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Fibromyalgia,Chronic Fatigue Syndrome.Chronic Pain

Fibromyalgia

Fibromyalgia is a common syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues.

Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, and anxiety.

Causes, incidence, and risk factors

The cause is unknown. Possible causes or triggers of fibromyalgia include:

  • Physical or emotional trauma
  • Abnormal pain response - areas in the brain that are responsible for pain may react differently in fibromyalgia patients
  • Sleep disturbances
  • Infection, such as a virus, although none has been identified

Fibromyalgia is most common among women aged 20 to 50.

The following conditions may be seen with fibromyalgia or mimic its symptoms:

  • Chronic neck or back pain
  • Chronic fatigue syndrome
  • Depression
  • Hypothyroidism (underactive thyroid)
  • Lyme disease
  • Sleep disorders
Symptoms

Pain is the main symptom of fibromyalgia. It may be mild to severe.

  • Painful areas are called tender points. Tender points are found in the soft tissue on the back of the neck, shoulders, chest, lower back, hips, shins, elbows, and knees. The pain then spreads out from these areas.
  • The pain may feel like a deep ache, or a shooting, burning pain.
  • The joints are not affected, although the pain may feel like it is coming from the joints.

People with fibromyalgia tend to wake up with body aches and stiffness. For some patients, pain improves during the day and gets worse at night. Some patients have pain all day long.

Pain may get worse with activity, cold or damp weather, anxiety, and stress.

Fatigue, depressed mood, and sleep problems are seen in almost all patients with fibromyalgia. Many say that they can't get to sleep or stay asleep, and they feel tired when they wake up.

Other symptoms of fibromyalgia may include:

  • Irritable bowel syndrome (IBS)
  • Memory and concentration problems
  • Numbness and tingling in hands and feet
  • Reduced ability to exercise
  • Tension or migraine headaches
Signs and tests

To be diagnosed with fibromyalgia, you must have had at least 3 months of widespread pain, and pain and tenderness in at least 11 of 18 areas, including

  • Arms (elbows)
  • Buttocks
  • Chest
  • Knees
  • Lower back
  • Neck
  • Rib cage
  • Shoulders
  • Thighs

Blood and urine tests are usually normal. However, tests may be done to rule out other conditions that may have similar symptoms.

Treatment

The goal of treatment is to help relieve pain and other symptoms, and to help a person cope with the symptoms.

The first type of treatment may involve:

  • Physical therapy
  • Exercise and fitness program
  • Stress-relief methods, including light massage and relaxation techniques

If these treatments do not work, your doctor may prescribe an antidepressant or muscle relaxant. The goal of medication is to improve sleep and pain tolerance. Medicine should be used along with exercise and behavior therapy. Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are medications that are approved specifically for treating fibromyalgia.

However, many other drugs are also used to treat the condition, including:

  • Anti-seizure drugs
  • Other antidepressants
  • Muscle relaxants
  • Pain relievers
  • Sleeping aids

Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to:

  • Deal with negative thoughts
  • Keep a diary of pain and symptoms
  • Recognize what makes your symptoms worse
  • Seek out enjoyable activities
  • Set limits

Support groups may also be helpful.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001463/

Chronic Fatigue Syndrome

Chronic fatigue syndrome refers to severe, continued tiredness that is not relieved by rest and is not directly caused by other medical conditions.

See also: Fatigue

Causes, incidence, and risk factors

The exact cause of chronic fatigue syndrome (CFS) is unknown. Some theories suggest CFS may be due to:

  • Epstein-Barr virus or human herpes virus-6 (HHV-6); however, no specific virus has been identified as the cause
  • Inflammation in the nervous system, because of a faulty immune system response

The following may also play a role in the development of CFS:

  • Your age
  • Previous illnesses
  • Stress
  • Genetics
  • Environmental factors

CFS most commonly occurs in women ages 30 to 50.

Symptoms

Symptoms of CFS are similar to those of the flu and other common viral infections, and include muscle aches, headache, and extreme fatigue. However, symptoms of CFS last for 6 months or more.

