Fibromyalgia One Might Consider Fibromyalgia to Be

Fibromyalgia One might consider fibromyalgia to be one of the most confounding conditions around today. It is debilitating. It results in several quality of life issues. The confounding aspect of this condition is that it is difficult to diagnose. It is also difficult to treat. Most treatment modalities today recourse to treating one or more specific symptoms -- but there is no treatment that can comprehensively treat all the symptoms. (NIAMS, 2004) More holistic treatment modes however, are being researched, explored and considered. Fibromyalgia often presents symptoms of other diseases.

Essentially therefore, fibromyalgia is characterized by widespread pain that cannot be localized to any part of the body. It is also associated with fatigue and other specific (though not necessarily widespread) symptoms that will be discussed later in this work. Fibromyalgia syndrome is often referred to in its abbreviation FMS. Some of the symptoms (though not all) enjoy significant overlap with other conditions such as chronic fatigue syndrome (CFS), myofacial pain syndrome (MPS) and multiple chemical sensitivity syndrome (MCS).

Some researchers have averred that FMS, CMS, MPS and MCS are part of a larger meta-syndrome called dysregulation spectrum syndrome (DSS). While there is no large concerted effort to identify DSS, the school of thought is the myriad syndrome with its varied epidemiologies and acuity of presentation of symptoms is have its associations in the human "neuro-hormonal" system according to Dr. Yunus at the University of Illinois College of Medicine. Yet others have even pointed to psychological and sociological factors.

Put together Van Houdenhove and Egle provide a biopsychosocial component to fibromyalgia. They believe that any physiological manifestations come from stress. (Van Houdenhove & Egle, 2004) Fibromyalgia can trace its etymology to a combination of three words from the Greek language. Perhaps in keeping with the confusing nature of the condition the name combines fibro (Gr. Fibrous), myo (Gr. Muscle) and algia (Gr. Pain). Fibromyalgia is known as a rheumatic disease because of the pain originating from the joint and the soft tissues.

Rheum however, in Greek, means, to be in a state of flux. Not surprisingly, fibromyalgia is often confused with arthritis because of the chronic pain that comes from the joints. In addition, fibromyalgia can also afflict other soft tissue. Neither muscles nor bones, joints or ligaments are immune from pain for a person suffering from fibromyalgia. Even very slight pressure on certain parts of the body such as the neck, back and extremities can set in motion waves of pain.

This work will be dedicated to an exploration of different aspects of fibromyalgia. It will explore the symptoms, causes, and different methods of diagnoses, treatment modalities chemical, conventional and holistic. Clinical studies are often conducted to identify, among other things, how the symptoms manifest or how the condition progresses or what treatment methods are most effective from an epidemiological standpoint. To this point, fibromyalgia has not been referred to as a disease, but a condition. This is because a disease is often associated with a specific causative agent or agents.

Diseases are also identified by the defined symptoms, and -- hopefully -- a well-defined treatment modality. Fibromyalgia can be more readily classified as a condition or a syndrome -- the latter being more effective -- because it is more a collection of symptoms without a well-defined cause. For fibromyalgia, there is no well-defined treatment modality. Symptoms In addition to the debilitating, constant, chronic pain, or pain that varies in intensity; other symptoms are often observed. The pain that most people feel is often a shooting, throbbing and stabbing.

Patients often complain that the pain comes deep from within the muscles. The pain and stiffness are worse in the morning (as has been averred before). Headaches recur. Recurrent migraines are found in about 50% of the sufferers. Additionally, about one quarter of all patients suffer from an associated condition called temporomandibular joint dysfunction. TMJD is characterized by pain in the facial and jaw region. The pain is from the ligaments and muscles surrounding the jaw though not necessarily from the joints in the mandible.

