Re: Fw: Is Fibromyalgia Real?

[Guest guest]

I second the Vitamin D deficiency - have a friend who suffered with the pain

and misdiagnosis - had Vit D tested low - started supplements and is almost

pain -free.

On Tue, Jan 11, 2011 at 9:09 AM, Linke wrote:

>

>

> Vitamin D deficiency and lyme disease should also be ruled out as these can

> be misdiagnosed as fibromyalgia, or possibly be co-morbid, especially the

> vitamin D deficiency.

>

>

>

>

>

>

>

> From: Vajda <jennyvajda@...<jennyvajda%40sbcglobal.net>

> >

> Subject: Fw: Is Fibromyalgia Real?

>

> To: rd-usa <rd-usa%40yahoogroups.com>

> Date: Tuesday, January 11, 2011, 7:08 AM

>

>

> Magnesium Research 1994 Dec;7(3-4):285-8.Selenium and magnesium status in

> fibromyalgia.Eisinger J, Plantamura A, Marie PA, Ayavou T.

> Centre Hospitalier de Toulon, France.

> Abstract

> Muscle pain has been associated with magnesium (Mg) and selenium (Se)

> deficiency: magnesium and selenium status were investigated in

> fibromyalgia

> (FM). Erythrocyte (E), leucocyte (L) and serum (S) magnesium, serum

> selenium

> and zinc, and vitamin B1, B2, A or E status were assessed in 22 patients

> with

> fibromyalgia and in 23 age-matched healthy controls. LMg is significantly

> increased (P < 0.05) and EMg slightly decreased in fibromyalgia. These

> magnesium abnormalities are associated with previously-reported impairment

> of

> thiamin metabolism. Antioxidant status (as well as plasma malondialdehyde)

> is

> unchanged in fibromyalgia and serum selenium levels, slightly but not

> significantly correlated with serum magnesium, is normal.

> PMID: 7786692 [PubMed - indexed for MEDLINE]

> R Vajda, R.D.

>

>

> ----- Forwarded Message ----

> From: Vajda <jennyvajda@...<jennyvajda%40sbcglobal.net>

> >

> To: rd-usa <rd-usa%40yahoogroups.com>

> Sent: Mon, January 10, 2011 9:06:54 PM

> Subject: Re: Is Fibromyalgia Real?

>

>

> I vote yes it is part of the autoimmune cluster of diseases but also I

> agree the

>

> childhood trauma pain is a different type of pain and not part of the

> fibromyalgia group - we just knot up so easily that those of us with

> fibromyalgia symptoms might notice the PTSD trigger faster - with muscles

> already being over-contractile. One tense meeting could have my shoulder

> knot

> go from marble size to golf-ball, I eventually made the connection to work

> on

> relaxation techniques.

>

> The article described me to a tee, even the childhood trauma. There are

> different types of pain mentioned in the article, I had/have both

> conditions.

> Childhood triggers can leave me physically choked up/clenched up from

> stress

> -therapy helped- but that is unrelated to what I consider fibromyalgia -an

> autoimmune condition. I never got officially diagnosed with the 'new'

> condition

> - I didn't have muscle knots in the specific 13 spots on the body listed by

> the

> insurance or something like that. I knew enough from identifying my

> migraine

> triggers what things were also muscle knot pain triggers so I was

> controlling my

>

> symptoms through rigid label reading and food prep.

>

> The muscle knots are from excess calcium causing muscle spasms. I have

> learned

> to limit calcium and vitamin D intake and I take magnesium and eat a lot of

>

> beans, nuts and other magnesium rich foods, I do find that I am more

> comfortable

>

> avoiding gluten but I don't have to now - I used to be much more reactive

> to it.

>

> A lower acid diet helps to reduce urinary and intestinal losses of

> magnesium. I

> think part of the condition is over absorbing calcium in the intestines and

>

> wasting magnesium. I have recently discovered the easing and calming

> wonders of

> a bath with plenty of Epsom salts, 2-3 cups instead of one, good for PMS

> and any

>

> muscle tension - back or head ache. Bypass the gut and nourish through the

>

> skin.

>

> R Vajda, R.D.

>

>

> ________________________________

> From: Ortiz <nrord1@... <nrord1%40gmail.com>>

> To: RD-USA <rd-usa <rd-usa%40yahoogroups.com>>

> Sent: Mon, January 10, 2011 7:06:49 PM

> Subject: Is Fibromyalgia Real?

