Researchers suggest treatment for fibromyalgia should include a multidisciplinary approach combining pharmacological and non-pharmacological treatments. One very promising non-pharmacological option, they believe, is a fibromyalgia diet. This includes adding certain nutrient-rich foods (i.e., fish and green, leafy veggies) and subtracting those that may affect the central nervous system (i.e., MSG and soy sauce).

What Foods Trigger Fibromyalgia Pain? Certain foods may do more harm to the fibromyalgic body than good. To feel better, it may be necessary to cut them out. As stated by the Italian researchers mentioned above, “it seems reasonable to eliminate some foods from the diet of FM patients, for example excitotoxins.” These excitotoxins, a group of neurotransmitters, can cause injury or death to brain and nerve cells if consumed in high enough quantities. Examples include glutamate (i.e., MSG) and aspartame (i.e., the sweetener of the same name).

Foods which contain glutamate can enhance pain in those who suffer from fibromyalgia, says Kathleen Holton, PhD, MPH, a Nutritional Neuroscientist, Assistant Professor in Health Studies, and member of the Center for Behavioral Neuroscience at American University. “This includes processed foods with food additives, as well as some naturally occurring sources of free glutamate like soy sauce, fish sauces, and aged cheeses such as parmesan,” she says.

Another fibromyalgia diet no-no is gelatin. Since some gelatin-containing medications can’t be avoided, Holton recommends opening the gelatin capsule and mixing the medicine with a food like apple sauce instead.

What Foods Should You Avoid on a Fibromyalgia Diet? Other foods that may increase symptoms include processed foods that contain a long list of ingredients. “A good rule of thumb is that ingredient labels should be short, easy to read, and should only contain things you can add to a food,” says Holton. “For example, can you add ‘natural flavor’ to a food? Another example would be yeast. You can easily add yeast to a bread recipe but wouldn’t use ‘autolyzed yeast extract.’ Additives like ‘monosodium glutamate’ and all ‘hydrolyzed proteins’ should also be avoided.”

Multiple studies have found a link between eating gluten and increased fibromyalgia symptoms. This non-celiac gluten sensitivity may be an underlying cause of fibromyalgia, so it’s best to cut it out while on a fibromyalgia diet.

What Foods are Good for Fibromyalgia? Now for the good news. You can still enjoy yummy things while keeping fibromyalgia symptoms at bay. The most important foods to eat on a fibromyalgia diet are nutrient-packed whole foods, says Holton. “Certain nutrients can protect against the over excitation caused by glutamate additives,” she explains. Here are a few nutrients to increase:

1. Omega-3 fatty acids (e.g., from fish, cod liver oil, walnuts, canola oil, and flax seeds)

2. Magnesium (e.g., from nuts, seeds, green, leafy vegetables, fish, and whole grains)

3. Zinc (e.g., from meat, shellfish, nuts, and seeds)

4. Antioxidants (e.g., from lemons, garlic, onions, peppers, various fruits, and greens)

Basically, the ideal fibromyalgia diet, according to Holton, “would be something like the Mediterranean Diet, where a person is consuming fish, a little meat, lots of vegetables and fruit, and including green leafy vegetables, beans, nuts, and seeds.”

The post Got Fibromyalgia Pain? Dietary Changes Might Help appeared first on University Health News.

Fibromyalgia

Fibromyalgia affects up to 10 million Americans, according to the National Fibromyalgia Association. The condition causes tender spots in specific areas of the body that can be especially painful to pressure or touch. Exactly what causes fibromyalgia is unknown, but some studies show that genetic factors may predispose certain individuals to the condition. New evidence also suggests that fibromyalgia is related to how the body processes pain. Over time, the condition may cause the brain to become oversensitive to pain that most people would consider relatively minor. However, the pain that people with fibromyalgia experience is not imaginary—it’s real.

Fibromyalgia Risk Factors

Fibromyalgia usually develops between ages 35 and 60 and is more common in women than in men. People with RA, lupus, and spinal arthritis are more likely to develop fibromyalgia than people without these conditions. Fibromyalgia also has been associated with physically or emotionally stressful events, such as car accidents and illness.

Fibromyalgia Symptoms

Fibromyalgia is characterized by widespread muscle pain and multiple tender points on the neck, shoulders, back, hips, and extremities. The tender spots vary day to day in severity—one day they can be more severe in the shoulders; another day more severe in the lower back and legs. Joint stiffness also may occur, especially in the morning, and numbness or tingling may affect the extremities.

Many people with fibromyalgia find that the pain interferes with their sleep. More than 75 percent of people with fibromyalgia also report chronic fatigue as a major symptom, according to the Johns Hopkins Arthritis Center.

