Is It Normal To Have Leg Pain With Fibromyalgia
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Fibromyalgia causes chronic pain that seems to affect the entire body. Obviously, this can include the legs. But people with fibromyalgia may also experience leg pain that seems to be more intense, or maybe simply different, from their fibromyalgia pain. This sort of leg pain can sometimes be an indication of serious medical problems, so its always a good idea to take it seriously.
So, how can you tell the difference between the leg pain caused by fibromyalgia and the leg pain caused by other conditions? Lets look at some of the conditions that can cause leg pain that you should be aware of and how you can distinguish it from the pain of fibromyalgia.
Increased Sensitivity To Pain
You may sense that you are having an extreme sensitivity to pain if you have fibromyalgia. The pain is not that much but it is extreme and it makes the person to grow into less resistant. Over one-third of people with fibromyalgia develop a small fiber neuropathy caused from the chronic pain.
Management : Dr. Teitelbaum says medications known as NMDA receptor antagonists, memantine is one can help
Conditions That Can Cause Spinal Pain
You know you have a shooting pain in your spine, but whats now important is to figure out whats causing it. It can be near impossible to treat or manage pain properly if you dont know why its happening.
Sometimes it can be tempting to just go with the first answer you can find, whether its the right one or not. However, its essential you know so you and your doctor know how it can be managed.
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Alternative Fibromyalgia Treatment: Acupuncture
Acupuncture may help treat fibromyalgia because it can alter brain chemistry and help increase pain tolerance. During treatment, a practitioner inserts one or more dry needles into the skin and underlying tissues at specific points. Gently twisting or otherwise manipulating the needles causes a measurable release of endorphins into the bloodstream.
According to acupuncturists, during this process, energy blocks are removed, which restores the flow of energy along the meridians, which are specific energy channels. The patient’s brain chemistry is then altered by changing the release of neurotransmitters. These neurotransmitters stimulate or inhibit nerve impulses in the brain that relay information about external stimuli and sensations such as pain, which causes the patient’s pain tolerance to increase. One acupuncture treatment may alleviate chronic pain for an extended period of time.
To The Point: We Need To Rethink Fm
During the past half-century, neurologists have generally played little role in the research and management of fibromyalgia and related centralized pain conditions, with rheumatologists often taking the lead in this area. The finding of SFN in a subset of FM patients may change that in the future. In fact, some neurologists have concluded that all patients with FM should be screened for SFN and, if SFN is identified on skin biopsy, then treatment for neuropathic pain should be warranted.8
When neuropathic pain is caused by direct nerve injury, identifying and removing the physical cause of that injury
may cure the condition. With diabetic neuropathy, getting blood sugar under optimal control can improve the outcome. In zoster neuropathy, antiviral therapy might lessen its severity. With trigeminal neuropathy, removing the anatomic compression of the fifth cranial nerve can cure the condition. If large RCTs demonstrate that patients with fibromyalgia meeting criteria for SFN improve clinically and pathologically with treatments such as IVIg, then I propose that the pain research and management communities rethink the notion that FM is primarily a centralized pain disorder.
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Definitions We Can Agree On
In 1994, the International Association for the Study of Pain defined neuropathic pain as initiated or caused by a primary lesion or dysfunction of the nervous system. In 2008, the IASPs Neuropathic Pain Special Interest Group tweaked the definition to include disease of the somatosensory nervous system.
Fibromyalgia fits these definitions, says Dr. Berenger. Although the condition has no anatomically definable lesions, it is marked by altered neurological function in the spinal cord and brain. It can, therefore, be considered a dysfunction of the central inhibitory process of pain control.
Fibromyalgia Symptoms Are Real
Fibromyalgia. Is it real? Maybe. The symptoms are real, but many fibromyalgia clinics do patients a disservice by handing out anti-inflammatory drugs and antidepressants without first attempting to determine the real cause of the symptoms.
In fact, many of the symptoms of fibromyalgia are those of Hypemobility, and need to be considered as a whole, and not just one by one. If you think you have fibromyalgia you may actually be hypermobile, which would explain why you have this constellation of symptoms. Please check out our discussion of Hypermobility.
