Updated August 16, 2002
Q. Does fibromyalgia cause any joint or
tissue damage, or abnormal laboratory studies?
A. No. To date, there has been no evidence
indicating any consistent demonstrable abnormality in any body
tissues. In pure fibromyalgia, physical examination, laboratory
studies and X-rays are all normal, with the sole exception of
subjective muscle tenderness.
Q. How is fibromyalgia diagnosed?
A. The diagnosis is made by a history of
chronic muscle pains and the finding of muscle tender points in
specific areas.
Q. Are there any homeopathic or herbal
medications or vitamins that are proven to be of help in relieving
the symptoms of fibromyalgia?
A. Outside of anecdotal reports, none seem
to have any consistent effect in relieving symptoms.
Q. Do you recommend the use of narcotics/opiates
in the treatment of fibromyalgia?
A. We have long recommended the avoidance
of narcotics/opiates in the treatment of fibromyalgia. These drugs
have high addictive potential and often the doses of medication
must be continually increased for pain relief. We are aware that
some physicians advocate drugs such as Vicodin and methadone for
fibromyalgia, however we definitely advise against this! The proper
treatment of fibromyalgia consists of stress reduction, relaxation
techniques, graduated exercises and, when needed, psychological
counseling. Any medications chosen for the treatment of fibromyalgia
should be relatively safe and with no or a very low potential
for addiction and abuse.
Q. What is bursitis or tendinitis?
A. Bursitis simply means inflammation
of a bursa. It is often, although not always, associated with
pain. A bursa is a small sac filled with a small amount of fluid
that is found between certain muscles, muscles and tendons, tendons
and bone, etc.. Its function is to act as a medium to prevent
friction between tissues. It helps muscles, tendons, etc. to slide
over each other. There are many bursas in the body - particularly
in the areas of the shoulders, the elbows, the hips, the knees
and the Achilles tendon areas. The illustration below shows a
bursa in the shoulder, called the subacromial bursa. The biceps
tendon and anatomy of the shoulder are also seen.
Tendinitis is an inflammation of a tendon. Tendons attach
the muscles to the bones. There are many tendons in the body -
in the shoulders, hands, knees, feet and ankles, as examples.
Q. What are the symptoms of bursitis or
tendinitis?
A. Either of these conditions cause pain
on motion of the inflamed area. The pain can also be present at
rest.
Q.What causes bursitis or tendinitis?
A. These conditions may be caused by "wear
and tear", or may occur seemingly spontaneously. Calcium
deposits are not infrequently seen on X-ray in areas of chronic
bursitis or tendinitis.
Q. How are they treated?
A. There are a variety of therapies. A week
of resting the area may help. Non-steroidal agents such a ibuprofen,
naproxen and a host of other agents can be effective. Liniments
may give short term relief. A trained physical therapist may be
of value. Often, an injection of lidocaine and a corticosteroid
such as methylprednisolone can give prompt relief. In recalcitrant
cases, surgery may be necessary.
Q. What is trochanteric bursitis? (Bursitis of the hip area)
A. We are frequently asked questions about pain on the lateral aspect of one or both hips. Often (but certainly not always), the diagnosis is "trochanteric bursitis." This means inflammation of a bursa in the trochanteric area of the femur. The condition is somewhat similar to bursitis of the shoulder. There are many causes for this. It is commonly seen in athletes who overuse the hip areas without proper stretching and warm-up. It also occurs often with any type of low back pain or syndrome - probably because of alterations of the gait. Differences in leg length may also contribute to the causes of trochanteric bursitis.
Treatment initially consists of non-steroidal anti-inflammatory medications if they are tolerated. Physical therapy by a trained therapist is often helpful. This treatment consists of stretching exercises, the application of heat and/or cold, ultrasound, etc. Injections of medications such as lidocaine and a cortisone derivative into the area are often used and may be of great help. Shoe lifts may help if there is a discrepancy in leg length. Surgery is reserved for refractory cases and may consist of iliotibial band release with excision of the bursal sac and removal of calcified tissue. This is rarely done, however. In our experience, acupuncture is not effective, but may be worth a try. It is also important to rule out other causes of the pain, of which there may be many.
See if your library has a copy of Dr. Paul Davidson's book Are You Sure It's Arthritis?: A Guide to Soft Tissue Rheumatism. There are excellent chapters on all forms of soft tissue rheumatism.
For those who wish to pursue the matter further, we suggest getting a copy of the article "Trochanteric Bursitis (Greater Trochanter Pain Syndrome)." Mohammad I Shbeeb, M.D. and Eric L. Matteson, M.D., Mayo Clinic Proceedings, 1996, 71:565-569. It is up-to-date and will be of interest to you and your physician.
Q. What are the differences between polymyalgia
rheumatica (PMR), giant cell arteritis (GCA) and fibromyalgia
(FMS)?
A.There are many differences. PMR and GCA
are inflammatory conditions associated with a high sedimentation
rate, usually over 50 mm/hr. FMS has no known inflammatory component,
and the sedimentation rate is expected to be normal.
PMR and FMS can both cause muscle pain, however the muscle stiffness
and joint motion limitation are usually more severe in PMR.
In PMR, the gender distribution is close to even between males
and females. In FMS, females account for 90 to 95% of the cases.
The age distribution differs. PMR affects primarily people over
the age of 50 years, and the incidence increases with age. FMS
affects people primarily in the age group from 20 to 50 years,
however it can occur in children and those over 50 years of age.
PMR is often associated with GCA. This condition (giant cell arteritis
- not arthritis) causes inflammation of the arteries, and
can cause severe headaches and even blindness unless promptly
treated.
Q. Is there a difference of treatments
in the cases of PMR, GCA and FMS?
A. Absolutely! PMR and GCA are treated with
corticosteroids, such as prednisone. The therapy can last a year
or more. Prednisone has no place in the treatment of pure FMS
(unless the FMS is associated with an illness that requires prednisone).
FMS is treated with a multidisciplinary program including physical
therapy, stress reduction, amitriptyline (or the like) and psychological
counseling as needed.
For more detailed information, see if your library has a copy of Dr. Paul Davidson's book Are You Sure It's Arthritis?: A Guide to Soft Tissue Rheumatism, published in 1985. The book is out-of-print, but has an excellent chapter on PMR and GCA. Not much has changed in this area since 1985.