It can be hard to diagnose as all of the symptoms can be symptoms of other conditions and these symptoms can also be present with additional symptoms not noted here. The time of administration can be adjusted depending on individual patient response.How do I know if I could have fibromyalgia?įibromyalgia is a medical condition that causes sufferers to experience mood problems, fatigue, lack of sleep and most commonly, pain that runs throughout the body. This allows the peak sedative effect to be realized while avoiding unwanted carry-over sedation on awakening. The older agents (such as amitriptyline) can be started at a dosage of 10 mg taken daily two to three hours before bedtime. The dosages used are somewhat lower than those needed to treat depression. One study 13 found that while 25 mg of amitriptyline (Elavil) or 20 mg of fluoxetine (Prozac) reduced the symptoms of fibromyalgia, the combination of the two was twice as effective as either agent taken alone. In controlled studies, 1 approximately one third to one half of patients responded to pharmacologic treatment. The tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), or combinations of both, produce mild to moderate improvement in symptoms. Although antidepressants have a lengthy history in the treatment of chronic pain syndromes, they have received only limited study in the treatment of fibromyalgia. Lastly, trigger points often have a nodular texture described as similar to a pencil eraser, whereas tender points have no palpatory characteristics distinguishing them from surrounding tissue. The pain elicited on palpation of a tender point is localized to the area under palpation and does not elicit a jump or twitch. Palpation of trigger points often reproduces the pain radiation pattern experienced by the patient and can elicit a twitch in the muscle. Trigger points are located within taut bands of muscle, whereas tender points are not. Distinguishing between trigger points and tender points depends on characteristic findings associated with trigger points that are found on physical examination. Unfortunately, location alone does not differentiate between trigger points and tender points because they often occur in similar locations. Myofascial pain syndrome is defined by the presence of trigger points. The definitive differentiation between myofascial pain syndrome and fibromyalgia is made by physical examination. Knee: at the medial fat pad proximal to the joint line Greater trochanter: posterior to the greater trochanteric prominence Gluteal: at the upper outer quadrant of the buttocks at the anterior edge of the gluteus maximus muscle Lateral epicondyle: 2 cm distal to the lateral epicondyle Second rib: just lateral to the second costochondral junctions Supraspinatus: above the scapular spine near the medial border Trapezius: at the midpoint of the upper border Low cervical: at the anterior aspect of the interspaces between the transverse processes of C5–C7 Occiput: at the insertions of one or more of the following muscles: trapezius, sternocleidomastoid, splenius capitus, semispinalis capitus Pain on palpation with a 4-kg force in 11 of the following 18 sites (nine bilateral sites, for a total of 18 sites): Pain in the axial skeleton (cervical, thoracic or lumbar spine, or anterior chest) Pain above and below the waist (including shoulder and buttock pain) Pain on the right and left sides of the body Widespread pain for at least three months, defined as the presence of all of the following:
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