One of the most difficult problems with fibromyalgia that renders a person unable to perform daily functions or even remain employed is irritable bowel syndrome. Symptoms of this include upset stomachs, diarrhea, nausea, acidity and constipation. Not all fibromyalgics however, suffer from irritable bowel syndrome. The numbers are between forty and seventy percent. Another typical symptom of fibromyalgia is the extreme sensitivity to atmospheric temperature fluctuations. The person manifests the symptoms of a chill even during relatively warmer conditions. Cold- sensitivity affects about forty percent of sufferers.

The symptomatic cause is the abnormal response of blood vessels in the hand, which gives rise to spasms that mimic the bodies' response to a stimulus of cold. For women, who suffer from fibromyalgia more than men, menstruation is more painful. Though studies have shown the middle aged, post-menopausal women suffer from this syndrome the most. Cognitive problems also occur. There is a problem with motivation and concentration. Work is affected severely, as is the memory.

The latter is called being in a "fibromyalgic fog." Some of the cognitive problems arise from what is known as "brain fatigue." Patients complain that being constantly attacked by pain results in the pain taking over, leaving little ability to focus on other activities. Dry eyes, muscle stiffness, sensitivity to bright lights, loud noises and some odors, dizziness are common symptoms. In addition to muscle pain, twitching in the muscles and painful and swollen extremities are other symptoms.

Those afflicted suffer from numbness and tingling (in addition to pain) in the extremities. During sleep, which is a problem, restless leg syndrome or the constant twitching of legs is all to common. These sleep disturbances do not allow those with fibromyalgia to get into the stage of deep sleep. Therefore the person wakes up feeling tired and this exacerbates any other symptoms from fibromyalgia. There is enough evidence that this pain is also prevents proper sleep.

The problems with lack of the ability of sleep come from a condition known as alpha EEG (electro encephalogram) anomaly. (Gibson, Littlejohn, Gorman, Helme, & Granges, 1994) EEGs of people suffering from fibromyalgia showed that while falling asleep was not different from normal, sudden spurts in brain activity during sleep prevented test subjects from achieving the fourth stage of sleep or deep sleep. This part of sleep was constantly interrupted.

This part of sleep is when the person often gets the best rest from the body repairing itself by slowing down its metabolism. Other disorders associated with sleep are sleep apnea, sleep myoclonus (this is the jerking of the arms and legs while asleep) and the previously mentioned leg restlessness (RLS -- restless leg syndrome). In addition, recently researchers have identified another problem. This is associated with breathing. It is called airway resistance syndrome. It affects normal sleep patterns for the fibromyalgia patient.

If one considers FMS to be part of a larger system of conditions called DSS (explained in the Introduction), then consider which symptoms of Chronic Fatigue Syndrome are common with FMS. To keep this work focused, effort will be expended to bringing about the relationships and associations with symptoms of only CFS and not MCS or MPS. CFS is characterized by chronic feelings of tiredness that are not commensurate with the amount of physical, mental or intellectual effort put forth by a person.

CFS is also characterized by the onset of symptoms at a specific point and has no genetic disposition to extreme or chronic fatigue. Interestingly however, most of symptoms of CFS closely parallel that of FMS discussed previously in the section. These symptoms include: impaired cognitive function, widespread non-arthritic pain, muscle pain, headaches, impaired and disturbed sleep patterns, and unrelenting fatigue. Also in keeping with the neuroendochrinal nature of FMS, another condition confounds one of the symptoms of FMS -- namely, dizziness.

The same problems are seen in the renin-angiotensin-aldosterone system (a hormonal system). (Denko & Malemud, 2004) Depression is one of the primary symptoms of FMS, though it is known not to cause FMS. The lack of causative evidence will be discussed at length later in this work. A study by Ania Korszun showed that it was sleep impairment that caused the eventual depression. (Korszun, Young, Engleberg, Brucksch, Greden, & Crofford, 2002) The respondents in this study were divided into four groups.

