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Rajeshkr Kumar asked:




Though not fatal, Fibromyalgia can affect every aspect of one’s life. It can severely curtail the recreation and social activity. Medical report shows around 30% of the Fibromyalgia are unable to maintain their job. The patients should know much about the syndromes, symptoms and treatments, so that they can fully participate in the long course of Fibromyalgia treatment.

Fibromyalgia Syndrome

Fibromyalgia is a debilitating chronic syndrome characterized by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. People with Fibromyalgia may be genetically predisposed, but it is not contagious. Fibromyalgia syndrome is generally found in females; the male:female ratio of Fibromyalgia is 9:1. Of the general population 3% – 6% in the age group of 20 – 60 are affected by this syndrome. This figure of Fibromyalgia is a medical estimation, many cases go unreported or mistook for weakness, rheumatism or general fatigue. However, the disease is not life-threatening.

Fibromyalgia Symptoms

The primary symptom of Fibromyalgia is found in other disorders also. It is widespread and diffuse pain, often including needlelike tingling of the skin, ache in the muscles, weakness in the limbs, and pain in the nerves. Chronic sleep disturbances are also characteristic of Fibromyalgia. It is a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. Fibromyalgia symptoms may also include chronic Paresthesia marked by physical fatigue, irritable bowel, interstitial cystitis, dermatological disorders, headaches, hypoglycemia and myoclonic twitches.

Fibromyalgia can start as a result of some trauma or illness, though there is no strong correlation between any specific trigger and the initiation of Fibromyalgia. Trauma or illness aggravates the mild Fibromyalgia. Besides pains, aches and fatigue there is no physical inflammation that is found in arthritis. Some external factors make the Fibromyalgia symptoms visible. Those are:

• Extreme cold weather
• Hunger, starvation or malnutrition
• Exhaustive physical activity
• Lack of deep sleep
• Increase of stress
• Consumption of alcohol

Fibromyalgia Treatment

Fibromyalgia treatment relies much on the proper case history of the patient, excluding the Fibromyalgia-like diseases like arthritis, endocrine disorders, theumatism, etc. Modern diagnosis of Fibromyalgia considers the following points before confirming Fibromyalgia syndrome.

• Chronic pain lasting more than three months in all four quadrants of the body.

• More pain in the 18 tender points. During diagnosis, four 40 Newtons of force is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for Fibromyalgia to be confirmed.

Complete cure of Fibromyalgia is unavailable, of course, there are treatment options to reduce the pain, and the treatment includes symptomatic prescription medication and alternative medicine. Experimentally Guaifenesin Protocol is prescribed to patients. It becoming more and popular day by day. To alleviate pain low doses of antidepressants like amitriptyline and trazodone are used to reduce the sleep disturbances associated with Fibromyalgia. Anti-depressants are also prescribed if depression is the major aggravator of the disease.

The drugs used in the treatment of Fibromyalgia include milnacipran, gabapentin, meloxicam and pregabalin. Muscle relaxants such as Cyclobenzaprine and Orphenadrine Citrate are also prescribed in Fibromyalgia.

Along with the Fibromyalgia medication, patients are advised to practice gentle exercises. Cognitive behavioral therapy helps patients relieve from chronic pain. EEG Biofeedback is gaining popularity in Fibromyalgia treatment.

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Yury Bayarski asked:




Skeletal muscle relaxants are a heterogeneous group of medications. As a class, they are structurally and pharmacologically diverse. Muscle relaxants are used to treat two different types of underlying conditions:
spasticity from upper motor neuron syndromes muscular pain or spasms from peripheral musculoskeletal conditions

Although muscle relaxants have by convention been classified into one group, the Food and Drug Administration (FDA) has approved only a few medications in this class for treatment of spasticity. The remainder are approved for treatment of musculoskeletal conditions.

