This is Chapter 13 from “The Complete Idiot’s Guide to Fibromyalgia” by Lynne Matallana with Laurence A. Bradley, Ph.D., Stuart Silverman, M.D., and Muhammad B. Yunus, M.D. (Reprinted with permission)
Assessing Overlapping Conditions
Overlapping conditions are a case of bad news and good news. The bad news is that people with fibromyalgia experience a variety of overlapping conditions; the good news is that many treatment options are available to successfully treat these conditions. If you can get relief from the symptoms of the overlapping conditions (such as headaches, migraines, irritable bowel syndrome, dry mouth and eyes, restless legs, and so on), your fibromyalgia pain and fatigue will often also become less pronounced. As you and your healthcare professional work toward relieving the pain, stress, and discomfort of the symptoms of these other conditions, it will have a positive effect on your overall health. For example, treating and getting your migraine headaches under control or finding the right medications to relieve your restless legs will reduce the number of symptoms you are dealing with and alleviate some of your physical and emotional stress. Focusing on the overlapping conditions that you have been diagnosed with is a good place to start your quest to become healthier.
When you experience the sleep disorders than can accompany fibromyalgia, it’s hard to believe that you ever took sleep for granted. Not only is the inability to get a good night’s sleep frustrating, but it has a major impact on overall health. Sleep is needed to produce certain hormones and chemicals that help regenerate certain parts of the body, especially in the brain. Researchers believe that the primary function of sleep might very well be cerebral restoration. After an individual experiences even short periods of insomnia or restless sleep, certain neuro-chemicals can begin to malfunction, visibly affecting a person’s behavior and preventing them from functioning physically to their full potential. It is known that a person experiences changes in glucose tolerance and endocrine function simply by not getting enough deep, restorative, and quality sleep. The muscles of the body are not able to regenerate, unless the delta (deep sleep) stage of sleep is reached. It is vital to diagnose sleep disorders such as sleep apnea and restless legs syndrome, so proper medical treatment can be implemented. (To learn more about specific types of sleep disorders go to Chapter 15 of this book.) The symptoms of non-restorative sleep is central to a fibromyalgia diagnosis; however, the treatment can be different for each individual based on what is causing the lack of sleep. There are many effective management tools that can be used to help treat sleep disorders. They can include the following: --Exercise --Addressing the psychological problems, such as depression and anxiety --The use of pharmacological agents, including antidepressants, benzodiazepine medications, antispasmodics, and muscle relaxants --In cases of sleep apnea, the use of a CPA (Continuous Positive Airway Pressure) machine or surgery --Relaxation exercises.
Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome (IBS) is a functional GI disorder characterized by abdominal pain and altered bowel habits in the absence of any organic pathology findings. The symptoms of IBS are cramping, bloating, abdominal pain, constipation, diarrhea, or alternating constipation and diarrhea. Between 50 and 75 percent of people with fibromyalgia also receive an IBS diagnosis. Due to abnormal sensory processing in people with fibromyalgia, IBS symptoms can cause much despair. In other words, because IBS causes abdominal discomfort and fibromyalgia causes pain amplification, a person with both syndromes can experience severe visceral (intestinal) pain. Robert Bennett, M.D., suggests trying the following treatment options: --Eliminate foods that aggravate symptoms --Minimize stress --Adhere to basic rules for maintaining a regular bowel habit --Use proper medications for specific symptoms:
-Constipation: stool softener, fiber supplementation, and gentle laxatives such as bisacodyl
-Diarrhea: loperamide or diphenoxylate
-Antispasmodics: di-cyclomine or anticholinergic, or a sedative such as Donnatal Mark Pimental, M.D. and director of the Gastrointestinal Motility Program and Laboratory at Cedars-Sinai Medical Center, found that up to 80 percent of all irritable bowel syndrome sufferers are infected with bacteria that overgrows in the intestines. The condition can be detected through a special breathalyzer test that checks for abnormal lactose levels, which is indicative of bacterial overgrowth. The protocol is to reduce the bacteria with long-term treatment of antibiotics such as erithomyacin.