A control group who had no signs of FMS or depression, an FMS group that did not show signs of depression, a depressed group without other symptoms of FMS, and a FMS group that also showed signs of depression. This study was conducted using a technique called actigraphy. An actigraph is a device that measures the levels of activity. It is placed on the non-dominant arm. The levels of activity can then be measured throughout the day, including the sleep.

It was discovered that patients with FMS and depression showed abnormal levels of nighttime activity. The worst results were observed among FMS patients who showed signs of depression. Even the depression-only subjects showed unconscious elevated nighttime activities. In terms of coping with these symptoms, one has to be able to trace the progress of symptoms of FMS. Most aver that these symptoms do not decrease. The good news is that they do not increase either. They remain the same.

Without truly finding a cure, patients felt more vitalized with passing time because they had learned to carry on their lives despite the discomfort and were used to living with the problems. A study of people who had been part of a clinical trial over six years ago involved measuring the symptoms over time. Most of the respondents to this study reported that they had better control over the symptoms.

(Baumgartner, Finckh, Cedraschi, & Vischer, 2002) The parameters measured were "sleep quality, morning stiffness, amount of medications used per week, functional ability, anxiety, or perceived severity of overall symptoms" These parameters were qualitatively assessed and patients did not report any exacerbation except in instances of certain pains. Understanding Pain Since pain is an important component of fibromyalgia, it is necessary within the context of this work to understand the mechanisms in pain and the natural responses of the body to it.

There is a journal that is dedicated to the subject of pain -- Pain. This is an important aspect of life because it is the mechanism by which the body protects itself. The capacity to monitor the integrity of our bodies and to be made immediately aware of injury through the experience of pain is critical for our survival. International Association for the Study of Pain defines pain "..

An unpleasant sensory and emotional experience associated with actual or potential tissue damage." (Merskey, 1979) Margaret McCaffrey, a social scientist and registered nurse, was quoted in cancer-pain.org as saying: "Pain is whatever the experiencing person says it is, and exists whenever he says it does." There are different types of pain. Chronic pain persists for a period of a month or more beyond the normal recovery time of an illness. Chronic pain can range from dull and nagging to intense and severe. Acute pain is a short-lived condition.

This pain is experienced with injury or acute illness. Another kind of pain is called breakthrough pain. It lasts for a short time. Breakthrough pain is of moderate to severe intensity occurs over already existing or controlled pain. While it is difficult to quantify pain, clinicians frequently use methods to make effective diagnosis based on the level of discomfort experienced by the patient. These are McGill Pain Questionnaire, which consists of a questionnaire answered by the patient in a descriptive fashion. The Submaximal Effort Tourniquet Test is a physical test.

The Visual Analogue Scale measures the range between two extremes of pain. The 101-point Numerical Rating Scale (NRS-101) - a progressive numerical scaling method from 1-100. When these methods are compared, the NRS-101 scale rating is generally considered optimal for clinicians to measure a patient's pain. (Jensen, Karoly, O'Riordan, Bland, & Burns, 1989) PET and MRI studies and autoradiography in animals help identify the neurological mechanisms in the brain and the nervous system following a pain stimulus. There are several millions receptors in the body.

Some of these receptors carry impulses related to temperature, organ status. Nerves carry these impulses from the receptors to the brain. The nerves consist of bundles of fibers. Large bundles are associated with the sense of touch and the smaller bundles carry the pain impulse. The smaller bundles project their impulses slower that the larger bundles. These bundles meet at the spinal cord. The central nervous system serves the primary function of processing stimulus. The information is processed across different brain regions and transmitted via parallel pathways.

This enables the mechanism of pain to function even if one pathway becomes somehow damaged. The structures that are important in the processes of pain and pain relief are sensory receptors and their afferent nerve fibers, the dorsal horns, ascending and descending pathways, the reticular formation in the midbrain and medulla, the thalamus, the limbic system and the cerebral cortex. Melzack and Wall (Melzack & Wall, 1965) developed their now-famous theory on pain mechanisms called the gate theory.