I have been a neurologist for over three decades. Nearly every patient I have seen who comes to see me with the diagnosis of fibromyalgia really has a neurologic explanation for their symptoms. These symptoms include headache, neck pain, fatigue, numbness, pain in the limbs, and mild depression.
Finally we have an explanation for the links between these symptoms, and that is the hypermobility syndrome, described here. The parallel between the symptoms associated with hypermobility syndrome and fibromyalgia are striking, and may finally provide a path toward improved quality of life for patients who have been diagnosed with fibromylagia.
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Neuroinflammation And Brain Changes
Scientists have used PET scans to study the brains of people with a fibromyalgia diagnosis. They found widespread neuroinflammation across their brains. Other researchers tested the spinal fluid of people with fibromyalgia and discovered proteins linked to neuroinflammation.
Irritated brain cells arent the only culprit, though. Its more complicated than just neuroinflammation alone, says Dr. Abraham. There also seems to be a change in the size and shape of certain areas of the brain. Scientists have found that some brain regions are smaller than expected.
Theres also evidence of differences in the brains connections, he explains. Typically, brain areas involved in pain processing are in constant communication. In people with fibromyalgia, there might be awkward pauses in that conversation. If one area has trouble communicating with another, you might process sensations like cold, pressure or exercise as something painful, he says.
Similarities And Differences Of Sensory Symptoms
It is important to estimate which sensory symptoms are clinically relevant as perceived by the patients themselves. Therefore, ‘Patient-Reported Outcomes’ that collect health-related data directly from the patients are increasingly used in clinical research . Sensory disturbances were considered as clinically relevant if the patients replied to the questions with a score of > 3 . Interestingly, patients of both aetiologies chose very similar descriptors to characterize their sensory perceptions. In fact, pain of burning quality, a prickling sensation and the existence of touch-evoked allodynia was indicated in almost the same frequencies. Thus, both disease entities are obviously associated with the perception of similar sensory symptoms. It has to be kept in mind, however, that the patients might not perceive exactly the same sensory phenomenon although they mark the same verbal description.
Another unexpected finding is the relatively high incidence of touch-evoked allodynia in fibromyalgia . Allodynia is thought to be induced by activation of touch-sensitive cutaneous Ab-fibers that synapse on nociceptive second-order neurons in the CNS. Thus, allodynia might be explained by a convergent afferent input of deep somatic and skin nerves on sensitized second-order neurons .
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Multiple Studies One Conclusion: Some Fibromyalgia Patients Show Peripheral Nerve Pathologies
Fibromyalgia syndrome ranks among the most enigmatic and prevalent chronic pain conditions. Researchers and clinicians have searched in vain for an underlying cause for the unexplained widespread muscle pain, fatigue, and tenderness. In recent years, FMS has come to be seen as a “central” pain disorder, arising from changes in pain processing in the central nervous system. Now several new reports show evidence for peripheral nerve abnormalities in FMS patients that could contribute to their chronic pain.
Jordi Serra of the University of Barcelona, Spain, and University College London, UK, said that together the studiesincluding his own worksuggest that at least some people with FMS have peripheral neuropathy and support the idea that FMS is a neuropathic pain condition. Even though FMS is currently not considered a neuropathic disorder, it really looks the same in some respects, Serra said.
Peripheral nerves damaged
A condition by any other name?
The results raise the question of whether some patients diagnosed with FMS actually have SFPN. Sommer and colleagues stop short of calling their findings SFPN, instead describing small fibre pathology in the FMS patients. But Oaklander says making the diagnosis is important, because unlike FMS, which has no known cause and thus no disease-based treatment, small fiber polyneuropathies have some known causes that suggest treatment options.
Another peripheral trigger?
How Can You Get A Fibromyalgia Diagnosis
Wish we could say that theres an X-ray or lab test you can take, but, Typically, a rheumatologist will see patients for widespread pain and will do tests to rule out autoimmune and rheumatological conditions, Dr. Mukai says. Sometimes, one can have fibromyalgia on top of autoimmune conditions. It is typically a diagnosis of exclusion, meaning other conditions causing pain need to be ruled out. There are no classic X-ray findings or lab findings with fibromyalgia.
