IBS and Fibromyalgia

http://www.fibromyalgia-information-relief.com/fibromyalgia-news-page3.html

Soft Tissue Rheumatism

Fibromyalgia has also been known as Soft Tissue Rheumatism or Muscle Rheumatism (Muscular Rheumatism). Rheumatism indicates an inflammation of the joints and their appendages (the tissues that participates in the joint function such as the tendons, the capsule, the ligaments and the muscles around).

So it was a good appellation to call it Soft Tissue or Muscle Rheumatism because it is a muscle disease. It indicated also that as much as the joints can be painful, there is no joint destruction as we can see in rheumatoid arthritis.

Fibro-myalgia is a contraction of soft tissue (fibro), muscle (my for myo) and algia (pain). A good choice. Let's not change it!

Stress Triggers But Stress Is Not Fibromyalgia!

Stress triggers fibromyalgia. There is no doubt about it. Be it physical stress like trauma or psychological stress like moving house. In fact, we should not separate stress into psychological or physical. It's the same!

Stress is what the body goes through when put under pressure. Physiological changes happen from an accelerated heart rate to muscle tension. Huge hormonal changes occur.

The main problem is that what is stress to someone is not to someone else. Or what is very stressful to someone is not so much to another. For example, if a loud noise occurs whilst you're asleep you will be extremely stressed, but if the same bang occurs whilst you're enjoying watching fireworks you will not be afraid.

The health status also plays an important role. If you are healthy, the same event will not be as stressful than if you're sick! For a fibromyalgia sufferer, walking 100 meters can be as stressful as climbing the Everest!

But is stress the same as fibromyalgia?

If I start my car with a key, does it mean it's the only function of a key? Obviously not! I can use a key to open a door, to open a lock, to use as jewelry, or even as a symbol like receiving the keys of a town!

So, let's not do it again. Stress is not fibromyalgia! It's not because fibromyalgia patients are extremely sensitive to stress or even to what should not be stressful in healthy people that we can say "stress = fibromyalgia". It's not because fibromyalgia has many symptoms and signs that we can relate them all to stress!

Avoiding stress and using relaxation techniques are important.

Yes, stress triggers fibromyalgia but stress is not fibromyalgia!

Fibromyalgia: Immunological Theory?

The title of the following article says it all.

High plasma levels of MCP-1 and eotaxin provide evidence for an immunological basis of fibromyalgia.
Zhang Z, Cherryholmes G, Mao A, Marek C, Longmate J, Kalos M, Amand RP, Shively JE.
Exp Biol Med (Maywood). 2008 Sep;233(9):1171-80.

How funny! They show that cytokines (products of inflammation) are elevated in fibromyalgia and because of that, fibromyalgia is an immunological disease.
So, if I hurt my finger with a hammer, then develop the expected inflammation, and produce cytokines like in any inflammation, I can say that the cause of my pain is immunological. Gone the hammer, hello immunological!

I am not saying that the cytokines in fibromyalgia are not important! They are part of the problem and of the signs and symptoms ( http://www.fibromyalgia-information-relief.com/fibromyalgia-symptoms-toxins.html). But they are not the cause of fibromyalgia.

Lyrica (Pregabalin): Again!

Pregabalin Treatment Improves Fatigue, Function and Self-Reported Presenteeism in Fibromyalgia

Poster presented in San Diego at the 28th Annual Scientific Meeting of the American Pain Society (APS).
Kevin Murphy, MD, of Pfizer.

Using 3 previous studies done over 13 and 14 weeks only!
On a self-assessment scale, the mean difference compared to placebo showed a reduction of work missed of 0.22 days per week.

That is over 14 weeks only and they have the audacity to translate it to 11.6 days per year!
When are we going to stop this kind of skewed information?

• 14 weeks studies for a life-long disease
• Result extended to a year
• Author: Pfizer employee
  

No more comment!

Lyrica (Pregabalin): Really Useful?

3% improvement at 6 months compared to placebo. Is that really useful?

http://www.fibromyalgia-information-relief.com/fibromyalgia-news-page2.html

Hairy Story!

In 1999, a study on hair calcium and magnesium content concluded: In the presence of high hair calcium and magnesium levels, calcium and magnesium supplements may be indicated as an adjunctive treatment of fibromyalgia.

The problems about this study:

• Retrospective study
• Small numbers
• No parallel with other measurements

are not making it very convincing. To do this study does not bring any positive or negative test about testing for fibromyalgia. Moreover, it does not constitute an indication for treatment with magnesium.
The testing of fibromyalgia relies on a probability test based on the clinical signs and symptoms.
Any fibromyalgia calls for magnesium supplement, whatever the magnesium levels in the blood or in the hair (as long as there is no renal failure).

To test for fibromyalgia:
http://www.fibromyalgia-information-relief.com/fibromyalgia-test.html

Hair calcium and magnesium levels in patients with fibromyalgia: a case center study.
Ng SY. J Manipulative Physiol Ther. 1999 Nov-Dec;22(9):586-93

Interview with Dr Susan Wong, MD

Philippe: I am happy to welcome Dr. Susan Wong. I met her last year in a conference on fibromyalgia. She has now retired but keeps a keen interest in fibromyalgia.



