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April 12, 2005
By Kathleen Louden
It took Deborah Gillaspie seven years and four doctors to learn that her chronic pain was due to fibromyalgia, and another seven years to find effective treatment.
"'Fibromyalgia' doesn't show up on an X-ray, so some doctors made me feel it was in my head," says Gillaspie, 49. "I was 39 when I was diagnosed and was basically told to 'live with it,' since there's no cure."
Gillaspie is one of an estimated 3 million to 6 million Americans with fibromyalgia, 80 to 90 percent of whom are women, according to the American College of Rheumatology.
Fibromyalgia can be difficult to diagnose and even harder to treat. But recent advances are ushering in a new era for sufferers.
Diagnosis is based on a history of pain all over the body lasting more than three months and the presence of at least 11 of 18 tender points -- spots on the body where slight pressure causes an exaggerated pain reaction. Because there is no diagnostic lab test, doctors must exclude other conditions that cause muscle pain, stiffness and fatigue.
Most women wait three or four years to get a correct diagnosis of fibromyalgia, says Lynne Matallana, president and co-founder of the National Fibromyalgia Association. That's an improvement over five years ago, when diagnosis averaged nearly eight years, research has shown.
People are being diagnosed more quickly partly because of increased awareness of the condition, says Dr. Jeffrey Oken, medical director of Marianjoy Rehabilitation Hospital's Integrative Pain Treatment Center in Oakbrook Terrace.
"The credibility problem with fibromyalgia is reducing yearly," says Dr. Robert Katz, a rheumatologist at Rush University Medical Center.
Traditional drug therapy depends on a patient's symptoms. It may include one or more of the following, Katz says: muscle relaxants, low-dose antidepressants prescribed to help sleep or fatigue -- often a problem in these patients -- or to relieve pain, and sometimes non-narcotic pain relievers.
Doctors treat fibromyalgia with medications that the U.S. Food and Drug Administration has approved for other purposes. But pharmaceutical companies are conducting clinical trials with several medications designated for fibromyalgia treatment, a step in seeking FDA approval for that use. The investigational drugs include a new class of antidepressants, epilepsy drugs and a potent hypnotic.
The September issue of the journal Arthritis & Rheumatism contained results of a study of the new antidepressant duloxetine in more than 200 fibromyalgia patients. Lead author Dr. Lesley Arnold, associate professor of clinical psychiatry at the University of Cincinnati College of Medicine, says it was the largest study to show that duloxetine reduces fibromyalgia pain and tenderness in women. Symptoms improved even in women without depression, she says.
Duloxetine belongs to a newer class of antidepressants called serotonin and norepinephrine reuptake inhibitors, or SNRIs. These drugs raise levels of two brain chemicals whose shortages are associated with pain, fatigue and depression. These medications have fewer side effects than tricyclic antidepressants, such as amitriptyline, which usually are prescribed first for fibromyalgia, Arnold says.
Sometimes fibromyalgia patients are prescribed selective serotonin reuptake inhibitors, or SSRIs, such as Prozac and Zoloft, to reduce fatigue. But these antidepressants do not help fibromyalgia pain, says Dr. Michael McNett, medical director of the Chicago-based Fibromyalgia Treatment Centers of America. McNett puts patients taking these drugs on SNRI therapy, and "they often improve," he says.
Another SNRI under study is milnacipran. The drug has not been approved by the FDA, but it is approved to treat depression in more than 30 countries outside the U.S., according to its manufacturer, Cypress Bioscience Inc. in San Diego. The company expects to have initial results of its fibromyalgia study in the fall, spokeswoman Mary Gieson says.
Other drugs that may help some fibromyalgia patients include medications used to prevent seizures. Two, gabapentin and pregabalin, are approved for treating some types of nerve pain but not fibromyalgia.
The University of Cincinnati is among the centers studying pregabalin in patients. "Early results look promising for benefit in fibromyalgia," Arnold says.
Another type of drug that may help reduce fibromyalgia symptoms is a new sleep-inducing drug, sodium oxybate. Used in patients with the sleep disorder narcolepsy, this medication improved fibromyalgia-related pain, fatigue and disruptive sleep in small studies.
Despite the promise of new drug therapies, there is no magic bullet for a syndrome that may have multiple causes. "There hasn't been a startling breakthrough therapy that's going to save patients with fibromyalgia," Oken says.
Non-drug therapies continue to play an important role in controlling symptoms. One of these is regular exercise.
If a patient has severe symptoms, Oken recommends a chronic pain program that has specialists from multiple medical disciplines.
Doctors caution that not every treatment works for every person. Researchers looking for effective treatments still "have a long way to go," Katz says.
The Fibromyalgia Association's Matallana says recent medical advances give her hope.
"With new medications and new interest in doctors diagnosing and treating this illness, people will find that there will be more help for them," she says.
Source: www.rep-am.com. Copyright © 2005 AP Wire
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