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SENSITIVE POINTS

For millions suffering from Fibromyalgia Syndrome, diagnosis and effective treatment have been elusive, until now

For millions suffering from Fibromyalgia Syndrome, diagnosis and effective treatment have been elusive, until now

June 03, 2002
(Page 2 of 2)

There are no FDA-approved drugs specifically for treatment of FMS. Treatment usually includes low doses of tricyclic antidepressants such as Elavil, muscle relaxants such as Flexeril, or selective serotonin reuptake inhibitors (SSRIs) such as Zoloft, Paxil, or Prozac.

Dr. Wei insists that under no conditions should opiates be used to treat FMS. Depending on the particular symptoms exhibited, other medications may be indicated. Dr. Wei noted that patients with FMS are usually supersensitive to drugs and very small doses are used when treating FMS patients.

n Cognitive-behavioral psychotherapy:

Patients are encouraged to learn more about their disorder, recognize the onset of symptoms, pay particular attention to the conditions that may trigger flare-ups and, when possible, learn to control them. Relaxation techniques and other stress-reducing techniques as well as biofeedback also have been found to be helpful.

What causes FMS?

FMS is most likely caused by an imbalance in the brain's chemical messengers (called neurotransmitters) - serotonin, norepinepherine, and dopamine- resulting in hypersensitivity to stimulation and abnormal activity in the brain.

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Scientists do not yet know what the specific imbalance is or how it may have happened. Drugs that reduce symptoms act on these neurotransmitters, for example, by reducing the serotonin deficiency seen in some patients.

Thus far drug therapy has been a trial and error process, with some patients responding to some drugs and not others, and the effectiveness of drugs changing over time.

Difficult diagnosis

Although fibromyalgia has been around for a long time, it was identified as a distinct disorder only recently, and the American College of Rheumatology first established diagnostic criteria for FMS in 1990.

But there is still resistance in the medical community from people who don't believe it's a real illness, Wendy Radonivich-Crum says.

"On the other hand," Radonivich-Crum says, "FMS may be over-diagnosed. There are many potential causes for the symptoms of FMS. The only way to be sure that the patient has FMS is to rule out these other options."

Radonivich-Crum recommends that before people decide that FMS is the right diagnosis, they should see a rheumatologist or a physiatrist ( a physician specializing in physical medicine and rehabilitation) who has experience with FMS.

Resources on FMS

Dr. Wei and his collaborator, Dr. Barbara Kage, are taking part in multi-site clinical trials of new and promising medications specifically intended for FMS. For information, call the Arthritis and Osteoporosis Center of Maryland, 1-301-694-5800

n Total Rehab Care of the Washington County Hospital sponsors Management of Fibromyalgia, an eight-week self-help program, 301 714-4025

n Fibromyalgia Support Group co-sponsored by the Arthritis Foundation meets in Hagerstown monthly August through May, 301-714-4025

n Frederick County Support Group for Fibromyalgia meets monthly, 1-800-750-9078

n "Your Personal Guide to Living Well with Fibromyalgia; an official publication of the Arthritis Foundation." Contact your local Arthritis Foundation or book store.

n Arthritis Foundation 1-800-750-9078;

www.arthritis.org/conditions/default.asp

n National Fibromyalgia Partnership 1-866-725-4404;

www.fmpartnership.org

n National Fibromyalgia Research Association;

www.nfra.net/Homeinfo.htm

n National Institute of Arthritis and Musculoskeletal and Skin Diseases,

www.nih.gov/niams or 1-877-22-NIAMS

Niles Bernick, Ph,D. is a retired N.I.H. policy maker who lives in Falling Waters. W.Va.

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