—posting due by July 21
Cyclobenzaprine (Cycloflex, Flexeril) is indicated for use in the treatment of fibromyalgia. What is fibromyalgia? Causes? Symptoms? Treatments? How do the treatments differ—ie how are the prescribed drugs different? The same? (ie their mechanisms of action)
One good source is http://www.fibromyalgia-symptoms.org/fibromyalgia_benzo.html .
Be sure not to copy directly—and find some other good resources.
7 comments:
Fibromyalgia (FM or FMS) is a chronic syndrome characterized by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. It is not contagious, and recent studies suggest that people with fibromyalgia may be genetically predisposed. It affects more females than males, with a ratio of 9:1 by ACR
Symptoms:
The defining symptoms of fibromyalgia are chronic, widespread pain and tenderness to light touch, and usually moderate to severe fatigue. Those affected may also experience heightened sensitivity of the skin, tingling of the skin achiness in the muscle tissues, prolonged muscle spasms, weakness in the limbs, and nerve pain. Chronic sleep disturbances are also characteristic of fibromyalgia, and some studies suggest that these sleep disturbances are the result of a sleep disorder called alpha-delta sleep, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. Deeper stages of sleep are often dramatically reduced.
In addition, many patients experience cognitive dysfunction, which may be characterized by impaired concentration and short-term memory consolidation, impaired speed of performance, inability to multi-task, and cognitive overload. Many experts suspect that "brain fog" is directly related to the sleep disturbances experienced by sufferers of fibromyalgia. However, the relationship has not been strictly established.
Treatment:
Traditionally, low doses of sedating antidepressants have been used to reduce the sleep disturbances that are associated with fibromyalgia and are believed by some practitioners to exacerbate the symptoms of the disorder. Because depression often accompanies chronic illness, these antidepressants may provide additional benefits to patients suffering from depression. Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain. Standard clinical doses of newer anti-depressants (SSRIs) like Citalopram (Celexa) are being used.
Anti-seizure drugs are also sometimes used, such as gabapentin and pregabalin (Lyrica). Pregabalin, originally used for the nerve pain suffered by diabetics, has been approved by the American Food and Drug Administration for treatment of fibromyalgia. A randomized controlled trial of pregabalin 450 mg/day found that a number needed to treat of 6 patients for one patient to have 50% reduction in pain.
Holistic approach
Studies have found gentle exercise, such as warm-water pool therapy, improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia. Stretching is recommended to ease muscle stiffness and fatigue, as is mild aerobic exercise. Because strenuous activity can exacerbate the muscle pain and fatigue already present, patients are advised to begin slowly and build their activity level gradually to avoid inducing additional pain. Exercise may be poorly tolerated in more severe cases with abnormal fatigue after exercise. Many patients find temporary relief by applying heat to painful areas. Those with access to physical therapy and/or massage may find them beneficial. Chiropractic care can also help relieve pain due to fibromyalgia.
A holistic approach—including managing diet, sleep, stress, activity, and pain—is used by many patients. Dietary supplements, massage, chiropractic care, managing blood sugar levels, and avoiding known triggers when possible means living as well as it is in the patient's power to do.
http://www.fibromyalgia-symptoms.org/fibromyalgia_benzo.html
http://en.wikipedia.org/wiki/Fibromyalgia#Treatment
Fibromyalgia is an illness that causes chronic pain in muscles and ligaments. Although this disorder affects about 4 million Americans, the vast majority of them are women in their mid-30s to late-50s.
In addition to muscular pain and stiffness, this ailment can also cause fatigue, sleep problems, depression, and an inability to think clearly.
Fibromyalgia Causes
No specific cause for fibromyalgia has been found.
One of the leading theories is that low levels of a chemical called serotonin may lead to the illness. Serotonin is found throughout the body and plays an important role in controlling pain and regulating sleep. Blood tests have confirmed that people with fibromyalgia have low serotonin levels.
Other researchers believe fibromyalgia is caused by a lack of deep sleep. It is during stage 4 sleep that muscles recover from the prior day’s activity and the body refreshes itself. Sleep studies show that as people with fibromyalgia enter stage 4 sleep, they become more aroused and stay in a lighter form of sleep. Even though they may sleep for a long period of time, they get poor quality sleep. Also, when researchers took normal volunteers and did not allow them to enter into stage 4 sleep, they developed symptoms similar to fibromyalgia.
Fibromyalgia Symptoms
Pain: The most prominent symptom of fibromyalgia is pain. Unlike arthritis, the discomfort is not in the joints but in the muscles and ligaments. The pain is commonly located in the neck, shoulders, back, and hips. The tenderness is worse in the mornings and has been described as flulike, burning, throbbing, aching, or stabbing.