Phil: Do you believe in fibromyalgia? Some doctors still don't believe in it and even some who thought it existed have changed their mind.



Dr SW: Yes, I know that Dr Wolfe, who participated in the "classical definition" in 1990, seems to have changed his mind. I think the definition has created a nightmare! It imposes that any fibromyalgia sufferer has to be in a very chronic stage and difficult to treat before being given the proper diagnosis. In the meantime, the fibromyalgia patient has been suffering from many other problems and is starting to have doubts. The same happens to the family, friends and doctors! Moreover, this definition concentrates almost exclusively on the pain factor. This has attracted the false theory of fibromyalgia being a Central Pain.


Phil: That was my next question! Do you think this Central Pain theory, the brain
theory, is wrong?



Dr SW: Well, this theory is based on changes in brain activities and regional cerebral blood flows that are common to all chronic pains. I defy any neuro-radiologist to make the diagnosis of fibromyalgia from those images. They are just not specific to fibromyalgia! All we can say from those images is that fibromyalgia is one of the chronic pain, but we knew that already! However, if the Central Pain theory is wrong (there is no central nervous system lesion), the images do give credential to fibromyalgia being a real disease. But we knew that one too!


Phil: If you say that the "classical diagnosis" is too late, what should we use?



Dr SW: I use a probability diagnosis very similar to the one you have in your website (http://www.fibromyalgia-information-relief.com/fibromyalgia-test.html). Instead of only considering the pain, I consider the whole body and the different functions. When I had groups of fibromyalgia patients, I have always been very attentive to the fact that they never had all the symptoms and that many were surprised by some of their fellow sufferers complaints. I have never seen anyone saying, “I have everything you complain of”. Every one of them is an individual with different problems, even if they are all related to fibromyalgia.

Hysteria and hypochondria are never part of fibromyalgia but in very rare cases. The same happens with psychological profile: they do not have any specific psychological profile! All that psycho babbling is exactly that: bull dust!


Phil: What’s your opinion about the fact that the FDA has recognised 3 medications to treat fibromyalgia and the European Council for Health has refused them?



Dr SW: For many years, long before they were recognized, I have used tricyclic antidepressants and anti-epileptics in my armamentarium against chronic pain. The success has always been limited and tends to be short lived. It does not mean that they should not be used. But they should be used with caution and with careful follow-up. There is no advantage of having no effect on the pain and getting side effects from the medication!

But suddenly we have seen appearing a new theory and at the same time pharmaceutical companies’ reps appear with free lunches, paid for conferences etc... And what they present to us is a very dubious small series of publications on their new drugs. Most of them are 8 to 12 weeks long when we are talking about a life disease. The longest that I know of is 6 months long and shows a very narrow difference in the outcome between medication and placebo. Whenever we try discussing this aspect, we are at best ignored. I have done a review of the published articles and I cannot find any justification for prolonged use except in those rare patients where the effect is positive. But to add misery from side effects is not acceptable. A frank and opened discussion with the patient does sort it out. The risk-benefit ratio is so narrow that a full informed consent is necessary.


Phil: So, can you give us a summary of your treatment of fibromyalgia?



Dr SW: A summary is difficult because every individual is different. I would say that there is a basic treatment that everyone should get and individual additions.

The basic treatment includes: magnesium supplement, vitamin B6 supplement, diet, relaxation techniques, avoidance of stress, simple exercises, electromagnetic stimulation.

Additions depend on individual problems such as symptoms flare up, necessity to increase the speed of results or needs for special support. Obviously, we must not forget the painkillers. The pain needs treatment! By the way, the effect of "soft morphinics" such as codeine, tramadol or buprenorphine is too good to be a so-called Central Pain! Central Pain requires huge amounts of morphine. This is another proof against this theory.


Phil: Thanks for this perfect summary! What’s your vision for the future?



Dr SW: We really need the same amount of investment in safe and non invasive techniques similar to the investment made by pharmaceutical companies that are allowed to introduce unsafe drugs of clinically dubious interest. The justified outcry from fibromyalgia patients must not be met by pseudo-magic pills. Lets make a pledge for the incoming fibromyalgia day: we just don't need a new carburator or a new fuel. We need a full car on a good road to recovery and that journey must be efficient and safe!


Phil: Thank you for your precious time!

Vitamin D Levels Must Be Corrected

Vitamin D levels were shown to be low in up to 50% of fibromyalgia patients in the following articles.


Why are Vitamin D levels low in fibromyalgia?

• The chronic pain limits the outside activity and the time spent in the sun (the sun is the main factor for Vitamin D production by the body).
  