The model depicts a mechanism of a gate opening and closing which allows pain to flow or retards the pain impulse into the spinal cord. This is the first step of pain before it is processed in the brain. The science of acupuncture is associated with "pricking" those points in the system where the gates are likely to be. Acupuncture decreases pain by causing the gates to close to the pain impulse. A previous theory of pain was called the Specificity Theory.

This theory held that pain was a separate system in the body that had its own neurons and pathways that were separate from other impulse and sensory mechanisms. Yet another theory was called the Pattern theory. This theory held that pain receptors were just like other receptors. (Baldry, 1993) Pain in fibromyalgia is often reported as originating from the muscles -- though others report that it originates from the joints. Causes Definable causes are hard to come by primarily because the symptoms are widespread and varying in intensity.

At best, causes can be attributed to hormonal imbalances. One way would be to identify the causes would be identifying the triggering mechanism. For example, if the root cause of sleep impairment would be able to help with muscle stiffness, pain and depression that comes from a lack of sleep. While rennin-angiostensis-aldosterone levels in both normal and FMS women were the same, FMS test subjects showed an impaired metabolism to angiotensin resulting in decreased blood pressure.

This decrease in "intravascular volume" resulted in dizziness, one of the common symptoms of FMS. (Maliszewski, Goldenberg, Hurwitz, & Adler, 2002) Sleep impairment is one of the most discernible symptoms of fibromyalgia. In identifying triggering mechanisms therefore studies have implicated the growth hormone. This is simply because secretions of the growth hormone is secreted (perhaps to aid in slow metabolism and body repair during sleep) during the third and fourth stages of non-REM (rapid eye movement sleep).

The study included IGF-1 level measurements in 500 patients with FMS and one hundred and fifty-two patients without FMS. (Valcavi, Valente, Dieguez, Zini, Procopio, Portioli, & Ghigo, 1993) The normal response of elevated growth hormone secretions was absent. When patients were treated with pyridostigmine, growth hormone secretions resumed to normal levels. Pyridostigmine is known to suppress hypothalamic somatostatin secretions. Mengshoel and co-workers studied the hormonal responses after a typical work out involving training the quadriceps muscles. The researchers found that most physiological responses were comparable between the test and the healthy patients.

The only statistically significant difference was between the levels of the catecholamine secretions. Runners' high is a term that is described as a feel-good sensation after a particularly strenuous work out. Clinicians aver that seeking this high might result in people working out at levels that are dangerous to their bodies. One of the theories advanced was catecholamine release. This was associated not only with runners' high but also with the second wind. The depressed release of this chemical might cause symptoms of depression.

(Mengshoel, Saugen, Forre, & Vollestad, 1995) Another ideation that makes the rounds is the beta-endorphin theory. Beta-endorphin secretions have, like catecholamine been implicated in the feeling of runner's high. (Colt, Wardlaw, & Frantz, 1981) These endorphins have are also the first respondents in the study of pain. They are also implicated in helping with mood disorders and in the response to stress. A study was conducted in Italy that measured the ?-endorphin levels in patients with depression, FMS, CFS and a healthy control.

A total of forty subjects participated in the study and the differentiation of subjects in each subgroup was not uniform. Seventeen subjects of the patients suffering from CFS formed the highest sub-group. Only five patients suffered from FMS. This study showed that ?-endorphins levels in those suffering from CFS and FMS were significantly lower. Interestingly, depressed test subjects without FMS or CFS had elevated endorphin levels when compared to the healthy subjects.

Since ?-endorphins are created in the brain, this study pointed to a possibility that fibromyalgia might find its origins in the central nervous system. This test will also prove useful. In making an effective diagnosis for FMS, the symptoms caused by other disease often confound truly identifying the condition as FMS. A test of beta-endorphins will allow patients to differentiate between FMS patients and those suffering from non-FMS related depression. The above studies sought to find physiological changes that caused FMS -- namely, the triggering mechanism.

