Dr. Jacob Teitelbaum's Column
...expert advice on CFS, Fibromyalgia and other Health Topics.
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Monday, April 16th, 2012:
Ten Commonly Asked Questions About Fibromyalgia
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by Jacob Teitelbaum MD
There are some questions about fibromyalgia that seem to come up repeatedly. So I thought I'd share the answers to 10 of these in this article!
1. Can fibromyalgia cause a "pins and needles" sensation?
Fibromyalgia can cause a whole range of nerve sensations, including pins and needles. They occur mostly in the hands and feet (called paresthesias). If you don't have other nerve symptoms — such as severe, localized numbness or weakness — it's unlikely to be anything worrisome in FMS. Other types of nerve pain are also common in fibro — and natural treatments are very effective in reducing or eliminating them. Those treatments include daily doses of magnesium (200 mg), vitamins B6 (25 mg) and B12 (500 mcg), acetyl L-carnitine (1,500 mg) and lipoic acid (300 mg, twice daily). An excellent natural mix for people with nerve pain is called Healthy Feet and Nerves by EuroPharma. Effective medications for nerve pain include Neurontin, Ultram and Cymbalta (and many others). In most cases, arthritis medications such as ibuprofen are not effective.
2. Can fibromyalgia cause muscle twitching?
Visible muscle twitching, called fasciculation, is also common in fibromyalgia. Proper treatment of fibromyalgia with the S.H.I.N.E. protocol (Sleep, Hormones, Infections, Nutrition, Exercise) decreases the twitching. Magnesium is especially helpful.
3. Can fibromyalgia cause pain on the top of the skull?
Fibromyalgia can cause a lot of different pains, in a lot of different places. Sometimes it's sharp, electric, shooting-type nerve pain. But most often it's muscle pain from "trigger points" — either the bunched up "bellies" (middle) of tight muscles, or tender points where tight muscles attach to bone. Pain on the top of the skull is usually from tight muscles in the back of the neck, where they attach to the base of the skull. This pain "refers" (travels) to the top of the skull and also behind the eyes. Sometimes, another type of pain called allodynia, when even just a light touch on the skin is painful, is also present in fibromyalgia. Fortunately both pains generally respond well to overall treatment of fibromyalgia with S.H.I.N.E.
4. Can fibromyalgia cause shortness of breath?
Shortness of breath, or a sense of breathlessness (sometimes with chest tightness), is common in fibromyalgia. There are three main causes of this symptom:
- Hyperventilation. If when you're short of breath you also feel like you can't take a deep enough breath, you have numbness and tingling around the lips and perhaps in the fingers, you're dizzy, and you're anxious, then the problem is most likely hyperventilation. Basically, this is a severe anxiety attack — probably caused by feelings that you've previously buried that suddenly bubble to the surface during a period of relative calm, such as watching TV or driving a car. You can confirm this diagnosis by taking rapid, deep breaths for 30 to 60 seconds. If it's hyperventilation, your symptoms will dramatically worsen. Unfortunately, rapid, deep breathing while hyperventilating can also trigger a full-blown panic attack — so it's best done at home, in a place that feels safe to you (and please don't hate me too much when you try this!). One way to stop hyperventilation? Let your stomach expand at the end of each breath, which allows more air into your lungs.
- Feeling unable to take a deep enough breath, without associated anxiety or dizziness. This is very common in fibro, and is usually caused by tight muscles in the chest. A study conducted about15 years ago by the excellent physician and acupuncturist Neoh Aum Choo showed that the acupuncture points at the back of the skull (three on each side) can relieve this sense of breathlessness in fibromyalgia.
- On exertion. This is the least common type of breathlessness in fibro, and requires a medical evaluation to rule out a serious heart or lung problem. Once such problems are ruled out, treatment with ribose, coenzyme Q10 and acetyl L-carnitine can help.
5. Are there effective medications to treat fibromyalgia pain?
Three new medications have been approved for fibromyalgia pain: Savella, Cymbalta and Lyrica. They can help but they're also quite expensive — and older medications, available in cheaper, generic forms, are often more effective! These include Neurontin and Ultram, and also Skelaxin, which should go generic soon. Natural remedies can also relieve pain — without the side effects and at much lower cost. Try Curamin by EuroPharma and End Pain by Enzymatic Therapy. The best dosage to see the full effect is two caps, three times a day, for two to six weeks, (then lower the dose to a level that still relieves the pain). You can take those two natural supplements together, and also combine them with pain medications.
