What the Heck is Fibermyalgia?

The cause of fibromyalgia (FM) is unknown but theories pointing toward abnormal hypothalamic pituitary axis function or dysfunction of neurotransmitter pathways in the brain are currently popular.

Several studies have demonstrated different abnormalities in central nervous system functioning. Abnormal sleep studies showing alpha intrusion during delta (stage 4) sleep and a reduction of rapid eye movement (REM) sleep have been seen. In addition, abnormal SPECT scans have suggested lower blood flow to the thalamus and caudate nucleus in the brains of fibromyalgia patients.

Approximately 2 percent of the population has fibromyalgia. About 80 percent of patients with fibromyalgia are women. While fibromyalgia may occur as a primary condition, it is also a secondary condition, occurring in as many as 30 percent of patients with systemic lupus erythematosus and rheumatoid arthritis.

Patients with fibromyalgia complain of generalized pain affecting both sides of the body and both the upper as well as lower part of the body.

Pain tends to be aggravated by weather changes as well as by stress.

While patients will complain of subjective joint swelling, objective swelling is absent.

Sleep disturbance occurs in almost all patients. Complaints of chronic fatigue and non restorative sleep (feeling as if they haven’t slept) are common. Sleep apnea may aggravate the situation.

Tender trigger points are noted in all patients. A patient with 11 of 18 tender trigger points fulfills a major diagnostic criterion for the diagnosis of fibromyalgia. These trigger point tender areas are stereotypic meaning the same areas are tender in all patients with the diagnosis of FM..

Other symptoms include migraine headache, decrease in short term memory, cognitive dysfunction, blurred or double vision, hypersensitivity to sound and smells, shortness of breath, chest pains, palpitations, irritable bowel, irritable bladder, painful menses, painful urination, multiple drug allergies, multiple sensitivities to chemicals.

Laboratory testing will not be diagnostic. However, laboratory testing will help to exclude other conditions such as polymyalgia rheumatica, hypothyroidism, rheumatoid arthritis, systemic lupus erythematosus, etc., that might masquerade as fibromyalgia. FM is a diagnosis of exclusion so it is imperative that other possible causes of aches and pains are ruled out.

Imaging tests may also be helpful in establishing the presence or absence of FM.

Treatment must be individualized. Most patients will respond to a combination of non impact aerobic exercise (swimming, stationary bike, elliptical trainer), cognitive behavioral therapy, and medication.

Medications that have been found to be helpful include tricyclic antidepressants in low doses, muscle relaxants such as cyclobenzaprine, also in low doses, and selective serotonin reuptake inhibitors (SSRIs).

Pain Medication You Can Legally Order Online

Millions of American live with pain. Chronic pain, daily pain, short term severe pain. Of all the medications sold by online pharmacies, by far the most common type is pain relievers. You might think then that online pharmacies are a great source of pain relievers.

Well, did you know the Drug Enforcement Agency of the United States (DEA) has busted and close over 5000 online pharmacies? Did you know that many online pharmacies sell counterfeit medication? Did you know it is a federal crime for you to order prescription drugs from outside the United States?

It is true, online pharmacies are a great source of pain relief medication. This article teaches you to order pain medication legally, from within the United States, with a legal prescription. It’s the only way to go!

First, the caveats: You cannot legally order medication from outside the United States, even if you have a prescription. We always hear about the elderly taking buses to Canada to buy cheap medicine. The fact is, as of this writing, this course is illegal. Also, you cannot legally order medicine from a pharmacy without a prescription. Many online pharmacies (including my own) have physicians on staff who review your medication request and write you a prescription if they think it’s safe. In addition, NEVER order narcotics through the mail. Forget codeine, Tylenol #3, oxycontin, demerol, percodan and percocet. You can be charged with a federal crime for buying these substances. Lastly, regardless of the medication you buy, be sure to read the package insert (or a monograph on my web site). Drugs interact with each other and with your body- the package insert will tip you off to potentially dangerous behavior with respect to the medication you ordered.

The following are quick summaries of common pain relief drugs you can order through the Internet with very little risk:

Fioricet (butalbital)

Fioricet is a combination drug. It is made up of acetaminophen, caffeine and butalbital. Acetaminophen is the same medication in Tylenol You know caffeine from coffee (or even your favorite candy bar.) Butalbital is a mild barbiturate. It relaxes you.

Medical Science does not have an explanation for the reason this combination of drugs works so well, but the fact is Fioricet (and its generic form butalbital) is highly effective for tension headache. Presumably, it relaxes the muscles in the head and neck which typically tighten during tension headaches.. This is the top selling drug at our pharmacy month after month- it really helps headaches!

Soma (carisoprodol)

Soma is a muscle relaxant. It acts by blocking electrical signals among nerves in the reticular formation of the brain and in the spinal cord. Carisoprodol, combined with rest and physical therapy, is prescribed for the short term relief of painful muscle conditions- particularly muscle spasm (where the muscle tightens and does not relax). Most back strains result in muscle spasm, so patients find carisoprodol highly effective in relieving back pain.

Celebrex (celecoxib)

Celebrex is used in the treatment of symptoms of arthritis. This includes joint pain, stiffness, swelling and inflammation. The medication does not cure arthritis, but does provide symptomatic relief. It s a nonsteroidal anti-inflammatory drug (NSAID) which relieves pain and inflammation. The drug works by blocking the production of prostaglandins in the body. Prostaglandins contribute to the pain and swelling associated with arthritis.

Ultram (tramadol)

Ultram is used for treatment of moderate to severe chronic pain. It binds to the opiod receptors on nerves (the same mechanism used by narcotics), but it has a far lower potential for dependency. It’s the closest medication to a narcotic you can order legally in the US online. It is not a NSAID (nonsteroidal anti- inflammatory drug) and does not carry the risk of stomach ulceration and internal bleeding which can accompany the use of such medications. It is often prescribed for pain associated with shingles, fibromyalgia and other chronic diseases.

Ulracet

Ultracet is a combination of acetaminophen and tramadol. It is typically prescribed for the short term (up to five days) relief of moderately severe acute pain. It is often prescribed for post-surgical pain or after dental procedures.

The ultram mechanism as described above is very similar to the mechanism employed by narcotics. Acetaminophen of course is the active ingredient in Tylenol. It works by increasing the threshold to pain (i.e. it takes more pain stimulus to cause the sensation of pain). These two drugs work by different mechanisms, and they combine to be more effective than either drug alone.

Pain relief medication can be ordered safely online, but one should exercise appropriate caution before doing so. Specifically, it’s important to determine whether you need to see a physician before ordering pain medication. If you have a sudden onset of pain which is not readily explained, you should consult a physician first. If in doubt, go to the emergency room. If however you are a patient who has been diagnosed, and pain is a recurring problem, you can conveniently order pain medication online- typically at a lower cost than the combined cost of a doctor’s appointment and the medication itself.