Fibromyalgia - page 9
What are your opinions, nurses? Is Fibromyalgia a justified condition or just a basket term ? I am interested in your feedback. It seems like we see a large number of patients (usually women) with... Read More
Apr 6, '04Quote from BeachNurseTO: Beach Nurse: Thanks for the response...I am sorry to hear that your experience with your Rheumatologist was not positive...You should definitely seek a new one. I have had personal experiences with my husband's health that involved Professionals ignoring his complaints (specifically general practice and ER staff) and it turned for the worst in his case (aplastic anemia) as he almost lost his life :imbar ...but that is another story.To CBarnett, I have a negative R factor, however I have had painful joints in both hands, fingers, wrists, knees, elbows, feet, ankles, toes and occaisonally ribs for the past several months (since last summer). My ANA is positive and other tests are positive for inflammation. One of the docs I work with doesn't believe in FM and thinks everything is due to my arthritis. I do have unexplained muscle pain. My mother has severe RA and had both knees and hips replaced before the age of 50 and her mother died of scleroderma.
I don't know about what you can do to prevent RA..I have always been a healthy person and it came on suddenly. Just because I don't have red, swollen joints and a + RF my doctor won't treat me with DMARDs..I am seeking another Rheumatologist who is more aggressive because I don't want to be crippled in 10 years..I have 2 boys and a 1 yr old baby girl to raise..
Anyways it is always my advise, to find a DR that "hears" you and don't let anyone brush you off and tell you that you are imagining pain or other chronic symptoms. This is you life and your health and sometimes (as you see witnessed in this particular forum) that some medical professionals find it easier to brush off things they do not under or cannot explain or are inconvenient to them.
I wish you the best!
Apr 6, '04Hello everyone. I think fibromyalgia could be real as I have done some research and there are certain things such as pressure points, etc. that are used to diagnose. I do think at times it seems similar to arthritis and I guess I would be depressed if I were in pain all the time too. I know some people dx with fibromyalgia and they do all seem to be dealing with depression to me. So if it is nothing but depression, how do we explain the pain they say they are experiencing? I can't say they are not experiencing pain, just because I don't feel it. I think it needs more research.
Apr 6, '04Quote from yaddadoiti know my fm is much worse with not enough rest. until i had my restless leg syndrome diagnosed and treated (take mirapex) i was up until 3-4 am every night...i almost had to quit work. rls goes hand in hand with fm. the lack of sleep from rls can contribute to the increase in the fm symptoms.i know from the information gathering i have done on fm that the majority of people who have it have difficulty sleeping. it would be really interesting to find out how many of these people have had sleep studies done and what the findings are.
Apr 6, '04Yaddadoit, I would just like to say that if you look hard enough, you will always be able to find a doc who will substantiate any medical condition that you think you have.... I know a 26 yr old hypochondriac who found a doc to put a pacemaker in her heart, and she has not ever had any documented clinical cardiac abnormality....ever.
I think pain is a part of life. I am sorry that these people are having discomfort, however I do not think they should be classified as "disabled." I think there are times when we just have to go ahead and function, whether we are having pain or not.
I have seen RA patients in huge amounts of pain and still being active members of society. I have seen MS patients doing the same. My heart goes out to them.
Apr 6, '04Quote from SmilingBluEyesI am sure in the minds of some others here, PMS does not exist, either. Cause there is NO definitive and objective test to PROVE it does. So kinda like many things unseen, lack of faith makes it NOT so. Let one of your loved ones suffer a "non-existant" condition and see how quickly you jump on the band wagon to become a believer!
sigh... The practice of medicine is based on principles of diagnostics and treatment. what a chaotic world it would be if we were to accept anyones vague complaint about anything they were experiencing at any given time as a new disease.....Last edit by canoehead on Sep 6, '04 : Reason: edited quote
Apr 6, '04I think I will withdraw from this discussion. There has been some excellent information presented and for anyone who cares there are great research articles out there... For those who don't care or aren't interested in listening to their patients complaints.... I sincerely hope that I will never have to place my trust in you as a caregiver or even a coworker.
Apr 7, '04I was thinking of this thread in class today as I listened to the lecture on CNS disorders, most of which have no "definitive, objective test". By the definition of some of the users here, that means that people who suffer from myasthenia gravis, ALS, and even MS are hypochondriacs! MS is "diagnosed" by plaques that show up under MRI, but not everyone with MS shows the plaques, and some people with the plaques never show any signs of the condition. The point is that there are no definitive tests for MOST conditions of the central nervous system, but that DOESN'T mean that they don't exist.