6. Is fibromyalgia just a form of depression?
Fibromyalgia and depression are two very different conditions. Fibromyalgia is characterized by widespread pain, insomnia, severe exhaustion and cognitive dysfunction — and is often a very severe illness. And depression can (and often does) accompany almost any severe illness. That's why one out of eight people with fibromyalgia also have depression. But they are two separate processes, and need to be addressed separately. Unfortunately, many physicians blame the fibromyalgia symptoms on the depression. That's like telling someone with cancer and depression that they're "just" depressed — and then denying them health and disability benefits for their actual disease! This is not only wrong-minded and unethical — it's downright abusive. How to distinguish between fibromyalgia and depression? Depression is usually associated with sadness and lack of interests. Fibromyalgia is usually associated with many interests, but with frustration over the lack of ability to do them. The two conditions are also very different biochemically. For example, cortisol levels are usually high in depression but low in fibromyalgia. Bottom line: fibromyalgia and depression are very different conditions, but both may be present in the same person.
7. Why do my arms hurt when I'm running on a treadmill?
Probably because you're using muscles you don't usually use, to either hold on to the bar or to keep your hands elevated. The solution? Instead of holding on to the bar for "dear life," rest your arms gently on the bar, letting it support your weight.
8. Is fibromyalgia causing my fever?
Although people with fibro often feel feverish, they normally have low body temperatures, under 98.6ºF. That's why I consider any temperature in fibromyalgia over 98.6ºF to be a fever. And if persistent, chronic temperatures over 98.6ºF are present, I look for evidence of an infection — typically sinus, dental, lung or bladder. For chronic sinusitis, treatment with antifungals is a must, because fungal infection is the root cause of the condition. However, an obvious source of infection usually is not found. In these cases, I recommend a six-week trial of antibiotics (either doxycycline or Zithromax) to see if it helps the fibromyalgia symptoms. (See Treating Hidden Antibiotic Sensitive Infections in CFS/FMS). Have you ever had a course of antibiotics that also improved your fibromyalgia symptoms? I am amazed at how often the answer is yes — but then the doctor refused to repeat the antibiotics. If one of my patients says yes to that question, I prescribe an extended trial of the antibiotic, as it usually continues to improve the fibromyalgia.
9. What causes fibromyalgia pain — and how do I make it go away?
Pain is like the oil light on your body's dashboard — it's telling you that something desperately needs attention. Now, when you put your hand on a hot stove or break your leg, the cause of the pain is obvious. But when metabolic problems trigger pain, the cause may not be clear. And in fibromyalgia, pain is usually caused by a body-wide energy crisis that locks your muscles in a shortened position, eventually causing widespread, chronic pain. In addition, chronic pain triggers "central sensitization" — your brain amplifies the muscle pain. The tight muscles also cause secondary nerve pain. This is the source of pain in fibromyalgia. Fortunately most people with fibro can get pain-free! When you put oil in the car, the oil light goes off. Our published, placebo-controlled research shows that when you treat fibromyalgia with the S.H.I.N.E. protocol, pain usually goes away — to a level where a person no longer even meets the definition of having fibromyalgia!
10. How can I get effective treatment for my fibromyalgia?
Our free Symptom Analysis Program can create a custom tailored S.H.I.N.E. protocol for your particular case (along with your symptoms, you can also enter the results of pertinent lab tests, if you have them). My article Eliminating Fibromyalgia Pain will show you more about freeing yourself from fibromyalgia pain. You can also learn more by reading my books From Fatigued to Fantastic, Real Cause Real Cure, and Pain Free 1-2-3!
In addition, now that I've finished my 4-year book writing sabbatical (during which I wrote 4 books), I am now doing both phone and in-person consultations, and physicians trained in the S.H.I.N.E. protocol who know how to treat you effectively can be found at Fibromyalgia and Fatigue Centers nationwide.
It's time for you to get your life and health back — now!
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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