Increased Risk for Death From Suicide and Accidents Seen in Fibromyalgia Patients

From Clinical Pain Medicine ISSUE: MARCH 2011 | VOLUME: 9:03

Increased Risk for Death From Suicide and
Accidents Seen in Fibromyalgia Patients

by Alice  Goodman
Atlanta-Although patients with fibromyalgia  are not at an
overall increased risk for mortality, they are at greater risk for
suicide and accidents, according to a large observational study
presented at the annual meeting of the American College of
Rheumatology.This is only the second study to evaluate death in
patients with fibromyalgia, said study investigator Kaleb Michaud, MD,
MS, PhD, assistant professor of medicine at the University of Nebraska,
Omaha, and co-director of the National Data Bank (NDB) for Rheumatic
Diseases, who presented the findings. “Prior to 2010, mortality in
fibromyalgia patients was unknown,”  he added.
According to Dr. Michaud, these results are consistent with those
reported in the first study to evaluate fibromyalgia mortality
(Arthritis Rheum 2010;62:3101-3108). This initial study found no
increase in overall mortality in Danish women with fibromyalgia, but
did find a significant spike in deaths from suicide, liver
cirrhosis/biliary tract disease and cardiovascular disease.
The most recent study, conducted in the United States, included 8,186
patients with fibromyalgia who were observed over 35 years in three
settings: 1,115 patients from clinical practice, 3,482 patients
enrolled in the NDB longitudinal outcome study and 3,589 others who had
declined to participate in that study.
The investigators calculated standardized mortality ratios (SMRs) based
on age- and sex-stratified U.S. population data after adjusting for
those who did not respond to the NBD study. Overall, they recorded 539
deaths and calculated an SMR of 0.90. The SMRs were 0.92 among clinical
patients, 0.67 among NDB-enrolled patients and 1.1 in non-enrolled
patients.
More than 93% of the patients were female and almost all were
non-Hispanic white ethnicity. The mean Health Assessment Questionnaire
(HAQ) score was 1.1 (range, 0-3), the mean pain score was 6.4 (range,
0-10) and the average global disease severity was 5.5 (range, 0-10).
The researchers diagnosed fibromyalgia, according to ACR criteria, in
67.4% of the patients and reported the presence of pain in 81%.
Compared with the general U.S. population, patients with fibromyalgia
had more accidents that resulted in death (7.1% vs. 5%, respectively),
had more deaths from influenza/pneumonia (5% vs. 2.3%, respectively)
and septicemia (4.1% vs. 1.4%, respectively), and committed more acts
of self-harm, such as suicide (4.4% vs. 1.4%, respectively). Predictors
of death also included body mass index (BMI) greater than 29, smoking,
HAQ score and more severe pain.
“These two studies relay an important message that physicians [caring
for patients with fibromyalgia] need to be sensitized to the risks of
suicide, particularly for patients who receive medications that may be
used in suicide attempts,” cautioned Mary-Ann Fitzcharles, MD,
associate professor of medicine in the Division of Rheumatology and
director of the Alan Edwards Pain Management Unit at McGill University,
in Montreal.
Generally, patients with chronic pain conditions have an increased rate
of suicide ideation and completed suicide, said Dr. Fitzcharles, who
was not involved in the study. Factors that may contribute to suicide
risk, specifically in patients with fibromyalgia, include depression
and psychogenic distress, such as anger, frustration or fear of having
an undiagnosed condition.
Dr. Michaud speculated that women with fibromyalgia may be at a higher
risk for suicide because they use more painkillers and antidepressants
and have high levels of somatic symptoms and depression.
Dr. Fitzcharles added that “the health of patients with fibromyalgia is
often suboptimal compared with that of the population in general for
both physical and psychological symptoms.” Patients with fibromyalgia
generally report reduced physical activity, which also contributes to
poor health, obesity and poor mood.
“These studies raise an important red flag warning for health care
professionals caring for fibromyalgia patients,” Dr. Fitzcharles
concluded.

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Medication and Fibromyalgia

Often Cymblata is a useful medication in the treatment of fibromyalgia. It is said to reduce the pain and improve overall functioning.  It is not clear how the medication works to alleviate the pain but we do know it increases the activity of serotonin and norepinephrine; two naturally occurring substances in the brain and spinal cord. Your doctor will direct you on how to take it but most likely it will be in a once daily capsule.

Savella an antidepressant recently out has been noted for the treatment of both depression and fibromyalgia.  It has been proven in multiple trials for ability to demonstrate concurrent improvement in fibromyalgia pain, physical function, and overall impression of change. This medication blocks the reuptake of both norepinephrine and serotonin, with greater selectivity for the inhibition of norepinephrine reuptake in vitro. It is prescribed by your medical professional and you must be sure to take it accordingly.