Maybe if more men suffered from FMS, there would be more belief out there.
I will be starting a separate thread for those of us who suffer from this condition, or for those whe are legitimately interested in a exchange of information. Some great information has been given over this thread, but it is lost in a sea of frustration, disbelief, and prejudice.
Apr 7, '04As someone who did not have fibromyalgia, and now does have it, I can report that there definitely is a difference. Constant pain of varying degrees of intensity in a minimum of 20 trigger points throughout the body is not something that can be ignored. Nor can, or should, the increasing volume of information gathered by research studies be ignored. Just google "fibromyalgia" to learn more
or use this excellent site for more info. Ignorance should not be an excuse for unkindness or less than professional caregiving.
Apr 7, '04There is no definitive test for rosacea-but a doc can dx it based on how it looks. There is no definitive test for depression-again a dx is made based on what the patient reports and how the patient acts. Until MRIs were widely available, there was no definitive test for MS except autopsy-but the disease has been around for ages. How about Meniere's disease-dx by patient's reported symptoms and the doc r/o other dx that are definitive. My ophthamologist has to take my report of what I can and can not see to dx my myopia-he has no definitive way to do so other than the reported line I can see on the eye chart. I'm glad he takes my word for it and I don't have to wait for a "definitive" eye test before I can be prescribed eyeglasses! Those who need a "definitive" test to believe in fibromyalgia are just proving their ignorance and lack of knowledge of scientific theory & practice.
The pressure points used to dx fibromyalgia are not merely sore when someone "pokes" any area with too much pressure. These are specific spots and the pain is overwhelming-a 9 or 10/10. This pain occurs form the lightest of touches in the pressure point areas. I have had my husband give me a back massage and he inadvertantly pressed a pressure point with his thumb. I can nearly scream with pain-and the severe pain remains long after the pressure ceases, much longer than it should. He can press even harder on a non pressure point and nothing happens. I don't wish that pain on the worst skeptic here. The pain has nothing to do with over-use or muscle strain-it occurs in the absense of activity that might cause discomfort. It is a deep and generalized aching, coupled with sleep disturbances.
The point is that many people may come to the ED seeking pain meds for fibro (as well as countless other conditions causing pain). Some are drug seeking, but many are actually legit. Still thousands of others, like myself, have never visited an ER for pain relief, have never taken a narcotic for pain relief-but that doesn't mean we don't have pain. Just like there are degrees of severity with MS, so it is with fibro. Some have it worse than others.
I too was quite disappointed to see the judgemtal attitude of some on this board but with a few that is nothing new. It is difficult to change ignorance and intolerance. I was heartened to see many more who are compassionate and up to date on recent developments with fibro and other auto immune disorders.
I wish everyone who suffers from this disease a painfree night.
Apr 7, '04I have found some very good information on another thread from a Nurse Practitioner who treats FM. I am going to try to find it and copy it over to here.
Apr 7, '04i am someone who has fibromyalgia and it is real. i am 48 years old, just finished lvn school and will be taking my boards in 2 weeks. i have had fibromyalgia since i was 15 years old. i have taken human growth hormone to help me make it through nursing school and i did! about 2-3 years ago i was on a cane and did not think i could make it. i do have to take antidepressants and other medications to help me. i am determined to be a nurse no matter what. i have worked in the medical field for 19 years and nursing is what i wanted to do all along other than becoming a doctor. my worst injury now is having carpal tunnel from doing medical transcription for 16 years. i do wish there was a cure for fibromyalgia. if anyone wants more info on it i can tell you about it as i used to be a volunteer for the arthritis foundation. undefined
Apr 7, '04Here is some great info from Dave that I pulled from another thread. He is a Nurse Practitioner and focuses on Fibromyalgia. Hope everyone takes something away from this and maybe even to your present Dr. to try some of these treatments. I know when I was first diagnosed by a Rheumatologist he started me on Prozac for energy and something else (fibro fog) LOL It was in 1995. But with the studying I've been doing on my own it sounds like Dave is right on top of it.
Firstly let me both thank you and apologize. Many of you have sent me lengthy e-mails regarding questions you have about Fibro. I really appreciate you holding my opinion high enough to ask it. Secondly, please accept my sincerest apologizes for not getting back with all of you all sooner.