>

> What Is Fibromyalgia? found on www.medscape.com (free registration

> required)

>

> * Kay, MD:* " Fibromyalgia " is a label that has been given to a

> large

> number of patients who experience chronic pain. A small subset of these

> patients have characteristic tender points, but the vast majority of

> patients who carry this label describe diffuse pain that is not more

> pronounced when specific areas are palpated. The vast majority of these

> patients also describe migraine headaches, shooting pains in their

> extremities, chronic fatigue, and sleep disturbances. Some report

> alternating constipation and diarrhea, which usually is labeled as being

> " irritable bowel, " but others do not experience these gastrointestinal

> symptoms.

>

> Also, patients with inflammatory arthritis or early fibrosing syndromes may

> experience pain in multiple areas without manifesting detectable signs of

> joint inflammation or tissue fibrosis. Some of these patients may be

> labeled

> as " fibromyalgia, " but display signs of more typical disease as time

> passes.

> Other conditions, such as certain endocrinopathies, may also present with

> fatigue, generalized aching, and other symptoms that prompt giving these

> patients the label of " fibromyalgia. "

>

> Although a few patients may present with increased tenderness over

> characteristic tender points, fatigue, migraine headaches, shooting pains

> in

> the extremities, fatigue, and irritable bowel syndrome symptoms, without

> another obvious diagnosis, it is clear that " fibromyalgia " is not by itself

> a distinct condition with a single pathophysiologic mechanism. Rather, it

> is

> a common symptom complex that is characteristic of the heightened

> perception

> of pain associated with a number of different precipitating factors.

>

> * Argoff, MD:* Clinicians should be accustomed to being faced with

> managing conditions for which absolute knowledge regarding the conditions

> and their etiology and pathophysiology are not known. In fact, this is true

> for most medical conditions we encounter including many nonpain-related

> conditions such as hypertension, various cancers and diabetes. Even the

> wisest among us cannot state with absolute certainty the exact cause(s) of

> fibromyalgia syndrome and/or its mechanisms(s). Fibromyalgia syndrome is

> not

> a label to be applied to another human being. It is a common chronic

> medical

> condition associated with widespread pain, lowered pain thresholds, and

> augmented sensory perception. Recent efforts by the American College of

> Rheumatology have focused attention as well on the nonpainful aspects of

> fibromyalgia syndrome such as fatigue and sleep disturbances as important

> diagnostic features.

>

> *Dr. Kay:* I agree with Dr. Argoff that clinicians often face and manage

> conditions for which the etiology is unknown. In rheumatology, we do not

> know the etiology of most rheumatic diseases. However, the pathophysiology

> of most diseases that we treat is understood, at least to the extent that

> there is some understanding of the mechanism by which therapies interfere

> with the disease process.

>

> I disagree with Dr. Argoff that the pathophysiology of " fibromyalgia "

> syndrome is not known. No specific pathophysiology is ascribed to the label

> of " fibromyalgia " ; however, patients develop the symptoms of this syndrome

> in association with various underlying disorders. Applying the label of

> " fibromyalgia " syndrome to the syndrome of widespread pain, lowered pain

> thresholds, and augmented sensory perception without attempting to identify

> an underlying pathophysiologic process makes treatment of patients with

> this

> symptom complex more difficult than necessary. Considering sleep

> disturbances, for example, to be " aspects " of the syndrome rather than

> predisposing factors is " chicken and egg " logic. It is important to

> acknowledge which comes first, so that the predisposing factor may be

> treated to prevent the resulting symptoms.

>

> *Dr. Argoff:* Given that all patients currently diagnosed with fibromyalgia

> do not have completely identical symptoms including the fact that not all

> patients share the same sleep disturbances, Dr. Kay's comments actually

> underscore the complexity of managing the person with fibromyalgia as well

> as the urgent need to learn more about its pathophysiology, which is

> currently incompletely understood.

> What Causes Fibromyalgia?

>

> *Dr. Kay:* The fibromyalgia symptom complex can result from a number of

> different etiologies. The vast majority of patients labeled as having

> " fibromyalgia " describe a disturbed sleep pattern, either as a primary

> process or resulting from their underlying pain syndrome. Many obese

> patients who experience a heightened perception of pain have obstructive

> sleep apnea that either has not been diagnosed or is inadequately treated.

> A

> number of patients, many of whom have normal body mass indices, describe

> symptoms of restless legs syndrome. Those patients may have associated iron

> deficiency and often report family members who also have restless leg

> syndrome.