Drugs classified as skeletal muscle relaxants include:
baclofen (Lioresal) carisoprodol (Soma) chlorzoxazone (Paraflex) cyclobenzaprine (Flexeril) dantrolene (Dantrium) metaxalone (Skelaxin) methocarbamol (Robaxin) orphenadrine (Norflex) tizanidine (Zanaflex)
Muscle relaxants for treatment of spasticity

Spasticity is a state of increased muscular tone with exaggeration of the tendon reflexes. Some of the more common conditions associated with spasticity and requiring treatment include multiple sclerosis, spinal cord injury, traumatic brain injury, cerebral palsy, and poststroke syndrome. In many patients with these conditions, spasticity can be disabling and painful with a marked effect on functional ability and quality of life.

The upper motor neuron syndrome is a complex of signs and symptoms that can be associated with exaggerated cutaneous reflexes, autonomic hyperreflexia, dystonia, contractures, paresis, lack of dexterity, and fatigability. Spasticity from the upper motor neuron syndrome can result from a variety of conditions affecting the cortex or spinal cord.

Only baclofen, dantrolene, and tizanidine are approved for treatment of spasticity. There is fair evidence that baclofen and tizanidine are roughly equivalent for efficacy in patients with spasticity, but insufficient evidence to determine the efficacy of dantrolene compared to baclofen or tizanidine. Tizanidine is associated with more dry mouth and baclofen with more weakness.

Muscle relaxants for treatment of musculoskeletal conditions

Muscle spasm is defined as a sudden involuntary contraction of one or more muscle groups and is usually an acute condition associated with muscle strain (partial tear of a muscle) or sprain (partial or complete rupture of a ligament). Common musculoskeletal conditions causing tenderness and muscle spasms include fibromyalgia, tension headaches, myofascial pain syndrome, and mechanical low back pain or neck pain. If muscle spasm is present in these conditions, it is related to local factors involving the affected muscle groups.

The skeletal muscle relaxants carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine are approved for treatment of musculoskeletal disorders.

Clinical studies show, that cyclobenzaprine, carisoprodol, orphenadrine, and tizanidine are effective compared to placebo in patients with musculoskeletal conditions (primarily acute back or neck pain). Cyclobenzaprine has been evaluated in the most clinical trials and has consistently been found to be effective.

Efficacy

Most studies have shown the skeletal muscle relaxants to be more effective than placebo in the treatment of acute painful musculoskeletal disorders and muscle spasm, while efficacy was less consistent when treating chronic disorders. When muscle relaxants were used alone, they were not consistently superior to simple analgesics in relieving pain. When the skeletal muscle relaxants were used in combination with analgesics, pain relief is superior to either agent used alone. Studies have suggested that these drugs are effective, have tolerable side effects, and can be an adjunct in the treatment of painful musculoskeletal conditions with associated muscle spasm.

No studies have documented superior efficacy of one skeletal muscle relaxant over another.

Side Effects and Adverse reactions
All skeletal muscle relaxants may cause sedation (drowsiness, dizziness). Baclofen may cause severe central nervous system depression with cardiovascular collapse and respiratory failure. Dantrolene has a potential for hepatotoxicity. Overt hepatitis has been most frequently observed between the third and twelfth months of therapy. Risk of hepatic injury appears to be greater in women, in patients over 35 years of age and in patients taking other medications in addition to dantrolene. Carisoprodol has some potential for dependence and withdrawal symptoms. Cyclobenzaprine, closely related to the tricyclic antidepressants, causes the expected lethargy and anticholinergic side effects, and may have some toxicity in overdose and in combination with other substances. Tizanidine may cause low blood pressure, but this may be controlled by starting with a low dose and increasing it gradually. The drug may rarely cause liver damage. Methocarbamol and chlorzoxazone may cause harmless color changes in urine – orange or reddish-purple with chlorzoxazone and purple, brown, or green with methocarbamol. The urine will return to its normal color when the patient stops taking the medicine.

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