The main symptom of CFS is extreme tiredness (fatigue), which is:

  • New
  • Lasts at least 6 months
  • Not relieved by bed rest
  • Severe enough to keep you from participating in certain activities

Other symptoms include:

  • Feeling extremely tired for more than 24 hours after exercise that would normally be considered easy
  • Feeling unrefreshed after sleeping for a proper amount of time
  • Forgetfulness
  • Concentration problems
  • Confusion
  • Joint pain but no swelling or redness
  • Headaches that differ from those you have had in the past
  • Irritability
  • Mild fever (101 degrees F or less)
  • Muscle aches (myalgias)
  • Muscle weakness, all over or multiple locations, not explained by any known disorder
  • Sore throat
  • Sore lymph nodes in the neck or under the arms
Signs and tests

The Centers for Disease Control (CDC) describes CFS as a distinct disorder with specific symptoms and physical signs, based on ruling out other possible causes.

CFS is diagnosed after your health care provider rules out other possible causes of fatigue, including:

A diagnosis of CFS must include:

  • Absence of other causes of chronic fatigue
  • At least four CFS-specific symptoms
  • Extreme, long-term fatigue

There are no specific tests to confirm the diagnosis of CFS. However, there have been reports of CFS patients having abnormal results on the following tests:

  • Brain MRI
  • White blood cell count
Treatment

There is currently no cure for CFS. The goal of treatment is to relieve symptoms. Many people with CFS have depression and other psychological disorders that may improve with treatment.

Treatment includes a combination of the following:

  • Cognitive-behavioral therapy (CBT) and graded exercise for certain patients
  • Healthy diet
  • Sleep management techniques
  • Medications to reduce pain, discomfort, and fever
  • Medications to treat anxiety (anti-anxiety drugs)
  • Medications to treat depression (antidepressant drugs)

Some medications can cause reactions or side effects that are worse than the original symptoms of the disease.

Patients with CFS are encouraged to maintain active social lives. Mild physical exercise may also be helpful. Your health care team will help you figure out how much activity you can do, and how to slowly increase your activity. Tips include:

  • Avoiding doing too much on days when you feel tired
  • Balancing your time between activity, rest, and sleep
  • Breaking big tasks into smaller, more manageable ones
  • Spreading out more challenging tasks throughout the week

Relaxation and stress-reduction techniques can help manage chronic pain and fatigue. They are not used as the primary treatment for CFS. Relaxation techniques include:

  • Biofeedback
  • Deep breathing exercises
  • Hypnosis
  • Massage therapy
  • Meditation
  • Muscle relaxation techniques
  • Yoga
Expectations (prognosis)

The long-term outlook for patients with CFS varies and is difficult to predict when symptoms first start. Some patients completely recover after 6 months to a year.

Some patients never feel like they did before they developed CFS. Studies suggest that you are more likely to get better if you receive extensive rehabilitation.

Complications

Chronic Pain

What is Chronic Pain?

While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap -- sprained back, serious infection, or there may be an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage. Many chronic pain conditions affect older adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system).  A person may have two or more co-existing chronic pain conditions.  Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia.  It is not known whether these disorders share a common cause.

Is there any treatment?

Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for chronic pain. Some physicians use placebos, which in some cases has resulted in a lessening or elimination of pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain.
What is the prognosis?

Many people with chronic pain can be helped if they understand all the causes of pain and the many and varied steps that can be taken to undo what chronic pain has done. Scientists believe that advances in neuroscience will lead to more and better treatments for chronic pain in the years to come.
What research is being done?

Clinical investigators have tested chronic pain patients and found that they often have lower-than-normal levels of endorphins in their spinal fluid. Investigations of acupuncture include wiring the needles to stimulate nerve endings electrically (electroacupuncture), which some researchers believe activates endorphin systems. Other experiments with acupuncture have shown that there are higher levels of endorphins in cerebrospinal fluid following acupuncture. Investigators are studying the effect of stress on the experience of chronic pain. Chemists are synthesizing new analgesics and discovering painkilling virtues in drugs not normally prescribed for pain.
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm