Finding fibromyalgia relief

Thanks for joining our chat Feb. 23 with Dr. Paul Christo of Johns Hopkins to discuss fibromyalgia. The disorder, which causes muscle pain throughout the body and fatigue, affects 5 million Americans 18 or older, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Christo, director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine, answered reader questions on the nature of the disease and the latest treatments. Read the transcript below.

Find more live chats on a variety of health topics from national experts here.

Note: Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

 Health chat: Finding fibromyalgia relief(02/23/2011) 
Baltimore Sun Health: 
Hi, Dr. Christo will be joining us at noon, but feel free to submit your questions in advance.
Wednesday February 23, 2011 11:33 Baltimore Sun Health
Baltimore Sun Health: 
Welcome to our live chat on fibromyalgia. We have Dr. Paul Christo, a pain specialist from Johns Hopkins, to take your questions on treatments and research on the disease. We'll get to as many questions as we can within the hour. If we get many queries on similar topic, we will combine them and answer the one time.
Wednesday February 23, 2011 12:00 Baltimore Sun Health
[Comment From FredFred: ] 
I was diagnosed with fibromyalgia in 2007 but have had symptoms since 2005. Is it one of those conditions that once you have it, you can't get rid of it and can only attempt to treat it successfully? I've been treating it since 2008 with supplements with limited success.
Wednesday February 23, 2011 12:01 Fred
Fred, generally, fibromyalgia doesn’t go away on its own. Medications that are approved by the FDA for fibromyalgia are pregabalin (lyrica), duloxetine (cymbalta), and now milnacipran (savella). Consider trying one of these medicines along with a physical therapy program (like aquatherapy) for better pain control. Low impact exercises like walking, swimming, biking are typically encouraged. Restoring lost function is a prime goal in fibromyalgia treatment. Sodium oxybate has been impressively shown to decrease pain, fatigue, sleep problems, tender points in a few studies. In large doses, it can cause excessive sleepiness, and problems breathing (rare). It¿¿¿s not approved by the FDA for use yet, but it may be one of the most effective drugs for fibromyalgia.

Wednesday February 23, 2011 12:02 drchristo
[Comment From PJPJ: ] 
Hello Dr. Christo Do you know if there are any primary care physicians in MD who are knowledgeable about Fibromyalgia, if so can yuo make some recommendations? My problems have been not being able to get someone who has knowledge about my condition and they try to treat my other problems
Wednesday February 23, 2011 12:03 PJ
Baltimore Sun Health: 
Here is a specialist list from Fibromyalgia Association. The link is for Md. providers, but the site has them for other states as well:
Wednesday February 23, 2011 12:06 Baltimore Sun Health
PJ, I would seek out a rheumatologist or pain specialist that is knowledgeable about fibromyalgia and is wiling to treat you. It requries patience from both the patient and the doctor because there is no "quick fix". Progressive use of medications, an exercise program, and psychological support are often pretty helpful.
Wednesday February 23, 2011 12:07 drchristo
[Comment From KarenKaren: ] 
I was diagnosed with MS 5 years ago and recently diagnosed with fibromyalgia. I suffer from muscle pain as well as fatigue. Are these 2 diseases commonly linked and are the symptoms listed above most likely from fibromyalgia (not from MS)?
Wednesday February 23, 2011 12:08 Karen
Baltimore Sun Health: 
Here are some other informational sites on fibromyalgia:
Wednesday February 23, 2011 12:09 Baltimore Sun Health
Baltimore Sun Health:
Wednesday February 23, 2011 12:09 Baltimore Sun Health
Baltimore Sun Health:
Wednesday February 23, 2011 12:09 Baltimore Sun Health
I'm not aware of a connection between MS and fibromyalgia. Conditions like interstitial cystitis, hepatitis C, irritable bowel syndrome are often connected, though. The fatigue is most likely associated with the fibromyalgia as well as the muscle pain. MS patients do complain of pain and it can be from muscle spasm or later, increased muslce tone. MS patients also complain of nerve pain like shooting or pins and needles.
Wednesday February 23, 2011 12:13 drchristo
[Comment From KathyKathy: ] 
Can you recomend any new medications such as miraplex, milnacaprin, sodium oxbate, pregabalin, equilibrant, etc.
Wednesday February 23, 2011 12:14 Kathy
Baltimore Sun Health: 
We have a few related sodium oxybate questions too, which Dr. Christo will answer in conjunction with Kathy's.
Wednesday February 23, 2011 12:15 Baltimore Sun Health
[Comment From ss: ] 
what is sodium oxybate?..... is it accessible?
Wednesday February 23, 2011 12:15 s
[Comment From PJPJ: ] 
Hello Dr. Christo; can you tell me what sodium oxybate is? a medication, or a suplement?
Wednesday February 23, 2011 12:15 PJ
[Comment From PJPJ: ] 
Thank you very much
Wednesday February 23, 2011 12:15 PJ
Sodium oxybate has been impressively shown to decrease pain, fatigue, sleep problems, and tender points in a few studies. In large doses, it can cause excessive sleepiness, and problems breathing (rare). It¿¿¿s not approved by the FDA for use yet, but it may be one of the most effective drugs for fibromyalgia.