Cognitive Impairments: Fibro Fog
Cognitive problems such as impaired memory, concentration, and thought processing are common in people with fibromyalgia. It can be a difficult symptom to deal with, especially because the symptoms can interfere with your ability to remain employed. Jennifer Glass, Ph.D., says “Cognitive function can be thought of as the ability to carry out intellectual activities or processes, such as thinking, reasoning, remembering, imagining, or learning words. When the ‘thinking’ or ‘remembering’ actions seem faulty, completing simple daily tasks or job-related activities can become challenging and frustrating, no matter how familiar the activity.” In research studies at the University of Michigan, Denise Park, Ph.D., and Jennifer Glass, Ph.D., found that the cognitive performance of fibromyalgia patients was equivalent to that of adults who were 20 years older than them. However, on tests that evaluated speed of cognition, the people in the fibromyalgia group performed the same as those in their same age range. This seems to show that the cognitive problems experienced by a person with fibromyalgia are not the same as cognition problems that develop with age. There are several types of systems that are involved in the process of memory. They include the following: --Working memory: Combines short term memory with other mental processes to enable us to “work things out in our heads.” We use working memory when we do mental arithmetic. --Episodic memory: Refers to the memory for particular episodes. An example is remembering what we were doing when we heard about the September 11 terrorist attacks. --Semantic memory: Refers to our stored knowledge of facts, separate from any particular episodes associated with those facts. The working and episodic memory systems of people with fibromyalgia, which combine short term memory with other mental processes, were found to be less efficient than those without fibromyalgia who were the same age and had the same amount of education. Park also found that the cognition problems are not associated with depression, because the fibromyalgia study participants were still able to perform at a relatively fast rate and those with depression were not. Although the exact reason why people with fibromyalgia have fibro fog is not know, it is thought to have something to do with our neuroendocrine abnormalities, sleep problems, mental fatigue, and chronic pain. By treating these problems, you might also find relief from cognitive symptoms.
Just like fibromyalgia, migraine headaches used to be blamed on the sufferer. Today, there is more acceptance of this painful affliction and new research is helping to find more effective treatments. Migraine headaches usually affect one side of the head and can last a few hours or a few days. At the onset of a migraine, you might become sensitive to any type of stimuli, including light, noise, and smells. You might begin to feel nausea and start to vomit, and your head might feel like it is shrinking. Some experience flashing lights or colors, exhaustion, or even depression. These symptoms can continue throughout the migraine or give way to just the intense, piercing pain. When a migraine begins, there are alterations in the blood flow to your brain, which contributes to the severe pain. It is thought that there may even be unusual electrical activity in the brain during a migraine headache. The best way to treat migraine headaches is to try to avoid them. You should become aware of food or environmental triggers that precipitate a migraine and avoid them. If you are taking a prescription medication, you should take the medication at the first sign of migraine to try to limit the headache’s severity. You can apply icepacks to your forehead, the back of your neck, or behind your knees. Lie down in a quiet, dark room and just rest. Do not try to watch TV or read. A drop in your blood sugar can also trigger a migraine, so a small glass of fruit juice may help you feel better. Over-the-counter pain relievers may be helpful, and today there are dozens of prescription migraine medications that can be effective. They include triptans (Amerge, Imitrex, Zomig, Maxalt, and Axert), and antiseizure medication (Depakote), and a barbiturate sedative (Fioricet), which is mixed with a nonaspirin pain medication (acetaminophen) and caffeine.
