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On July 22, 2012, in Health conditions, MEDICAL FACTS, by Dr. Tuchinsky

You can’t write a blog about fatigue without mentioning fibromyalgia at some point.

Your fatigue may be due to fibromyalgia if:

–       widespread musculoskeletal pain on both sides of the body

–       poor sleep and waking up not refreshed

–       much more common in women than in men

–       impaired memory and “brain fog”

Other associated symptoms:  tension headaches, irritable bowel, anxiety, depression, temporomandibular joint disorder (TMJ), mood swings, memory loss and prolonged muscle spasms

Fibromyalgia affects 2% of general population and 90% of those who are affected are women. Fibromyalgia occurs due to poorly understood neurochemical changes that heighten perception of pain. People with fibromyalgia have multiple tender points on their body, which are very sensitive to touch. Nobody knows for sure what causes fibromyalgia but it is linked to disruption of slow wave sleep and increased level of Substance P, the chemical responsible for our perception of pain signals.


There is no cure for fibromyalgia but there are many therapies aimed at improvement of symptoms. Fibromyalgia is most often treated with antidepressants. There are new antidepressants on the market now which have been specifically designed for treatment of fibromyalgia: Savella (milnacipran) and Cymbalta (duloxetine). They selectively increase both levels of serotonin and norepinephrine. Another class of drugs is medications that are taregeted to decrease nerve pain: Lyrica (pregablain) and Neurontin (gabapentin). Muscle relaxants such as Flexeril (cyclobenzaprine) and Zanaflex (tizanidine) are prescribed for muscle spasm and  opioids andUltram (tramadol) are often used for pain but I recommend against it because they actually disrupt the deep sleep and make the fatigue even worse.  NSAIDS (Aleve, Motrin, etc) and Tylenol can be just as effective for muscular pain in fibromyalgia.

Low-intensity exercise, acupuncture, massage, and improved sleep quality and adjunctive therapies.


While it certainly came to be more accepted in the medical community in the last twenty years, it is still not a fully accepted diagnosis. Firbromyalgia is such a vague and poorly defined condition, and so little is understood about its that many authorities on the subject claim that it doesn’t really exist. Even Frederick Wolfe, the physician who first defined the criteria for fibromyalgia in 1990, came to conclusion after two decades of research that fibromyalgia was simply a psychosomatic response, which means it was physical manifestation of stress.

Because there is no simple and easy cure for fibromyalgia, I would only chose that diagnosis if you have ruled out everything else out there. For example, when I struggled to find an explanation to my own fatigue, I felt that my symptoms fit the description perfectly but as I continued to search for other explanations I realized that there was a much more simple and easier to address explanation.




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