Milnacipran (savella) is more recently approved by the FDA for the treatment of fibromyalgia. The dose starts low and then increases to a maximum of 200 mg per day. It increases levels of serotonin and norepinephrine in the body which helps to decrease pain. Pregabalin is also approved for treatment. It¿¿¿s an anticonvulsant that works on altering different pain pathways in the body to reduce pain.
Wednesday February 23, 2011 12:18 drchristo
[Comment From GuestGuest: ] 
It is common for people with Fibromyalgia to suffer from other ailments. What is known about the link between or frequent concurrence of Fibromyalgia, Inflammatory Bowel Disease, reproductive health problems (e.g., Endometriosis), and mental health issues (e.g., ADD, depression, anxiety)?
Wednesday February 23, 2011 12:19 Guest
Yes. It is often associated with sleep disorders, bowel irritability, and mood changes (depression). Patients can describe tension headaches, and fatigue too. I'm not aware of a link between fibromyalgia and reproductive problems, but interstitial cystitis/ female urethral syndrome is associated with fibromylagia.
Wednesday February 23, 2011 12:24 drchristo
[Comment From LindaLinda: ] 
Is fibro considered a form of arthritis?
Wednesday February 23, 2011 12:25 Linda
Fibromyalgia is a disease unto itself. It should be confirmed by its own clinical findings from a history and physical examination. There are specific criteria (based on the American College of Rheumatology) for proper diagnosis, and then conditions that can resemble fibromyalgia like myofascial pain syndrome, hypothyroidism, and chronic fatigue should be ruled out. It's not a form of arthritis; rather, it's believed to result from a problem with the pain processing areas in the spinal cord (central nervous system sensitization).
Wednesday February 23, 2011 12:33 drchristo
[Comment From VeronicaVeronica: ] 
Diagnosed in april 2010 and I stopped taking all medications because of side effects. I have sharp pain in my groin area and my gyn says it"s from Fibro. How do you know if there is something seriously going on when all the doctors blame it on Fibro?
Wednesday February 23, 2011 12:34 Veronica
If the gyn has ruled out other causes of the pain in the groin (nerve contriction, hernia, or from the pelvic organs), then something serious is probably not occuring. If you've tried all medications, then consider acupuncture and biofeedback because they have shown to be effective in some studies.
Wednesday February 23, 2011 12:38 drchristo
[Comment From DebbyDebby: ] 
Dr Christo, what is the current thinking on the causes of fibromyalgia. It is my understanding that problems with lack of deep sleep can bring on the symptoms of fibromyalgia,but is not necessarily the cause of it.
Wednesday February 23, 2011 12:39 Debby

The cause is unclear, but the evidence points to a problem with how pain is processed in the central nervous system (spinal cord and brain). There are associations with a number of triggers such as stressufl or traumatic events as well as repetitive injuries, and certain diseases like Lyme disease, Lupus, and anklosing spondylitis. Viral infections like Hepatitis B and C, and HIV are also associated with the development of fibromyalgia.

Sleep is often disturbed and specifically a lack of deep sleep, but sleep is not disturbed in all patients adn restoring sleep does not fully improve the symptoms or pain and fatigue.
Wednesday February 23, 2011 12:44 drchristo
[Comment From mary trottamary trotta: ] 
After years of symptoms of extreme fatique, all over aches(flu-like symptoms),lethargy, pelvic pain which I was attributing to chronic UTI condition, my last urologists mentioned fibromyalgia. Exactly what are the symptoms OF FIBROMYALGIA. My symptoms will sometimes abate and I can have a few "good" days in a row. I have also been on Tamoxifen four last 4 years.
Wednesday February 23, 2011 12:48 mary trotta
Fibromyalgia typically presents as widespread pain involving both sides of the body, above and below the waist as well pain in the axial skeleton (spine) that lasts for at least 3 months. Patients present with 11 tender points among nine pairs of specific sites in the body. Fibro is associated with other things like fatigue, insomnia, headaches, bowel and bladder irritabilty, and cognitive (thinking) disturbances.
Wednesday February 23, 2011 12:52 drchristo
[Comment From MeredithMeredith: ] 
My mom was recently dx with fibromyalgia. Her insurance will no longer cover Lyrica or Celebrex. Any drug recommendations for her?
Wednesday February 23, 2011 12:53 Meredith
Drugs like nortriptyline or amitriptyline can be considered. These drugs have been among the most thoroughly studied in fibro, even though they aren't approved for the condition. they are not particularly expensive either. Tramadol, cyclobenzaprine, and fluoxetine have also shown effectiveness.
Wednesday February 23, 2011 12:56 drchristo
[Comment From CindyCindy: ] 
I am a RN and I work with fibro and fatigue patients. How do environmental toxins affect Fibro symptoms. Toxins such as those found in personal care and cleaning products? Formaldehyde is used widely in personal care products as a preservative. I look forward to hearing your response.
Wednesday February 23, 2011 12:56 Cindy
Cindy, Many patients report increased sensitivity to physical and environmental stimuli, like pressure, heat, cold, electricity, hypertonic saline (hi concentration salt water) and sounds. There is evidence that patients are also hypersensitive to weather and chemicals. These stimuli have been tested and measured in human pain for fibromyalgia patients and other conditions like chronic fatigue, irritable bowel, and tension type headaches. I¿¿¿m not sure that specific cleaning products have been tested, but I would consider avoiding such chemicals if they are triggering or worsening symptoms.

Wednesday February 23, 2011 12:58 drchristo
Baltimore Sun Health: 
That's all of the time we have for today. I hope we answered a wide enough variety of all the questions that came in. It was quite a hot topic. We'll be back at in two weeks to discuss another pain issue.
Wednesday February 23, 2011 12:59 Baltimore Sun Health
Thank you. Great questions.
Wednesday February 23, 2011 1:00 drchristo