Pain Syndromes / Fibromyalgia

Fibromyalgia is a pain syndrome characterized by widespread muscle pain and tenderness. Young and middle-aged women are typically affected but any age or sex can have symptoms. Persistent pain that lasts three or more months can affect both sides of the body, above and below the waist, and muscles of the spine including the paraspinous, scapular, and trapezius muscles.  Patient’s also report stiffness, fatigue, especially disruptive sleep, cognitive difficulties, and multiple other unexplained symptoms of anxiety, depression, and impairment of daily activities.

The diagnosis of fibromyalgia is generally one of exclusion and patients are evaluated for the presence of other disorders. Some other disease processes that may be confused with fibromyalgia are hypothyroidism, rheumatoid arthritis, systemic lupus erythematosus, and polymalgia rheumatic.

Your doctor may order blood tests like a complete blood count, metabolic panel, and urinalysis to help rule out other medical conditions. There is no one laboratory finding with fibromyalgia so it is helpful to check a patient’s blood work.

Currently there is no cure for fibromyalgia but a healthy diet, exercise, proper sleep, and some medications may help to mitigate symptoms.  Medications used in the management of fibromyalgia include analgesics such as tramadol, anti-anxiety medications like buspirone, skeletal muscle relaxants like cyclobenzaprine, antidepressants like cymbalta, anticonvulsants like lyrica and gabapentin, and alpha 2 agonists like clonidine.

Our pain clinic is devoted to helping patients to improve their pain and quality of life.

Meralgia Paresthetica can be a particularly troubling and involves pain on the lateral side of the thigh secondary to the lateral femoral cutaneous nerve being compressed. This nerve is a sensory nerve but will not affect how the leg functions. Tight clothing, pregnancy, and obesity are some common causes of meralgia paresthetica. Sometimes injury or diabetes can cause the same symptoms. To help alleviate the symptoms, patients may try wearing loser clothing or use medications. In order to diagnosis meralgia paresthetica, a complete history and physical will be performed. Rarely are x-rays needed, but they may help to exclude other causes of the pain. An MRI or CT scan maybe ordered if there is suspicion of a mass or tumor.

Electromyography may be performed to exclude nerve and muscle disorders.  In meralgia paresthetica, an EMG will typically be normal. Nerve Conduction study is another way to determine if a nerve is damaged. A nerve block into the area where the nerve enters will help determine if the diagnosis is meralgia parasthetica. This test may be performed using ultrasound technology.

Taking over-the-counter pain relievers such as acetaminophen and advil may relieve the pain. If symptoms persist and/or are severe, a patient may need  a corticosteroid injections, tricyclic antidepressants, gabapentin, or pregabalin. Rarely is surgery ever neededand is only an option for patients with long-lasting severe symptoms.

Iliotibial Band Syndrome is a common injury to the knee that is usually associated with some movement like running or doing squats.  Sometimes, a patient will notice a stinging sensation or swelling on the outside of the leg or knee. Pain may increase over time and can be present above or below the knee. Diagnosis is often made on the history given by the patient and a physical exam. Often rest, ice, compression, and elevation are all that is needed to heal. Medications or physical therapy usually recommended.

Advanced (metastatic) cancer that has spread to the bone may cause bone pain which is different than other types of pain. Bone pain is extreme tenderness and aching in the bone and can be present even when you aren’t moving, unlike muscle and joint pain. Bone pain may be linked to many diseases including cancer, kidney failure, osteoporosis, celiac disease, sickle cell anemia, Lyme disease, osteomyelitis, rheumatological diseases, and neurologic injuries. Some treatments may include radiotherapy, sometimes surgical intervention, and occasionally medications.