>

> *Dr. Argoff:* Fibromyalgia is a medical condition whose diagnosis can be

> made based upon established diagnostic criteria. It may coexist and, in

> fact, often interrelates with other medical conditions including rheumatoid

> arthritis and others. Mental health comorbidities are common but are not

> the

> cause of fibromyalgia.

>

> *Dr. Kay:* Certainly, patients with symptoms that are labeled as

> " fibromyalgia " syndrome may have other medical conditions, including

> rheumatoid arthritis and other forms of inflammatory joint disease. I also

> agree with Dr. Argoff that mental health comorbidities are common among

> patients with " fibromyalgia " syndrome. However, having stated that the

> " etiology and pathophysiology " of " fibromyalgia syndrome are not known, "

> how

> can he then assert that mental health comorbidities are not the cause of

> " fibromyalgia, " if " even the wisest among us cannot state with absolute

> certainty the exact cause(s) of fibromyalgia syndrome? " My esteemed

> colleague seems to be engaging here in a circular argument.

>

> *Dr. Argoff:* Given that all patients currently diagnosed with fibromyalgia

> do not meet current diagnostic criteria for major depressive disorder or

> any

> other mental health disorder per se, and given that it is well documented

> that treatment benefit from serotonin*-*norepinephrine reuptake inhibitor

> (SNRI) agents is independent of whether or not an individual is depressed

> or

> not, it is clear that mental health comorbidities are not the cause of

> fibromylagia since they don't occur in all patients

>

> Is Abuse To Blame?

>

> *Dr. Kay:* A disturbingly high number of patients with chronic pain that

> has

> been labeled as " fibromyalgia, " upon direct questioning, report having been

> victims of preadolescent sexual abuse, often at the hands of close

> relatives

> or of others who abuse their position of authority and responsibility.

> Others report having been in an abusive relationship.

>

> Unfortunately, many patients who are victims of spousal abuse are

> accompanied to their medical visit by the abusive spouse who is trying to

> prevent them from disclosing the nature of this relationship. Thus, a large

> number of patients who are labeled as having " fibromyalgia " actually have a

> posttraumatic syndrome that manifests with a heightened perception of pain

> and associated symptoms. Interestingly, these patients typically report

> migraine headaches, shooting pains in their extremities, and fatigue, but

> no

> alternating constipation and diarrhea.

>

> *Dr. Argoff:* Victims of preadolescent sexual abuse are noted to experience

> autoimmune diseases, chronic migraine and other headache syndromes, and

> hypertension, to name just a few medical conditions. In other words, those

> individuals who are unfortunate victims of such horrifically traumatic

> experiences are at risk of developing many medical consequences, including

> but not restricted to fibromyalgia syndrome.[1-3] Being aware of a person's

> history of preadolescent sexual abuse does not diminish the legitimacy of

> the medical condition that has emerged in any way whatsoever.

>

> *Dr. Kay:* I am unaware of any evidence that demonstrates an autoimmune

> disease to result from preadolescent sexual abuse. Certainly, victims of

> such abuse develop chronic migraine headaches and other features of

> " fibromyalgia " syndrome as part of a posttraumatic syndrome. It is

> important

> for medical professionals to be aware of physical and sexual abuse to which

> patients have been subjected and to make certain that individuals are

> removed from the setting in which they are subject to such abuse. In no way

> does a history of physical or sexual abuse diminish the legitimacy of any

> objective medical condition.

>

> *Dr. Argoff:* There are numerous peer-reviewed articles that have examined

> this relationship.[1-3]

>

> *Dr. Kay:* The papers cited by Dr. Argoff support my assertion that many

> patients who are labeled as having " fibromyalgia " actually have a

> posttraumatic syndrome that manifests with a heightened perception of pain

> and associated symptoms. This is exactly the point made by Dr. and

> his colleagues and Dr. . [2,3] In the abstract of her review article,

> Dr. defines " autoimmune disorders " as irritable bowel syndrome,

> asthma, and fibromyalgia. Most rheumatologists would disagree with her

> classifying these 3 conditions as " autoimmune " and would instead classify

> them as belonging to the spectrum of " central sensitivity syndromes. " [4]

> The

> study by Drs. Goodwin and Stein used a self-report checklist form to query

> participants in the National Comorbidity Survey as to the presence of

> " physical illnesses " within the past 12 months. One of the categories asked

> about " thyroid disease, or other autoimmune disorders. " Although the

> adjusted odds ratio for an association between self-reported physical abuse

> and self-reported " autoimmune disease " ranged from 1.7 to 3.1, this

> self-diagnosis of " autoimmune disease " is of questionable legitimacy given

> that the patients' self-diagnoses were not validated and the absence of a

> definition for " autoimmune disease " on the checklist.[1] Thus, there

> remains

> no convincing evidence to demonstrate that an autoimmune disease results

> from preadolescent sexual abuse.