Fatigue: Another frequent complaint associated with fibromyalgia is fatigue. In fact, it occurs so commonly that some doctors think fibromyalgia and chronic fatigue syndrome are the same disease. The severity of the fatigue can range from mild to incapacitating. In its worse form, fatigue can be so debilitating that some people have trouble keeping their jobs. No amount of sleep at night or rest during the day is helpful.
Fibrofog: Another common symptom is a mental haziness some people call fibrofog. This refers to the inability to concentrate, memory loss, and depression that occurs with fibromyalgia.
Other symptoms associated with fibromyalgia are headaches, nervousness, numbness, dizziness, and intestinal disturbances.
Medical Treatment
No single treatment will take away all the symptoms associated with fibromyalgia. But most people do get some relief by trying a combination of therapies. Some of the treatment options your doctor may offer include these.
Treatment
Low doses of antidepressant medication: These medicines improve sleep and decrease pain as well as eliminate depression.
Biofeedback and relaxation techniques: Besides lessening pain, these therapies also decrease the number of tender points.
Acupuncture: Multiple studies have shown that acupuncture can decrease tender point pain.
Tender point injections: A steroid injection into a painful area may provide temporary relief.
Massage therapy: Helps relax and soothe painful muscles.
S-adenosyl methionine (SAMe): A small group of studies shows that this supplement may be helpful.
http://www.emedicinehealth.com/fibromyalgia
Fibromyalgia is an arthritis-related condition that is characterized by generalized muscular pain and fatigue. The term "fibromyalgia" means pain in the muscles, ligaments and tendons. This condition is referred to as a "syndrome" because it's a set of signs and symptoms that occur together.
Fibromyalgia is especially confusing and often misunderstood condition. Because its symptoms are quite common and laboratory tests are generally normal. However, medical studies have proven that fibromyalgia does indeed exist, and it is estimated to affect about 2 percent of the U.S. population today.
Symptoms include a history of widespread pain (pain on both sides of the body and above and below the waist) that is present for at least three months. Pain in at least 11 of 18 tender-point sites.
Doctors don't know what causes fibromyalgia. Current thinking centers around a theory called central sensitization. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals. Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors which receive signals from the neurotransmitters seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals. In this way, pressure on a spot on the body that wouldn't hurt someone without fibromyalgia can be very painful to someone who has the condition. But what initiates this process of central sensitization isn't known.
Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:
Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Anaprox, Aleve) — in conjunction with other medications. NSAIDs haven't proved to be effective in managing the pain in fibromyalgia when taken by themselves.
Antidepressants. Aantidepressant medications may be prescribed such as amitriptyline, nortriptyline (Pamelor) or doxepin (Sinequan) to help promote sleep. Fluoxetine (Prozac) in combination with amitriptyline has also been found effective. Sertraline (Zoloft) and paroxetine (Paxil) may help if you're experiencing depression.
Some evidence exists for a newer class of antidepressants known as serotonin and norepinephrine reuptake inhibitors or dual uptake inhibitors, which regulate two brain chemicals that may transmit pain signals. Studies have found that duloxetine (Cymbalta) may help control pain better than placebo in people with fibromyalgia.
Muscle relaxants. Taking the medication cyclobenzaprine (Flexeril) at bedtime may help treat muscle pain and spasms. Muscle relaxants are generally limited to short-term use.
Pregabalin (Lyrica) may reduce pain and improve function in people with fibromyalgia. Pregabalin, an anti-seizure medication that's also used to treat some types of pain, is the first drug approved by the Food and Drug Administration to treat fibromyalgia.
Prescription sleeping pills, such as zolpidem (Ambien), may provide short-term benefits for some people with fibromyalgia, but doctors usually advise against long-term use of these drugs. These medications tend to work for only a short time, after which your body becomes resistant to their effects. Ultimately, using sleeping pills tends to create even more sleeping problems in many people.
http://www.mayoclinic.com/health/fibromyalgia/DS00079/DSECTION=8
http://ww2.arthritis.org/conditions/DiseaseCenter/Fibromyalgia/fibromyalgia.asp
-Fibromyalgia- A chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points that occurs in precise, localized areas, particularly in the neck, spine, shoulders, and hips; also may cause sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms
www.ukhealthcare.uky.edu/patient/glossary/glossary-f.htm
-Signs and symptoms:
Symptoms of Fibromyalgia can vary, depending on the weather, stress, physical activity or even the time of day.
-Common signs and symptoms include:
Widespread pain. Fibromyalgia is characterized by pain in specific areas of your body when pressure is applied, including the back of your head, upper back and neck, upper chest, elbows, hips and knees. The pain generally persists for months at a time and is often accompanied by stiffness.
Fatigue and sleep disturbances. People with fibromyalgia often wake up tired and unrefreshed even though they seem to get plenty of sleep.
