Dealing With Bipolar Disease

Fibromyalgia (FM) is a condition characterized by chronic, widespread pain in muscles and soft tissues accompanied by fatigue. It is an extremely common condition that is often underdiagnosed or misdiagnosed because it does not cause any structural damage in an organ and there are no specific laboratory tests that point towards its presence.

Fibromyalgia, affects approximately 2% of the US population. It is considered the prime example of a group of diseases that are called central sensitization syndrome (CSS).

These diseases are based on neurochemical abnormalities and include irritable bowel syndrome, irritable bladder syndrome, migraine headache, Persian Gulf Syndrome, and restless legs syndrome.

FM occurs when the central nervous system (spinal cord and brain) becomes sensitized in different areas of the body, so that even mild pressure or touch will cause much pain. Such hypersensitivity may also be associated with other symptoms such as poor sleep and fatigue.

Recent research has documented changes using both PET and MRI scanning in neurochemical reactions within the brains of patients suffering from FM.

It is important to approach the patient in a standard diagnostic fashion so that conditions that can mimic FM be excluded. These include rheumatoid arthritis, systemic lupus erythematosus, inflammatory muscle disease, osteoarthritis, and hypothyroidism.

Once the diagnosis has been made, then the patient needs to be informed as to the need for specific treatment measures. These include a combination of cognitive behavioral therapy, non impact aerobic exercise, and medication. Without the integration of all of these modalities, optimal results will not be achieved.

The patient needs to realize that they must be an active participant tin their treatment. This permits them to avoid the victimization situation that often thwarts the ability to get better.

Cognitive behavioral therapy consists of strategies such as time management, goal setting, guided visualization, and so forth. Non-impact aerobic exercise includes such activities such as swimming, using a stationary cycle, or using an elliptical trainer.

Medications such as tricyclic antidepressants, selective serotonin reuptake inhibitors, selective serotonin reuptake and norepinephrine inhibitors can be useful. Muscle relaxants such as cyclobenzaprine have their advocates. Recent interest in the use of GABA stimulators such as gabapentin and pregabalin also are helpful.

Complementary therapies such as acupuncture, acupressure, low level laser (cold laser), ultra high frequency electrical stimulation, and trigger point injection can also be useful.

Investigational drugs such as milnacipran may be a welcome addition to our arsenal.

A term that has been coined by Dr. Muhammad Yunus, a pioneer in FM treatment, is the biopsychosocial model of disease.

He advocates further critical studies to fully test this concept which seems to have important significance for new directions for research and patient care involving physician and patient education. He states, "Each patient, irrespective of diagnosis," says Dr. Yunus, "should be treated as an individual, considering both the biological and psychosocial contributions to his or her symptoms and suffering."

It is important that the physician be supportive but at the same time be empowering and not let the patient fall into the miasma of self-pity.

Truer words have never been said.

Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: arthritis-treatment-and-relief/arthritis-treatment.htmlOnset Of Bipolar Disorder
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