Q: I am a 64-year-old woman who has suffered from fibromyalgia for several years. I get a lot of pain in my legs and back and have to take Tylenol every day. I have heard that an antidepressant medication can help. I am a little depressed, but that is because of being in pain all the time. Do you think it would also help the pain?
A: Fibromyalgia, which used to be known as fibrositis, is a chronic painful condition that seems to affect mainly women. Pain is in many parts of the body, including muscles, ligaments and tendons.
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The pain is usually accompanied by stiffness in the muscles and joints and a general fatigue. It is often associated with a condition known as chronic fatigue syndrome. Although symptoms may last from months to years, it is not life threatening, and the symptoms do not get any worse with time. In fact, they can disappear of their own accord in an average of two years from the onset.
Doctors are not sure of the causes of fibromyalgia syndrome, but one theory is that the brains of sufferers appear to be more sensitive to the perception of pain than others.
In other words, you have a lowered pain threshold. You may also be more sensitive to loud noises and bright lights. A lack of sleep or poor sleep pattern has also been blamed.
People with fibromyalgia often wake up tired and unrefreshed, even though they think they have had plenty of rest. A depressed mood often accompanies fibromyalgia, but it is not clear whether it is part of the syndrome or merely a result of being in constant pain.
Various situations have been thought to trigger fibromyalgia syndrome, including accidents or injuries and bacterial or viral infectious diseases. Acute or chronic psychological stress can also be a trigger. Marital, work or other relationship difficulties might be examples of such stress factors. Hormonal changes have also been implicated.
Before undergoing treatment, you should first receive a thorough medical checkup, which might include seeing an appropriate specialist such has an endocrinologist or a neurologist because undetected medical conditions are often mislabelled. An underactive thyroid gland, known as hypothyroidism, is one of the most common causes. Auto-immune diseases such as rheumatoid arthritis or lupus should also be ruled out.
If your doctors have not found any underlying medical conditions, then you may need treatment with antidepressant medications such as Elavil (Amitriptyline) or Surmontil (Trimipramine). The newer antidepressants such as Prozac and Effexor are not as useful because they tend to be less sedating and may cause anxiety symptoms.
The sedating effect of these medications is part of the treatment so that you get a deep and restful sleep.
Long-term use of pain killers is not recommended because after a week or two they will lower your pain threshold even more. It is better to try and build up a better tolerance to pain by training your brain to cope without the use of analgesics. Codeine-containing painkillers such as Tylenol No. 3 are famous for leading to addiction and dependency problems.
Elavil is thought to have a positive effect on chronic pain as well as being a tricyclic antidepressant, but it is not classified as an analgesic. You will not become psychologically or physically dependent on it.
Gentle exercise also appears to be beneficial in fibromyalgia sufferers. This could include walking, swimming or stretching exercises such as yoga. You may not feel like doing any exercise to start with, but eventually you will start to improve.
If there is marital, family or work stress, you may need to address these with the help of a psychotherapist.
Clare Rowson is a retired medical doctor living near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
