Complicated Fibromyalgia

Dear Ask The Doctor: My 40 year old female partner is suffering from chronic pain in multiple sites from multiple conditions. She also has been diagnosed with fibromyalgia. She also has bipolar disorder, post traumatic stress disorder, severe depression, osteoarthritis, irritable bowel syndrome, fibromyalgia, chronic abdominal pain, degenerative disc disease, migraine headaches. She has gone to see a pain management specialist that told her that she needs to loose weight, stop smoking, get up and move and that she has given up on life. They also inferred that the pain was all in her head. She wakes up screaming most days, if she is able to sleep at all and has a hard time doing simple household tasks. Her urologist, gyn, gastro, primary care, and physiatrist all say that pain management is the best option for her. I agree that the advice of the pain management doctor will help her health over all but if all of her doctors are saying that she needs pain management, and I understand that the preferred treatment for Fibromyalgia is not narcotic medications, but what about managing the pain from the other conditions that she has? Is it unreasonable for the fibromyalgia to out weight the other painful conditions she has? We are going to see another pain management specialist after the primary care doctor heard what the previous specialist said. Her depression is getting worse as she feels more and more like there is no hope to live a life with tolerable pain. I myself and her psychiatrist worry that if her pain is not addressed that she will move closer to a permanent solution, and commit suicide. She's not there yet but if she can not find a solution to control her pain she may get there fast. She has tried the drugs (Lyrica, Savella and a few others) that are most used for Fibromyalgia and they either did not work or she suffered from the suicidal ideation side effects. Maybe that diagnosis is wrong. The main questions of this is: How are patients with multiple pain conditions and firbo best treated? Any advice would be appreciated.

Dear Karen: Certainly, her bipolar condition and PTSD are being aggravated by the constant pain that if suffered chronically,it may produce depression itself, and also the fibromyalgia pain is aggravated by the other conditions: osteoarthritis, degenerative disc disease. Besides she should quit smoking, this is very harmful for her because her high BP and cholesterol and also she should begin a nutritional regime combined with a consistent and customized exercising routine to lose weight. Definitely is not an easy case, and should be managed in a multidisciplinary way. First of all, she needs psychiatric help and commit for safety in the view of her suicidal ideation, this condition itself is sufficient to hospitalize her for a very severe depression. Secondly,to answer your question,although there is no cure for fibromyalgia, home treatment can relieve some of the symptoms and also help her with the other conditions. The most important therapy for muscle pain is regular, low-impact exercise. Keeping muscles conditioned and healthy by exercising three times a week decreases the amount of discomfort. It is important to try low-stress exercises such as walking, swimming, water aerobics, and biking rather than muscle-straining exercises such as weight training. Besides helping with tenderness, regular exercises can also boost energy levels and help her with sleep. No single treatment will take away all the symptoms associated with fibromyalgia. But most people do get some relief by trying a combination of therapies.’Lyrica’, ‘Cymbalta’ and Savella, These are the only three drugs approved by the U.S. FDA for the treatment of fibromyalgia. Lyrica is an antiseizure medication, while Cymbalta and Savella are antidepressants. All three have been shown to reduce the pain of fibromyalgia. Flexeril: This muscle relaxant not only decreases muscle pain but also improves sleep. Mirapex: This drug is used in the treatment of Parkinson's disease. When used to treat fibromyalgia, it may reduce pain in 80% of patients. Low doses of antidepressant medication are used in patients with chronic and difficult to treat pain, because these medicines improve sleep and decrease pain as well as eliminate depression. Biofeedback and relaxation techniques: Besides lessening pain, these therapies also decrease the number of tender points. Acupuncture: Multiple studies have shown that acupuncture can decrease tender point pain. Tender point injections: Steroid or lidocaine injections into a painful area may provide temporary relief. Massage therapy: This can help relax and soothe painful muscles.