A Healthy Diet

 

A healthy diet is necessary for many things and now more people believe it will help decrease the symptoms of fibromyalgia. The maintaining of a balanced diet can not only be easy but fun too. So start by looking up a new recepie or ask a friend to help out. It is also a general rule that once the diet is under control other less productive patterns become less cumbersome. For example sleeping and concentration are often affected by poor diet so changing to one with more nutrient balance is going to help with this. So here are things to look out for; it is helpful avoid the artificial sweetener aspartame as they aggravate a pain receptor called NMDA. It is also important to note that those with chronic pain are highly sensitive in regards to this receptor. There are some that are safe to eat such as stevia, and Splenda. Decreasing the intake of sugary foods and those foods that include fructose and corn syrup is the next positive diet overhaul for those with fibromyalgia. We all know this already but caffeine is a false energy boost and will increase the feeling of tiredness in the long run. Dairy and gluten can increase fatigue in those that suffer from fatigue as a symptom of their fibromyalgia.  Try adding any necessary vitamin supplements if you are missing them in food. Remember you do not have to remove items from your diet unless they are causing physical discomfort and not everyone has the same problem foods. The key to any successful diet or meal plan is consistency and to be realistic.

Breakthrough Pain

Breakthrough Pain is defined as;  pain (The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage that comes on suddenly for short periods of time and is not alleviated by the patients’ normal pain suppression management.)

Breakthrough pain is common in cancer patients who commonly have a background level of pain controlled by medications, but the pain periodically “breaks through” the medication. The characteristics of breakthrough cancer pain vary from person to person, including the duration and possible causes. At times there is a trigger to the breakthrough pain but often there is no actual onset or cause to the pain spike. When this occurs the person is going to require more medication and often times the medication is stronger. When using narcotics to maintain the pain and if breakthrough pain occurs it may indicate that tolerance is happening. Tolerance is defined as- the person taking the drug has less of a reaction to it thus requiring a larger quantity for the same effect and or pain relief. To remedy the situation the seasoned medical professional best serves his patient by administering a different medication. Often this eliminates the dependence and the tolerance issues. There are several medications that your doctor will address in regards to your breakthrough pain. The goal is pain relief as quickly as possible.  Some of them include; actiq, fentora, dialudid, acetaminophen, percocet, vicodin and other narcotics that under the medical professional will be safely prescribed.

 

Fibromyalgia and Exercise

We know that exercise can alleviate the pain of fibromyalgia but what is the best form of exercise for fibromyalgia? The most consistent of sources say be slow and steady for the best results. It is also well proven that exercise improves a persons well being both internally and externally. You can start with a brief workout of easy movement that lasts no more than 15, 20, or 30 min. The movement can be Pilates, yoga, strength training, or aerobics. If that is too much, move to a less jarring type of movement such as walking a few min each day. As you feel more comfortable, increase to at least an hour a day. The goal is to be aware of the way your body is impacted by doing some form of movement each day. However athletes former and dancers alike report that the use of water and or strength training has been able to restore a sense or peace after injuries and or being diagnosed with fibromyalgia. Medical doctor’s report that the use of these forms of exercise are helpful in the transition from inactive to a more active life style. Warm water aerobics is another useful exercise to those with Fibromyalgia. The water temperature soothes the body and the group provides motivation and support.

People begin exercise programs everyday at all ages and they feel a change. Often the challenge with the person that has fibromyalgia is how hard to push… It is of course important to be sure that the exercise routine being done is proper for your body so ask support in the beginning if you don’t feel the  physical benefits at first. It is important to bear in mind that your health will benefit form use of your entire support system. Be sure all new or starting after a long time exercise programs with your doctor. That way the both of you can choose the best course of action.

 References:

WebMD January 28, 2010 Denise Mann

JULY 1996 Exercise and Fibromyalgia, Brad A. Roy, Ph.D. IIN THE U.S. SURGEON.

Fibromyalgia Tender Points

There are times when to have fibromyalgia seems worse than others. If you are feeling a sore spot it is just that. A place that is tender to the touch that there is no reason for the ache other than it was touched. Most people with fibromyalgia share the same tender spots in common. It is not clear what causes the tender points but they occur at anytime in the diagnosis of fibromyalgia. There is no understanding as to whether the tender spots diagnose fibromyalgia or the reverse. However if you visit a doctor for the first time with the pain from these painful areas it is important to ask about how they may relate or again the reverse if already diagnosed. There are many other symptoms of fibromyalgia. Your doctor will look for 11 of 18 points of diagnosis before making a legitimate diagnosis. In all the symptoms, primarily pain throughout the body must stay for a period of over three months. A dolorimeter or a doximeter regulates the true pressure or exertion of the tender points. Your doctor is trained to give this assessment for you . So how can you continue to care for yourself if you have fibromyalgia? There are several issues to discuss with fibromyalgia. First we have fatigue, muscle pain, ongoing depression and also periods of IBS (Irritable Bowel Syndrome). What may work; pain medication to relieve the muscle pain and antidepressants help both the depression and potentially the fatigue. Stress is often high so meditation or other relaxation techniques are important to learn in order to cut the stress of daily life and the on going pressures of the diagnosis. These techniques vary in how they help each person so it is important to know what works for you.

Protein and Calcium

Calcium is still number one in the prevention of not only bone loss but also potential building of bone.  However, studies showed that people that ate diets high in animal protein were more at risk for fractures than those that had more than 800 mg of calcium a day. Hence the reverse is true when you put protein and calcium  together it will benefit the bones only if the calcium did not go below 800 mg. Without 800mg or more of calcium daily the potential for hip fractures were greater and this was studied over an approximately 30 yr time frame. Over that course of time the study participants that followed a high protein diet and took calcium over 800mg a day were over 80% less likely to have hip fractures risk.