Rather than going through each message and repeating the same information over and over I'm going to post a rather lengthy reply that will hopefully cover everything you've asked. I've always been told that if you're wondering about it, someone else probably is too If there is something that I do miss, please smack me very hard and be kind enough to ask me again.
Firstly, treating FMS requires a very multifaceted approach. Typically, there are five goals we need to reach toward in an effort for the FMS patient to reach optimal functioning. These five goals are Sleep, Fatigue, Pain, Depression and Cognitive Dysfunction. Each of these requires therapeutic measures to be implemented in a hope of improving the FMS patients, QOL.
Many have asked about a Dietary Supplement regimen.
In Advance for Nurse Practitioners November 2003 edition, there was a WONDERFUL list of supplements that are suggested for Fibromyalgia.
I will post this list below.
Folic Acid. 1-10mg/day for months. In taking this supplement, we see a decrease in fatigue and depression. It will also boost immune function.
Vitamin B12. 6-70,000 mcg IM/wk. Again looking at a decrease in Fatigue and depression, as well as pain. Will also see a increase in circulation.
Vitamin C 10-50 g/day. Vitamin C boosts immune function, decreases pain and increases microcirculation.
Magnesium and Malic acid are also suggested by Advance, however I've never used these. They even state that taking these supplements shows a SUBJECTIVE improvement. Perhaps they're something to consider.
Advance for NP's does list several additional supplements, however I am choosing not to list those. The other supplements IMHO could effect the FMS patient in a negative way, and since we're not looking at a night and day difference with ANY supplement, I would never suggest them since we could cause more problems than good. The ones I have posted above are ones that I use in management of FMS.
Neatly, medications used in FMS. I have NEVER seen a FMS patient managed effectively on one drug. Polypharmacy runs rampant in the management of this disease. You simply cannot hit all of the target zones of the disease and use one drug. :: crosses finger:: Maybe in the future.
When it comes to treating the FMS patient, we need to look at four base classes of drugs that IMHO EVERY FMS patient needs to be on. These would be TCA's, Benzos, SSRI's and finally Muscle Relaxants. These drugs treat the fundamentals of the disease and are essential to improving QOL. We should also consider non-narcotic analgesics in this regimen.
Once patients are titrated to an effective dosage of these medications, Narcotic-Analgesics come into play. Again, we should titrate all other non-narcotic medications to an effective dose before using narcotic medication. However in extreme presentations, many people will need the addition of a narcotic analgesic right from the get-go.
In the treatment of FMS, two other conditions must be considered. These would be IBS and Overactive Bladder.
Treatment for them is pretty straight forward, but I will suggest medications for each below.
Drugs from the classes.
Below is a discussion of medications I use in FMS. Please note that these may not be for you, but if you were my patient ... would be drugs I would consider first.
Elavil, Elavil and Elavil. NOTHING has been more studied and proven for FMS. I am a huge fan of it and have seen great results from it.
Typical dosage for Elavil in FMS is 25-50mg QHS. We can titrate accordingly, but the greatest effects in terms of pain relief are usually seen at the lower dosages.
For FMS, I like nothing better than Klonopin. With its long acting duration Klonopin provides enough sedation to keep the FMS'er asleep through the night. WHICH IS CRITICAL to maintaining a balance. Klonopin 1mg QHS is usually what I give, but some will need a lower dose of .5mg.
For those who experience a lot of night time awakening but fall asleep easily, I will usually give Xanax. Doses range from .5 all the way to 1.5 in what I typically give. Since Xanax has a shorter duration, it is sometimes necessary to give it ever four hours at night time.
I have two SSRI's that I pretty much use exclusively. Firstly, NO SSRI has been more studied in FMS than Prozac. Prozac is a wonderful drug and has more uses than I think we'll ever discover. That said, it's not for everyone. I REALLY dislike using it in kids. However I use it a lot in FMS. If I'm giving Wellbutrin, I almost always give Prozac as the SSRI with it, as they work together beautifully.
For Prozac, 20mg QAM. AM is VERY important. Prozac is the MOST STIMULATING SSRI of ANY. IT WILL keep you awake at night.
Secondly, but my first drug of choice ... is Effexor XR. Simpyl put, IT WORKS! It's the best drug I've ever seen to come out of the SSRI class. For Effexor we start at 37.5mg and increase slowly to a total dose of 150mg. Be warned though, if you suffer from HTN Effexor may not be the drug for you. Effexor can spike your BP. Just something you need to watch for.
Finally, muscle relaxants.
For FMS I have three that I like.