  
• Many fibromyalgia patients have sudden onsets of feeling very hot. This makes them unhappy to expose to the sun
  
  
• Many fibromyalgia patients have skin hypersensitivity and avoid exposure to the sun

Low vitamin D symptoms:

• Diffuse musculo-skeletal pain
  
  
• Increased incidence of myalgias if you are on a statin to decrease your cholesterol
  
  
• Osteoporosis. This is compounded in fibromyalgia because of increased ferquency of smoking, low magnesium, poor circulation, decrease activity. It does cause further pain and increases the risk of fracture
  
  
• Fatigue
  
  
• Muscle weakness
  
  
• Cardiovascular problems: High Blood Pressure, Cardiac risk, Peripheral vascular disease
  
  
• Decreased immunity
  
  
• Increased cancers
  
  
• Increased MS and Parkinson's disease
  
  
• Memory loss and foggy brain
  
  
• Decreased magnesium absorption (increasing further the magnesium deficiency in fibromyalgia)
  
  
• Increased aging
  
  
• Increased mortality of all causes
  

Low vitamin D symptoms add to the already long list of fibromyalgia symptoms.

Is it absolutely necessary to make your fibromyalgia worse by adding the low Vitamin D symptoms? Certainly not!

Ask your doctor for vitamin D levels. They must be > 50 nmol/l

1. Vitamin D levels in women with systemic lupus erythematosus and fibromyalgia.
   Huisman AM, White KP, Algra A, Harth M, Vieth R, Jacobs JW, Bijlsma JW, Bell DA.
   J Rheumatol. 2001 Nov;28(11):2535-9.
   
   
2. Bone health in patients with fibromyalgia
   A. W. Al-Allaf, P. A. Mole, C. R. Paterson and T. Pullar1
   Rheumatology 2003; 42: 1202-1206
   

Fibromyalgia Catastrophic Week? The Truth Behind a Flawed Brain Theory

In the past few months the FDA in the USA has approved 3 medications* for fibromyalgia treatment.

In the past week, the European Council has denied it!

Let's have a look at the history of fibromyalgia pain.
Fibromyalgia pain is a chronic pain syndrome. Like any other chronic pain syndrome, it is marked by an abnormal sensitivity to pain. A stimulation that normally should not be painful becomes painful!

This is due to a "pain memory" phenomenon.
If you pinch your skin it is painful until you release it. However, if you pinch your skin for a longer period, the pain will persist even if you release it.

But if you pinch it for more than 30 minutes, not only the pain will persist longer, it may even persist forever! And it can progress to the stage of abnormal painful stimuli. A caress that should be pleasurable may become extremely painful!

Why did I say 30 minutes? Because this is the time after which genetic messages are appearing (c-fos proteins). And they appear in the central nervous system (brain and spinal cord)!

It may disappear without any further problem. But sometimes chronic pain may develop.

This is marked by the activation of pain memory receptors that allow any stimulation to become painful. Those receptors are all over the central nervous system, including the brain where they even support the normal memory! This activation will generate the development of new circuits of neurons that are not normally involved in pain but are recruited and now become involved in pain!

This can be seen in all chronic pain situations. Brain areas that are normally quiet suddenly become activated! And fibromyalgia being a chronic pain follows the same path. Those pains have usually started anywhere on the body: a finger, a foot, an arm etc...


Central Pain is one type of chronic pain that is a bit different.
Central Pain is a chronic pain that develops after a lesion in the central nervous system such as a stroke, a spinal cord lesion etc... Those lesions are true ones: they can be seen! They are very difficult to treat, extremely painful and have sometimes been tackled with very invasive neurosurgery.

Out of the blue, fibromyalgia is labelled a Central Pain.
This happened a few years ago. The justification given was the abnormal brain activity. But it is abnormal like in any other chronic pain!

When those in support of this brain theory are asked about the absence of visible lesions in the central nervous system, they talk about microscopic lesions that are not yet visible!

Coincidence?
Whilst some drugs such as antidepressants and anti-epileptics had been used for chronic pains, those same manufacturing companies got attracted to the plight of fibromyalgia patients and diverse studies appeared.

Coincidence or not, this is when fibromyalgia got labelled a central pain without proof.


The studies where of short follow-up duration, up to a few months only, when the disease is a life long one. Some studies had even on their board a pharmaceutical company’s doctor!


The reason behind the European Council decision has not yet been detailed.

It is most probable that:

1. The brain theory is unsatisfactory (many new studies point to this)
   
   
2. The studies on those drugs do not provide a long enough follow-up to justify their prolonged use and classification for fibromyalgia treatment.
   
   
3. A lot of doctors are unhappy to see many patients stopping the drugs because of

• side-effects
• they get worse
  
• the improvement is short lived and limited.
  

The lobbying in the USA has been very powerful for a multi-billion profit industry. The fact that those drugs are not classified in Europe as fibromyalgia treatment does not stop their use but it requires caution and good follow-up.

Fibromyalgia treatment does exist and the drugs are only a part of it, useful for crisis time but not enough on their own to treat it. They are not the magic pill that we were let to believe!

*The 3 drugs concerned: Lyrica (pregabaline), Cimbalta (duloxetine), Savella (milnacipran)