There is another view of identifying causes, which are more qualitative in nature. These have to do with triggering events. Many FMS patients have identifying a defining event from where symptoms of FMS started manifesting. An acute work related or athletic injury is often the primary cause. A study in Israel listed twenty-two percent of FMS sufferers blaming an automobile accident and the associated whiplash. One percent of the respondents believed leg fractures to be the cause.

(Buskila, Neumann, Vaisberg, Alkalay, & Wolfe, 1997) Lower back pain is also thought to be a triggering cause. There is a genetic predisposition to FMS. Others have a predisposition to certain causative events or behaviors that might trigger fibromyalgia. (Magaldi, Moltoni, Biasi, & Marcolongo, 2000) Diagnosis Diagnosing FMS is very difficult. This has been shown in the sections above. The overriding symptom is pain. Other symptoms could easily belong to other specific or generic conditions.

From a pain perspective, in making a diagnosis, doctors ensure that the widespread pain has been with the patient for three months of higher. Eighteen tender points are typically identified in diagnosing fibromyalgia. Pressure of approximately four kilograms, which result in pain on any eleven of the eighteen of these pressure points, may prompt a doctor to make a diagnosis of fibromyalgia.

These tender points are: at the base of the skull beside the spinal column, at the base of the neck in the back; on the top of the shoulder toward the back, on the breastbone, on the outer edge of the forearm about 2 cm below the elbow; over the shoulder blade, at the top of the hip, on the outside of the hip and on the fat pad over the knee. (Immunesupport, 2000) There are no specific clinical or laboratory tests that might ascertain fibromyalgia.

In addition to the eighteen tender points on the human body, seventy-five points have been identified. But these are not used in the diagnostic criterion. Despite the confounding symptoms, astute practitioners are often able to make accurate diagnosis. A researchers-blind study was used to identify if accurate diagnoses could be made. It involved over five hundred patients. Half of them had fibromyalgia and the rest were controls. Interestingly however, the controls were not healthy individuals that one sees in conventional clinical trials.

These were patients who belonged to the same general age and sex categories. Besides they also manifested some of the pain symptoms that were typical of FMS. (SeniorMag, 2004) The test practitioners were able to identify FMS sufferers about eighty eight percent of the time. These results are accurate and at least prove that the chances of misdiagnoses are relatively few. In making an effective diagnosis, practitioners should also be aware of one or more symptoms described previously in this work.

Both practitioners and patients will be able to recognize fibromyalgia using a simple questionnaire. This instrument is called the Fibromyalgia Impact Questionnaire. (Burckhardt, Clark, & Bennett, 1991) Abbreviated FIQ, it takes five minutes to complete. The directions in the FIQ are simple. It can also be easily scored. There are ten sections to this questionnaire. The maximum score on each section is also ten and the total score is out of a 100. The higher score means greater impairment. Average FMS patients score 50.

In cases of severe impairment, this score rises up to greater than seventy. Questions in the FIQ are typically designed to address pain, disability, affect on every day life and the results of treatment modes, whether they are medical or even holistic. FIQ has been gaining in use and is now available in several languages. More recently however, a new questionnaire is indicated as more efficient in making an effective diagnosis. This is the multidisciplinary health assessment questionnaire (MDHAQ). (DeWalt, Reed, & Pincus, 2004).

The MDHAQ involves questions on a one page, two-sided format. Questions are related to physical pain, fatigue, feelings of helplessness and societal pressures. Two types of controls were used in a study to understand the efficacy of this questionnaire. An erythrocyte sedimentation reading (ESR) determined whether fibromyalgia was present. The other control was to use patients with rheumatoid arthritis, whose symptoms are similar to fibromyalgia. The ESR readings were conducted blind to the queries on the MDHAQ.

The results from the questionnaire were equally useful in diagnosing fibromyalgia as the ESR results. MDHAQ therefore provides an effective alternative to the FIQ. Prognosis It was previously mentioned that the prognosis could be seen in either a positive or a negative light. Since there is on cure that fits every symptom the symptoms generally remain the same. Only in rare cases do symptoms get worse. The patient eventually learns to cope.