It really depends on the persons presentation when I choose which one to go with.
I'll list them and their dosages, then explain which ones I like for which.
Valium 5-10mg TID (MUST BE GIVEN TID/QID)
Cyclobenzaprine 50-150mg BID with occasionally a smaller dose AM and a larger dose HS.
For patients with FMS presenting with anxiety, 9/10 I give Valium. This allows the drug to serve two purposes and we all know that anxiety can effect pain.
For patients who's pain is intolerable, I usually use Soma. Mind you, that if I have a patient on ANY Hydrocodone containing compound, I do NOT WRITE SOMA. Soma and Lortab are part of a coctail that is very popular in the club scene. Supposedly it gives a rush similar to Heroin. It is not that I am trying to deny patients a medication, or that they don't need a medication ... however our job is to HELP with their problem. Giving them a combination of medication that will produce a Heroin like high? Well, I can't see as how we'd be helping them. Mind you, I do have patients on Soma and Hydrocodone. However I use this combination in patients who get relief from NOTHING else. These patients have also almost always been cleared by an addiction specialist.
When considering a non-narcotic analgesic we have a few options. I'll list them below and then describe where and I why I use them
APAP 500mg QID
Relafen 750 BID
Ultram 50mg two tabs QID PRN NTE 6 tabs QD.
Motrin 800mg TID-QID
Naproxen 500mg TID
Toradol 10mg Q-4-6hrs NTE 10days
APAP is a Band-Aid. Simply put. I use it rarely. If its Sunday night, someone is out of medication and they don't want to come into ER. I'll suggest it.
Relafen is a great drug. It's generally well tolerated and does a good job with the pain. I use it a lot.
Motrin and Naproxen. They're OK. I love 800mg Motrin for back pain. Some patients do REALLY WELL with these. When they do, I'm super happy. They're life is alot easier. They run of meds, Walmart will have it
Ultram. This is the drug I use right before someone moves over to a narcotic medication. Honestly, I'd rather give a Vicodin than this, but it's been my expeirence that if you're treating a patient for chronic pain the medical review boards and SBON REALLY EXPECT to see that you've given this. Ultram is a form of a synthetic opioid and many people get great relief from it. I also consider Ultram to have the same abuse potential as ANY schedule II drug, so I observe it's usage closely.
Toradol PO. Toradol has saved MANY of my patients from admission on a PCA. It is a great drug, but you must be aware of the risk of bleeding associated with it. I have several patients who request IV Toradol for pain crisis over ANY narcotic. As a one lady I treated told me "With that Dilaudid stuff you give, I get higher than a kite. Yea, my pain's gone, but it makes me loopy as h**l. That one medicine (Toradol) kills my pain and I still know exactly where I am. I like that!) I've had MANY patients with severe CA pain that I've treated with Toradol IV and allowed them to go home with a few days of it PO. More than one family has said that doing this allowed their loved one to be pain free and spend what little time they had left AT HOME with their loved ones.
I'm going to end this message here, however I will soon be posting part two which will cover narcotic pain medications. I will also be posting a set of lab tests which I suggest for all FMS patients to have.
Best wishes in your pain control!
Apr 7, '04[QUOTE=SmilingBluEyes]I am sure in the minds of some others here, PMS does not exist, either. Cause there is NO definitive and objective test to PROVE it does.
I've been stumped for YEARS as to why redheaded people(in the UK they are known as Gingernuts, for the cookie...the one that tastes like ginger)could tolerate a great amount of pain in certain circumstances....THEN, I read a magazine article from a health publisher that said that the SAME reason that
redheads didn't have a great pain threshold was because of their hair...now, I'm JUST as skeptical as you are, Deb, about scientific angle(we have to have EVIDENCE BASSED MEDICINE in order to do some of the stuff that we do), but to be honest, I truly believe that the human condition is made more difficult by
not having an open mind. IF WE as nurses can't be open minded, how does that tally with our health promotion attempts? If we have apatient who can really, REALLY benefit from, say, aromatherapy, or something else that s/he
wants to learn, who am I, as the nurse, to naysay that patient?
PMS/T(Tension-English definition) is quite prevalent here; my own suspicion
is that women here have a great deal of stress....and I will venture to say that stress is ***THE** number one killer of humans...followed closely by
malnutrition. That is MY two pence on the subject...have a great day, enjoy
what you do, and if you don't, look for a place that you can really be happy.
Blessings, SpiritusLast edit by canoehead on Sep 6, '04 : Reason: edited quote