There’s no one test for fibromyalgia your treatment team will have to rule out other conditions one by one, which is called a diagnosis of exclusion.
Patients can expect blood tests looking at things such as:
- Blood counts
Fibromyalgia treatment is heavily weighted toward medication. Over-the-counter options include:
- Over-the-counter nonsteroidal anti-inflammatory drugs like ibuprofen
- Topical ointments such as those containing menthol or capsaicin
If your pain is severe, your doctor will bring out the big guns: prescriptions. These may include:
- Fibromyalgia nerve pain medications like Lyrica or Neurontin
- Muscle relaxers
or some combination of the above. In general, opioid prescriptions and spinal injections are not going to be helpful for fibromyalgia pain, says Dr. Mukai.
Side effects are more common in patients with fibromyalgia due to the changes within their nervous system, so starting at low doses and gradually increasing is recommended, Dr. Bierle adds.
Is It Fibromyalgia Or Just Back Pain
Back pain can be difficult to diagnose because it can have many causes, such as age-related changes to the spine, trauma or a strained muscle or pinched nerve.
However, fibromyalgia is also difficult to diagnose because the symptoms are not always clear-cut and there is no quick blood test for it. But there are ways for doctors and patients themselves to pick up on it.
Rebecca Park, a registered nurse and founder of RemediesForMe.com, says it is difficult to diagnose fibromyalgia because the symptoms are often similar to other conditions. She adds, To make things more confusing, these symptoms can come and go and can also occur concurrently with other disorders.
This includes irritable bowel syndrome, restless leg syndrome, depression, anxiety and other neurological symptoms.
Back pain associated with fibromyalgia is typically unrelated to spine injuries like a herniated disc. The pain experienced with fibromyalgia also stands out from other conditions that cause back pain.
Physicians should suspect fibromyalgia if someone has complaints of pain in a number of different areas of their body, says Hulst. This pain should be present at a similar level for at least three months.
People with fibromyalgia will also have associated symptoms, says Hulst, including fatigue, impaired sleep and cognitive symptoms.
This last one is sometimes known as fibro fog, which can include forgetfulness, problems with concentration and attention, and thinking more slowly.
Epidemiological Features And Co
A total of 1623 patients with painful diabetic neuropathy and 1434 fibromyalgia patients took part in the survey. The demographic profile of the patients is shown in Table . The gender ratio was even in DPN patients, whereas in fibromyalgia patients only about 10% of the entire cohort was male. Patients with diabetic neuropathy were on average 10 years older and the females 4 kg heavier than fibromyalgia patients. As Table shows fibromyalgia patients had significantly higher scores in depression and anxiety questionnaires, also sleep disturbances occurred more frequently in fibromyalgia patients.
Table 1 Demographic and clinical characteristics
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Fibromyalgia Back Pain Relief
Fibromyalgia can last a long time, but it does not result in death or tissue damage. Back pain and fibromyalgia symptoms may improve if healthier lifestyle is followed. Regulating diet, increasing exercise, and losing weight can overcome fibromyalgia. Anxiety, depression, insomnia and trouble sleeping can all make pain feel worse. Comprehensive treatment strategies may include therapy to better cope with depression and anxiety. Cognitive behavioral therapy may also be helpful. The medications duloxetine, milnacipran or pregabalin can be used as a drug of choice but the use of opioid pain medication is controversial as there is no supportive evidence. Regular physical therapy and stretches can ease back pain and possibly make the living with fibromyalgia much easier. Acupuncture and dietary supplements âmay have valueâ for alleviating the fibromyalgia-related back pain.
Comparing Fibromyalgia And Peripheral Neuropathy: Causes
The cause of fibromyalgia is largely theorized, as it is not well understood. Researchers and doctors believe that a fibromyalgia patient experiences amplified pain as a result of abnormal sensory processing in the central nervous system. Much research has detected physiological abnormalities in fibromyalgia, including increased levels of substance P in the spinal cord, low levels of blood flow to the thalamus region of the brain, HPA axis hypofunction, low levels of serotonin and tryptophan, and abnormalities in cytokine function. Other fibromyalgia triggers include genetic factors and traumatic events or injuries.
