 5-HTP – 1 capsule before bed
– Magnesium Plus – 1 capsule before bed

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