Irritable bowel syndrome (IBS). The constipation, diarrhea, abdominal pain and bloating associated with IBS are common in people with fibromyalgia.
Headaches and facial pain. Many people who have fibromyalgia also have headaches and facial pain that may be related to tenderness or stiffness in their neck and shoulders. Temporomandibular joint (TMJ) dysfunction, which affects the jaw joints and surrounding muscles, also is common in people with fibromyalgia.
Heightened sensitivity. It's common for people with fibromyalgia to report being sensitive to odors, noises, bright lights and touch.
-Other common signs and symptoms include:
Depression, Numbness or tingling sensations in the hands and feet, Difficulty concentrating, Mood changes, Chest pain, Dry eyes, skin and mouth, Painful menstrual periods, Dizziness, Anxiety,
-Causes
Doctors don't know what causes fibromyalgia. Current thinking centers around a theory called "central sensitization." This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals. Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain, neurotransmitters. In addition, the brain's pain receptors, neurons, which receive signals from the neurotransmitters seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals
-Other theories as to the cause of fibromyalgia include:
Sleep disturbances Injury, Infection, Abnormalities of the autonomic sympathetic nervous system, fatigue, stiffness, dizziness and other signs and symptoms associated with the condition, Changes in muscle metabolism
-Treatment
-Medications
-Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:
Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. NSAIDs haven't proved to be effective in managing the pain in fibromyalgia when taken by themselves.
Antidepressants. Your doctor may prescribe antidepressant medications such as amitriptyline, nortriptyline (Pamelor) or doxepin (Sinequan) to help promote sleep. Fluoxetine (Prozac) in combination with amitriptyline has also been found effective. Sertraline (Zoloft) and paroxetine (Paxil) may help if you're experiencing depression.
Muscle relaxants. Taking the medication cyclobenzaprine (Flexeril) at bedtime may help treat muscle pain and spasms. Muscle relaxants are generally limited to short-term use.
Pregabalin (Lyrica). Pregabalin may reduce pain and improve function in people with fibromyalgia. Pregabalin, an anti-seizure medication that's also used to treat some types of pain, is the first drug approved by the Food and Drug Administration to treat fibromyalgia..
Prescription sleeping pills, such as zolpidem (Ambien), may provide short-term benefits for some people with fibromyalgia, but doctors usually advise against long-term use of these drugs. These medications tend to work for only a short time, after which your body becomes resistant to their effects.
**Ultimately, using sleeping pills tends to create even more sleeping problems in many people.**
Benzodiazepines may help relax muscles and promote sleep, but doctors often avoid these drugs in treating fibromyalgia. Benzodiazepines can become habit-forming, and they haven't been shown to provide long-term benefits.
Doctors don't usually recommend narcotics for treating fibromyalgia because of the potential for dependence and addiction. Corticosteroids, such as prednisone, haven't been shown to be effective in treating fibromyalgia.
http://www.mayoclinic.com/health/fibromyalgia/DS00079/DSECTION=8
-Flexeril- This medication relaxes muscles. It is used along with rest and physical therapy to decrease muscle pain and spasms associated with strains, sprains or other muscle injuries.
This medication is intended for short-term use, usually no longer than 3 weeks, unless otherwise directed by your doctor
http://www.webmd.com/drugs/search.aspx?stype=drug&query=Cycloflex&simprint=&sshape=&scolor=
The exact mechanism of action for cyclobenzaprine is unknown. Content research appears to indicate that cyclobenzaprine acts on the locus coeruleus where it results in increased norepinephrine release, potentially through the gamma fibers which innervate and inhibit the alpha motor neurons in the ventral horn of the spinal cord.
http://en.wikipedia.org/wiki/Cyclobenzaprine
Fibromyalgia is a muscle disorder that causes muscle pain and fatigue. Patients who have the disease experience tender points on their bodies. These tender spots are usually in the neck, shoulders, back, hips, arms, and legs.
Symptoms:
Trouble sleeping
Morning stiffness
Headaches
Painful menstrual periods
Tingling or numbness in extremities
Trouble thinking and memory
Causes:
The causes are unknown but factors such as stressful or traumatic events (car accidents), repetitive injuries, illness and/or certain diseases can trigger the disease.
Most researchers agree that it is involved with neurotransmitter dysregulation. The patient experiences pain because the sensory process is abnormal which amplifies pain. Some studies have shown that patients with the disease have high levels of substance P in the spinal cord, low blood flow levels to the thalamus area of the brain, HPA axis hypofunction, low serotonin and abnormal cytokine function.
It is also believed that patients could be genetically predisposed to the disease.
Treatments:
Often multiples drugs are prescribed for patients who have the disease.
Drugs like Cycloflex and Flexeril help relax the muscles.
Sometimes seizure medications such as Lyrica are used because they can ease pain and help the patient sleep. They can also help to relieve fatigue.
