tazzygirl
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quote:
ORIGINAL: DomKen
quote:
ORIGINAL: tazzygirl
quote:
If muscles etc. were the source of the problem then why do SNRI's work so well for so many?
Pain causes depression. Not all fibro patients are depressed. Not all fibro patients respond to SNRI's. But imagine the level of depression after dealing with the pain for years before most people are diagnosed. Of course SNRI's are going to be beneficial.
No. The study that tested the SNRI showed a marked decrease in pain associated with FM soon after taking the drug started (1week) which is too fast for for it to be simply a matter of getting better sleep.
http://www.ncbi.nlm.nih.gov/pubmed/19108787
Getting better sleep in just a few days can have amazing rejuvenating abilities.
Abstract
Purpose Published evidence on the pathophysiology, diagnosis, and treatment of fibromyalgia is reviewed, with an emphasis on recent clinical trials of various pharmacologic agents. Summary Fibromyalgia affects an estimated 2% of the general U.S. population, and its incidence is sevenfold higher among women. The diagnostic characteristics of fibromyalgia are chronic widespread pain, thought to arise from abnormalities of ascending pain and descending inhibitory sensory pathways, and allodynia on palpation of specific tender points. Three medications available in the United States are labeled for treatment of fibromyalgia-related symptoms: the serotonin- and norepinephrine-reuptake inhibitors duloxetine and milnacipran and the α(2)-δ ligand pregabalin. Evidence from clinical trials indicates that all three drugs can have a significant impact on fibromyalgia-related pain; duloxetine and pregabalin have been demonstrated to reduce sleep disturbances and improve quality of life (the former also has been shown to improve mood), while milnacipran can offer significant benefits in reducing fatigue. A growing body of evidence suggests that the best treatment approach may involve the use of one or more agents whose mechanisms of action are aligned with patient-specific clusters of symptoms. Several other agents have been used for fibromyalgia, with mixed results, including tricyclic antidepressants, selective serotonin-reuptake inhibitors, opioids, and gabapentin. Given the limitations of the evidence from clinical trials to date, controlled trials directly comparing different agents are needed to better delineate adverse-event risks, cost considerations, and optimal management approaches. Conclusion A broad range of drugs has been used to treat fibromyalgia. Symptoms, comorbidities, adverse effects, and patient preference are important considerations in drug selection.
http://www.ncbi.nlm.nih.gov/pubmed/21719591
RESULTS AND CONCLUSIONS:
We found eligible studies of treatment for fibromyalgia with amitriptyline, nortriptyline, citalopram, fluoxetine, paroxetine, cyclobenzaprine, pregabalin, gabapentin, milnacipran, and duloxetine. We found no eligible studies with the other included drugs and no eligible studies of included interventions when used as adjunctive therapy. Head-to-head trials were few, and provided low-strength evidence that short-term treatment with immediate-release paroxetine is superior to amitriptyline in reducing pain and sleep disturbance and provided low-strength evidence there are no significant differences between amitriptyline as compared with cyclobenzaprine and nortriptyline. Although there were some significant differences between drugs in overall adverse events, they did not produce any differences in withdrawals due to adverse events. Additionally, based on indirect comparison meta-analysis, we found low evidence that duloxetine was superior to milnacipran on outcomes of pain, sleep disturbance, depressed mood, and health-related quality of life. We found low evidence that both duloxetine and milnacipran were superior to pregabalin on improvement in depressed mood, whereas pregabalin was superior to milnacipran on improvement in sleep disturbance. Amitriptyline was similar to duloxetine, milnacipran, and pregabalin on outcomes of pain and fatigue, with insufficient data on the other outcomes. Although there were some significant differences between duloxetine, milnacipran, and pregabalin in specific adverse events, they did not produce any differences in overall withdrawals, overall adverse events, and withdrawals due to adverse events
http://www.ncbi.nlm.nih.gov/pubmed/21678632
Abstract
Disordered sleep is such a prominent symptom in fibromyalgia that the American College of Rheumatology included symptoms such as waking unrefreshed, fatigue, tiredness, and insomnia in the 2010 diagnostic criteria for fibromyalgia. Even though sleep recording is not part of the routine evaluation, polysomnography may disclose primary sleep disorders in patients with fibromyalgia, including obstructive sleep apnea and restless leg syndrome. In addition, genetic background and environmental susceptibility link fibromyalgia and further sleep disorders. Among nonpharmacological treatment proposed for sleep disturbance in fibromyalgia, positive results have been obtained with sleep hygiene and cognitive-behavioral therapy. The effect of exercise is contradictory, but overweight or obese patients with fibromyalgia should be encouraged to lose weight. Regarding the approved antidepressants, amitriptyline proved to be superior to duloxetine and milnacipran for sleep disturbances. New perspectives remain on the narcolepsy drug sodium oxybate, which recently was approved for sleep management in fibromyalgia.
http://www.ncbi.nlm.nih.gov/pubmed/21594765
Fibro isnt just one single thing, as all these studies show. Its pain, its sleep disturbances, its the inability to heal... its many things. Labling it all in the "brain" is discounting many things, including the actual pain of the patient. Not a single study listed above, and others from the same site, did not include sleep as a problem. In fact, each went out of its way to state the ability of the meds to actually help with sleep deprivation. There is a reason for that.
Sleep dysfunction is considered an integral feature of fibromyalgia syndrome. Seventy percent of patients with fibromyalgia recognize a connection with poor sleep and an increased pain, along with feeling unrefreshed, fatigued, and emotionally distressed. Several studies have linked abnormal sleep with these symptoms.
Some authors describe the altered sleep physiology and somatic symptoms as a nonrestorative sleep syndrome. This sleep dysfunction is believed to be linked to the numerous metabolic disturbances associated with fibromyalgia, including abnormal levels of neurotransmitters (serotonin, substance P) and neuroendocrine and immune substances (growth hormone, cortisol, and interleukin-1). These authors propose that these metabolic imbalances are responsible for the increase in symptoms associated with this alpha-wave intrusion sleep disorder by impairing tissue repair and disturbing the immunoregulatory role of sleep. Studies show that the greatest amount of alpha-wave intrusions occur during the first few hours of sleep, decreasing throughout the night to normal levels by early morning. Some researchers note that this hypothesis correlates well with patients' frequent reporting that their best sleep is obtained in the early morning hours just prior to arising.
Prognosis:
Fibromyalgia is not a life-threatening, deforming, or progressive disease. The symptoms are variable. Without proper diagnosis and treatment, the patient may have the illusion of disease progression. This illusion does not occur as a result of disease, but as a result of sleep deprivation and physical deconditioning. Some investigators state that, with the proper treatment and a caring informed physician, patients with fibromyalgia should be able to improve their function and reduce their pain.
http://www.fmscommunity.org/fibro.htm
Its actually quite a comprehensive article.
In conclusion, FM isnt just "one thing". But the one thing they all agree on is the sleep problems.
During the deep stages of NREM sleep, the body repairs and regenerates tissues, builds bone and muscle, and appears to strengthen the immune system. As you get older, you sleep more lightly and get less deep sleep. Aging is also associated with shorter time spans of sleep, although studies show the amount of sleep needed doesn't appear to diminish with age.
http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/sleep-101
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RE: Over stimulation with pain, causes Fibro? - 
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