> So Is It Depression?

>

> *Dr. Kay:* A very small number of patients who carry the label of

> " fibromyalgia " actually have inadequately treated depression. With

> appropriate adjustment of their psychopharmacologic regimen, the somatic

> symptoms that are labeled as " fibromyalgia " come under better control.

>

> *Dr. Argoff:* Mental health comorbidities are common but are not the cause

> of fibromyalgia. It is well established in the medical literature that many

> antidepressants have analgesic properties that have been conclusively

> demonstrated to be independent of their antidepressant properties. Two such

> agents are currently US Food and Drug Administration (FDA)-approved for the

> treatment of fibromyalgia syndrome.

>

> *Dr. Kay:* I do not assert that depression or other mental health

> conditions

> are the cause of " fibromyalgia " syndrome. Dr. Argoff is correct in his

> statement that antidepressant medications have analgesic properties that

> are

> independent of their antidepressant properties. The FDA has approved both

> pregabalin and milnacipran for the treatment of patients with

> " fibromyalgia "

> syndrome. Although milnacipran is also approved for the treatment of major

> depressive disorder, pregabalin is not an antidepressant medication.

>

> *Dr. Argoff:* There are 3 FDA-approved medications for the treatment of

> fibromyalgia. Two of them, duloxetine and milnacipran, are considered SNRI

> agents but only 1 of these, duloxetine, is also approved by the FDA for

> major depressive disorder and/or generalized anxiety disorder. Minalcipran

> is not approved by the FDA for any mental health indication. The European

> Medicines Agency (EMEA) however has approved milnacipran for the treatment

> of major depression, and it has been used in Europe for many years for this

> purpose. Pregabalin is an example of an alpha(2)-delta agonist medication,

> and it is not an antidepressant nor did any of my prior comments suggest

> otherwise!

> Where Does This Leave Us?

>

> *Dr. Kay: *Dr. Argoff and I agree that " fibromyalgia " syndrome is a

> condition in which patients experience chronic diffuse pain, typically

> accompanied by migraine headaches, shooting pains in their extremities, and

> chronic fatigue. It is frustrating to both the patient and the physician

> that this constellation of symptoms does not have a single cause and that

> its pathophysiology remains incompletely understood. Many patients with

> this

> condition do not have mental health comorbidities, yet they may respond to

> treatment with SNRIs.

>

> We disagree about the relationship between preadolescent sexual abuse and

> the subsequent development of autoimmune disease. Although Dr. Argoff

> states

> that " numerous peer-reviewed articles... have examined this relationship, "

> the " autoimmune disorders " included were " irritable bowel syndrome, asthma,

> and fibromyalgia. " [3] None of these conditions is associated with

> autoantibody production and none is typically considered to be an

> autoimmune

> disease.

>

> Regardless of how one categorizes its pathophysiology, individuals with

> chronic diffuse pain suffer with their symptom complex. As physicians, we

> must try our best to relieve their distress. Understanding the specific

> pathophysiologic basis for a patient's chronic pain helps to direct

> treatment: therapies that address underlying causes of heightened pain

> perception are more likely to be successful than those which merely lessen

> symptoms. However, the questions raised by our dialogue highlight some of

> the unanswered questions about " fibromyalgia " syndrome that warrant

> clarification by well-designed research studies.

>

> *Dr. Argoff: *It has been an honor to participate in this virtual debate

> and

> I agree with Dr. Kay that only with continued quality research efforts can

> we hope to clarify so many of the details of fibromyalgia and its care.

> --

> Ortiz, MS, RD

> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

> Check out my blog: mixture of deals and nutrition

> Check Amazon for your textbooks for college: students get FREE Amazon

> Prime<http://thefrugaldietitian.com/?p=12119>

> *Check out these FREE educational videos from Khan

> Academy*<http://thefrugaldietitian.com/?p=12191>

> **

> <http://thefrugaldietitian.com/?p=12001><

> http://thefrugaldietitian.com/?p=10437> " Nutrition

>

> is a science, Not an Opinion survey "

>

>