Neuropathy can be due to many other conditions and ailments, and so there is no single cause. Peripheral neuropathy is associated with nerve damage, which may be caused by alcoholism, autoimmune diseases, diabetes, exposure to poisons, medications, infections, inherited disorders, trauma or pressure on the nerves, tumors, vitamin deficiencies, bone marrow disorders, and other conditions, including diseases that affect the liver, kidneys, and thyroid.
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Differentiating Fibromyalgia And Peripheral Neuropathy: Risk Factors And Complications
Risk factors for fibromyalgia include sex women are at a higher risk of fibromyalgia than men, a family history of fibromyalgia a genetic component to the disease, and a rheumatic disease diagnosis.
One of fibromyalgia complications is poor ability to function due to lack of sleep, which worsens symptoms. Anxiety and depression, too, may be a result of fibromyalgia as it is not a well-understood condition. Living in pain can be frustrating when others simply dont understand what you are going through, especially because there is no specific cure or treatment.
Risk factors for peripheral neuropathy include poorly controlled diabetes, alcohol abuse, vitamin deficiencies, infections like Lyme disease, autoimmune diseases, exposure to toxins, repetitive motions, a family history of neuropathy, as well as kidney, liver, or thyroid disease.
Complications resulting from peripheral neuropathy include burns and skin trauma, infection and falls due to loss of sensation potentially leading to disability.
Fibromyalgia Treatment: Stress Reduction
Many fibromyalgia patients admit feeling anxious, nervous, and even panicked during a fibromyalgia flare-up. Therefore, stress may play a very important role in triggering fibromyalgia symptoms. It is extremely difficult to measure stress levels in different patients because people react differently to certain events. Stress reduction in the treatment of fibromyalgia must be individualized. This might include simple stress modification at home or work, biofeedback, relaxation tapes, psychological counseling, and/or support among family members, friends, and doctors.
Sometimes, changes in environmental factors can exacerbate the symptoms of fibromyalgia, and these factors need to be modified. Stress management in fibromyalgia patients may lead to less anxiety, depression, and fatigue. Patients may also experience better sleep and an increased quality of life.
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Fibromyalgia Vs Peripheral Neuropathy: Signs And Symptoms
The key distinguishing symptom of fibromyalgia is tender points on the body. Other signs and symptoms of fibromyalgia include chronic muscle pain, muscle spasms or tightness, moderate or severe fatigue, decreased energy, insomnia, waking up feeling unrefreshed, stiffness upon waking or after staying in one position for too long, concentration problems, difficulty remembering and performing simple mental tasks , abdominal pain, bloating, nausea, constipation alternating with diarrhea , tension or migraine headaches, as well as jaw and facial tenderness. With fibromyalgia comes sensitivity to odors, noises, bright lights, medications, certain foods, and cold. Fibromyalgia patients report feeling anxious or depressed, numbness or tingling in the face, arms, hands, legs, or feet, increase in urinary urgency or frequency , reduced tolerance for exercise and muscle pain after exercise, and a feeling of swelling in the hands and feet.
Signs and symptoms of peripheral neuropathy depend on the affected nerve. Nerves are classified into sensory, motor, or autonomic. Sensory nerves receive sensations, motor nerves control muscle movement, and autonomic nerves control functions such as blood pressure, heart rate, bladder, and digestion.
Some symptoms that may arise in peripheral neuropathy include:
All These Separate Neurologic Symptoms Must Be Treated Individually
Using drugs as a band aid for them will not help them in the long run. As with all we as doctors do, an accurate diagnosis is critical to their successful treatment.
For sleep disorders, the RNI has its own accredited sleep disorders center, and two physicians board certified in sleep medicine. For pinched nerves in neck, back, arms and legs, we have our own imaging and EMG.
So before you accept a canned diagnosis of fibromyalgia, and begin taking anti-inflammatory drugs and antidepressants for the rest of your life, you may want to check into the real causes of your symptoms
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