The first drug used to treat fibromyalgia was approved by the FDA on July, 21 2007. The drug was manufactured by Pifzer and is named Lyrica (pregabalin). This drug reduces pain and helps the patient’s mobility. It’s mechanism of action is unknown, but it is believed that it may effect the release of neurotransmitters in the brain.
Some doctors prescribe antidepressants such as Fluxetine (Prozac) for the disease. It seems that patients benefit most from a combination of medicines used to relieve pain and aid sleep. Patients are encouraged to use alternative treatments such as yoga and message. Also doctors like for patients to exercise because this has proven to be helpful.
http://ww2.arthritis.org/conditions/DrugGuide/about_fibromyalgia.asp#
http://www.fda.gov/consumer/updates/fibromyalgia062107.html#approved
http://www.fmaware.org/site/PageServer?pagename=fibromyalgia
Fibromyalgia is a chronic condition characterized by widespread pain in your muscles, ligaments and tendons, as well as fatigue and multiple tender points. Fibromyalgia is more common in women than men. The symptoms and signs of fibromyalgia vary depending on weather, stress, and physical activity. The symptoms and signs include pain in specific areas of body when pressure is applied, and this pain can persist for months accompanied by stiffness. Fatigue and sleep disturbances, irritable bowel syndrome, headache and facial pain, and heightened sensitivity are also symptoms. The exact cause of fibromyalgia is not known. There is a theory of “central sensitization”, which states that fibromyalgia patients have a lower threshold of pain because of increased sensitivity in the brain to pain signals. Repeated nerve factors that contribute to the development of fibromyalgia are sleep disturbances, injury, infection, abnormalities, of autonomic nervous system, and changes is muscle metabolism. Risk factors for fibromyalgia include sex, age, disturbed sleep patterns, family history, and rheumatic disease. Diagnosis for fibromyalgia is difficult because there is no one single test. Test that are used for the diagnosis include blood tests, and x-rays. According to the American College of Rheumatology a general guidline for the diagnosis of fibromyalgia includes experiencing widespread aching pain for at least three months with a minimum of 11 locations on your body which are abnormally tender under pressure. Treatment for fibromyalgia includes medications that reduces the pain and improve sleep. These medications include analgesics to ease the pain and stiffness, antidepressants if you are experiencing depression and help control pain. These antidepressants work by regulating the brain chemicals that transmit pain signals Muscle relaxants such as Flexeril to treat muscle spasms and pain. Flexeril works by blocking nerve impulses that are sent to your brain Lyrica an anti-seizure medication is the first drug that is FDA approved for the treatment of fibromyalgia. Prescription sleeping pills also provide work for a short term because your body becomes resistant to their effects. Benzodiazepines work by relaxing muscles and promoting sleep.
www.mayoclinic.com
http://www.fibromyalgia-symptoms.org/fibromyalgia_benzo.html
Fibromyalgia: is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points that occurs in precise, localized areas, particularly in the neck, spine, shoulders, and hips; also may cause sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms. ~Google Define.
Causes: overexertion, stress, lack of exercise, anxiety, depression, lack of sleep, trauma, temperature and humidity extremes, infection.
http://tinyurl.com/2zay4n
Symptoms: pain, nausea, dizziness,joint problems, skin problems, depression, myofascial pain syndrome, morning stiffness, sleep disorders, headache, multiple chemical sensitivities, chest pain, dysmenorrhea, weakness, muscle twicth and spasms, changes in menstrual cycle, fatigue, urinary problems, colds symptoms, memory impairment, anxiety, aggravation, breating problems, vision problems, weight gain.
http://tinyurl.com/k79pm
Rx drugs used for treatment:
Benzodiazepines;
Temazepam- promotes sleep and fights anxiety.
Lorazepam- reduces anxiety and depression.
Clonazepam- relieves pain, reduces anxiety and depression.
Hormones;
Somatostatin Therapy- increases levels of GH and IGF-1.
Human Growth Hormone Therapy- highly effective in reducing pain.
Muscle Relaxers;
Cyclobenzaprine- helps reduces muscle pain and stiffness by blocking nerve impulses from your muscles to brain.
Orphenadrine Citrate- acts on the brain to reduces muscle pain.
Tizanidine- increases muscle tone and reduces muscle spasms by blocking receptors in the brain.
Carisoprodol- eases pain from muscle spasms by blocking the pain sensations from the brain.
Assorted other drugs that have shown to reduce the effects or and treat Fibromyalgia include Mirapex, Dextromethorphan, Kadian, Modafinil, Milnacipran, Ramelton, Gabapentin, and Preqabalin.
http://tinyurl.com/23qpv3
http://tinyurl.com/patlz
http://tinyurl.com/ywfkqs
http://tinyurl.com/27e7o4
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