Given that the range of conditions and varied acute- or chronic nature of the symptoms, comprehensive studies have to be conducted longitudinally -- even if it means following up on the studies conducted by others. One study of thirty-nine patients with an average age of fifty-five, all of whom had FMS for more than fifteen years reported that most of the symptoms were still present. Fifty-five percent of the respondents indicated that severe to moderate pain was still present; forty-eight percent reported that they had problems sleepiness.

(Bennet, 2000) Chronic fatigue was implicated in fifty nine percent of the pages. Overall however, as a testament to the ability to cope against physiological improvement, almost seventy percent of the patients reported that they conditions (one or more symptoms) had shown signs of improvement. In a larger more comprehensive study involving more than sixteen hundred patients who had been diagnosed with FMS for more than seven years, the problems with pain, fatigue, sleep impairment, anxiety and depression were the same seven years after the first time diagnosis.

(Wolfe, Anderson, Harkness, Bennett, Caro, Goldenberg, Russell, & Yunus, 1997) Most of the patients from this study believed that they were in either poor or fair health. Still however, the prognosis for patients is very good. Or at least, it is better than it was for patients a few years ago. This is because FMS, having been hitherto forgotten, is now seeing a revival in research towards its cause.

A combination of effective medications to help in the treatment and more holistic approaches such as relaxation, visualization, sound and aromatherapy, acupuncture and hypnotherapy are can be used in treating the symptoms of pain. From a clinical standpoint, pain management is becoming more and more specialized because they point to a better quality of life. Fibromyalgia and pain are becoming so synonymously commonplace and hypnotherapists today specialize in and have to obtain special certification if they wish to treat patients with FMS.

Literature Review of Recent Case Studies Fibromyalgia is a fascinating study because of the myriad symptoms, confounding characteristics, lack of a definitive causative agent, and the lack of a one-size-fits all cure for the condition. The penultimate section in this report will be dedicated to the various treatment modalities for fibromyalgia. A study of PUBMED (PUBMED, 2004) reveals that there are 3,312 articles devoted to fibromyalgia. Most of these articles are devoted to symptoms. Fewer articles (no doubt with significant overlap) with articles in the earlier categories are devoted to treatment modalities.

In the rest of this section, a summary of the latest studies in understanding and treating symptoms of fibromyalgia will be presented. There is no specific direction for this subsection of this work. It is designed to make the reader aware of the kind of work being done and different symptoms and diseases with which fibromyalgia is becoming associated. Lynn and co-workers reported that a patient with a history of fibromyalgia reported warts on his hands and feet.

(Adiguzel, Kaptanoglu, Turgut, & Nacitarhan, 2004) The results indicated that medication that could be used to increase flow volume in the brain region alleviated symptoms of fibromyalgia. The medication in question was amitriptyline. The specific symptom that was not alleviated was depression. It is possible that the medication does not specifically address the problems associated with sleep deprivation. Music has been found to be profoundly effective in helping elderly patients with advanced stage Alzheimer's diseases. Music has been useful in relaxation therapy, especially when it is accompanied by visuals.

It would make sense therefore to be able to use music in the alleviation of pain. Leao and Silva used the classical music pieces of Ravel and Wagner for over ninety female patients that presented with the problems of fibromyalgia, work related pain and pain from spinal disorders. (Leao & da Silva, 2004) The effect of the music was demonstrated through drawings made by the test subjects. Without preference to music, patients showed significant decrease in intensity of pain after each musical session. There was no preference for either composer.

However, mixed compositions from both composers did not produce the same efficacious results as for individual composer. Depression and emotional negatives from fibromyalgia often manifests in anger and a condition called alexithymia -- the inability to express ones feelings in words. When fibromyalgia patients vs. control patients (who suffered from rheumatoid arthritis) were tested, anger was more prevalent in fibromyalgic patients. Even after treatment for pain, FMS patients still showed greater proclivities to emotional outbursts.