Restless Legs Syndrome (RLS)
Restless legs syndrome (RLS) is actually a type of sleep disorder, which is characterized by unusual and strong urges to move your legs (or ams), usually occurring in the evening or at night when you lie down to rest. Sensations in the legs can be described as creepy-crawly, itchy, pulling, nagging, and even painful. As you begin to rest, the symptoms become more pronounced and are accompanied by the desire to get up and walk, stretch, or move into another position. RLS can often be found in related family members. It can result in inadequate restorative sleep, causing you to feel tired and unrefreshed the next day. People with RLS may also have periodic limb movement disorder. This condition might cause you to have involuntary movement of your feet, legs, and arms while asleep. It can involve anything from small limited movements to wild and intense kicking and flailing of the legs and arms. The movements can be short in intensity or last up to 10 seconds. Treating RLS is determined on an individual basis. The first steps include identifying activities that worsen or improve the condition. If you walk, stretch, take a hot or cold bath or shower, perform acupressure, or rub your legs, you might be able to help relieve symptoms. Another option is to keep your mind busy by reading, doing arts or crafts, or even playing video games. It is thought that RLS may have an underlying iron or vitamin deficiency (B-12) that can be treated through supplementation. It these alternatives do not produce relief, there are four categories of medications that can be prescribed: --Dopaminergic agents: Dopamine-receptor agonists include Mirapex (pramipexole), Permax (pergolide), and Requip (ropinirole), but also drugs such as Sinemet (carbidopa/levodope) that add dopamine to your system. Although dopaminergic agents are used to treat Parkinson’s disease, RLS is not a form of Parkinson’s disease. --Sedative agents: Sedatives are used either alone at bedtime or in addition to a dopaminergic agent. The most commonly used sedative is clonazepam (Klonopin). --Pain-relieving drugs: Pain-relieving drugs are usually only used in extreme cases of RLS. Some examples of medications in this category include codeine, Darvon or Darvocet (propoxyphene), Dolophine (methadone), Percocet (oxycodone), Ultram (tramadol), and Vicodin (hydrocodone). --Anticonvulsants: People who have RLS daytime symptoms may be treated with the anticonvulsant gabapentin (Neurontin). This drug may be used if a pain condition is associated with the RLS.
Just like pain amplification, sensation amplification (including adverse reactions to light and sound) are common in fibromyalgia. As a result of sensory overload, you might find that even minimal light and noise can cause distress. Weather changes can aggravate symptoms and even light touch can be painful. To be sensitive to something is to be responsive to a stimulus. People with fibromyalgia become ultra sensitive to a variety of stimuli that do not normally cause a negative reaction. To dilute the response to stimuli, you should avoid the situation, practice relaxation techniques, and avoid multitasking. Decreasing the amount of stimuli you are exposed to will help decrease the intensity of your reaction. Take things one at a time and make an effort to reduce the amount of environmental stressors you are exposed to.
Other Overlapping Conditions
Fibromyalgia is not limited to only the overlapping conditions that are discussed in this chapter. The majority of healthcare providers treating fibromyalgia recognize up to 40 different related conditions. If you are affected by these other disorders, remember that there are treatment options, and if you and your healthcare team focus on one or two problems at a time, you will have success in symptom reduction and even symptoms elimination.
In Appendix C [of this book], we included forms to track medications, complementary or alternative therapies, and treatments for overlapping conditions that you have already tried. There is also a space to indicate whether you found any of them to be helpful. Sharing this diary with your healthcare provider will be helpful when evaluating what course of treatment you want to pursue. Remember, resolving one symptom can also help improve or resolve another. Do not be overwhelmed. Again, knowledge is power, and armed with the knowledge you are gaining, you will better understand your illness and how to focus on the treatments that help you.
About this book:
The preceding is an excerpt from “The Complete Idiot’s Guide to Fibromyalgia” by Lynne Matallana with Laurence A. Bradley, Ph.D., Stuart Silverman, M.D., and Muhammad B. Yunus, M.D., published by Alpha Books, and copyright (c) 2005 Lynne Matallana, all rights reserved. To purchase, please go to http://www.fmaware.org/store.htm