The researchers in this study averred, (Sayar, Gulec, & Topbas, 2004) "difficulty of identifying feelings, rather than other dimensions of alexithymia, seems to be associated with fibromyalgia," Depression is not necessarily restricted to patients themselves. Depression affects the family members who express symptoms of depression themselves. Several women from the New York and New Jersey metropolitan area who were diagnosed with FMS were tested for major depressive disorders. The first-degree relatives of each of this subset then went psychiatric tests.

The results startlingly show that relatives of patients with FMS also had depression problems, almost as much as if the FMS patient was also suffering from depression. This study has important sociological implications. (Raphael, Janal, Nayak, Schwartz, & Gallagher, 2004) Treatment Modalities In treating patients with FMS, in the absence of a cure for every symptom, clinicians have pushed for medication that helps alleviate some of the symptoms and not the condition. Naturally, since sleep deprivation and associated is depression is a problem, psychiatric help is often called for.

Some symptoms can be alleviated through behavior modification. The new move is to treat the patient holistically. Relaxation and pain management methods, which do not use medication, are becoming more popular. Physical therapy and a safe and active lifestyle are also helpful. Inactivity can exacerbate problems because patients often forego physical activity because of the itinerant pain. The treatment of fibromyalgia often requires a team of specialists, including doctors to treat the pain, psychiatric to help with emotional problems, and physical therapists who might help with preventive measures.

(NIAMS, 2004) While there is no solid evidence that painkillers work on chronic pain, analgesics such as acetaminophen and tramadol will provide temporary pain relief and even helps in the cases of a certain subgroups of FMS sufferers. Inflammation is not a direct symptom but might arise from the pain. Non-steroidal anti-inflammatory drugs are often used because they can be useful in helping with pain. Examples of NSAIDs are aspirin, ibuprofen and naproxen sodium. NSAIDs also help relieve pain from headaches and menstrual cramps.

Antidepressants increase levels of depression reducing transmitters such as serotonin and norepinephrine. The decreased secretions are associated with depression as well as chronic fatigue. They can also help reduced pain in fibromyalgia. Tricyclic anti-depressants such as amitriptyline hydrochloride, cyclobenzaprine, doxepin, and nortriptylin can enhance the secretions of endorphins that help with pain relief. In addition, these medications also act as muscle relaxants and help with problems sleeping.

SSRIs or selective serotonin uptake inhibitors, which prevent the quick uptake of serotonin allowing it to remain in the system longer, are often prescribed when TCAs fail. The increased serotonin decreases fatigue and helps the muscles relax. Fluoxetine (Prozac), paroxetine (Paxil), and sertraline are examples of SSRIs. One of the dangers with using SSRIs is that they make the patient feel good and more energetic. This has a counterproductive effect in the ability of the patient to sleep.

Benzodiazepams such as clonazepam and diazepam (marketed as Valium) are often used to increase muscle relaxation and decrease muscle pain. These chemicals are often used to prevent restless leg syndrome one of the more common symptoms of fibromyalgia. From a behavioral standpoint, some steps need to be taken in order to improve the chances to alleviate certain symptoms. Good sleep is essential. Therefore regular sleeping habits are called for. Also important is to avoid products that will disrupt sleeping habits such as caffeine.

Medications that can disrupt sleep should be taken as far from bedtime as possible. Physical activity should also be limited to times that will allow patients to sleep at the right time and also fall asleep instantly. Doctors recommend that daytime naps should be avoided. And the bed should be reserved only for sleep and not for activity such as reading or watching television. Liquids and food products that might cause heartburn or necessitate trips to the bathroom should also be avoided.

Activities that will put a person in the right frame of mind, such as listening to calming music or even a warm bath should be encouraged. Since it is possible that a lot of FMS symptoms arise from sleep disruptions, following these guidelines is very important.