In addition to pain and fatigue, other symptoms of fibromyalgia include headaches, dizziness, memory problems (referred to as “fibro fog”), painful menstruation, and depression.

Diagnosing Fibromyalgia

Since the symptoms of fibromyalgia are vague and occur with other health conditions, it can be difficult to diagnose the condition (see “Fibromyalgia May be Misdiagnosed in Many Patients”). However, researchers recently reported success in detecting fibromyalgia through a blood test (see “Experimental Blood Test Detects Fibromyalgia”).

At one point, doctors relied on the presence of tender points to guide their diagnosis, but the American College of Rheumatology now recommends consideration of three criteria:

• Pain and symptoms over the previous week, based on the total number of painful areas out of 19 parts of the body, plus the level of severity of fatigue, waking feeling unrefreshed, memory problems (such as misplacing objects), and the number of other general physical symptoms.
• Symptom duration. Symptoms must have lasted for at least three months at a similar level.
• No alternatives. There should be no other health problem that might be causing the symptoms.

Fibromyalgia Treatment

People with fibromyalgia typically see several doctors before getting a diagnosis. Once the condition has been identified, a team approach (doctor, pharmacist, physical therapist, and other specialists) seems to work best. Treatment typically involves pain-relieving medications, but exercise and complementary therapies also have benefits.

Nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn), are not particularly good at easing fibromyalgia pain when taken alone. Drugs that target neuropathic pain are more effective, and the U.S. Food and Drug Administration (FDA) has approved three—the antidepressants duloxetine (Cymbalta) and milnacipran (Savella), and the anticonvulsive drug pregabalin (Lyrica)—for treating fibromyalgia. These medications relieve fibromyalgia symptoms by inhibiting the activity of nerve cells involved in the transmission of pain, and research suggests that they improve physical function and overall quality of life in people with fibromyalgia.

Metformin (Glucophage), a drug normally used to treat type 2 diabetes, also has shown some success in reducing fibromyalgia pain (see “Diabetes Drug May Ease Fibromyalgia Pain”).

While your symptoms may put you off physical activity, exercise may help. It is advisable to stick to low-impact options, since these are less likely to aggravate muscle discomfort than high-impact exercise. One you may want to try is the ancient Chinese martial art, tai chi. In a small 2018 study, people with fibromyalgia who engaged in twice-weekly tai chi sessions across a period of 24 weeks reported less pain than those who took part in aerobics sessions.

As well as being low impact, tai chi is a “mind-body” exercise that focuses on deep breathing and relaxation. Its meditative component means that it may help alleviate the stress and anxiety that accompany fibromyalgia. Other low-impact exercise options include walking, cycling, swimming, and yoga.

Complementary and alternative therapies, such as massage, chiropractic, acupuncture, and dietary supplements, also produce varying degrees of success at relieving fibromyalgia symptoms (see Chapter 10 for more on these). Getting adequate, quality sleep can improve the symptoms of pain and fatigue.

Lupus

Lupus (systemic lupus erythematosus) is an autoimmune disease. It can cause inflammation in any organ or system but most commonly affects the skin, hair, mouth, joints, kidneys, blood, brain, heart, and lungs.

Lupus Risk Factors

Multiple factors are implicated in lupus, among them hormonal imbalances, mental health problems, ethnicity, genetics, viruses, and environmental toxins.

• Hormones. About 90 percent of people with lupus are women.
• Environmental toxins. Cigarette smoke and mercury exposure have been linked to lupus.
• Race. People who have African, Asian, and/or Native American heritage are at increased risk for developing lupus.
• Genes. About 10 percent of people who suffer from lupus have a parent or sibling with the condition.
• Viruses. Varicella zoster, which causes shingles, and cytomegalovirus (a type of herpes virus) increase lupus risk.
• Depression. Research points to possible links between lupus and depression.

Lupus Symptoms

Initial lupus symptoms include feeling generally unwell, with fever, weight loss, and fatigue. A butterfly-shaped rash on the face also is typical. Thickened red circular skin lesions may occur elsewhere on the skin and are aggravated by sunlight.

Other symptoms include stiff, painful joints, easy bruising, and mouth sores. More serious symptoms include anemia, kidney damage and failure, blood clots, inflammation in the heart and/or lungs, confusion, and depression.

Diagnosing Lupus

There is no definitive test for lupus, but an experienced rheumatologist may be able to diagnose the condition based on your symptoms and exclusion of other rheumatic diseases. Your doctor also may carry out these diagnostic tests:

• Blood tests. Antinuclear antibody and autoantibody tests may be positive. A complete blood count may reveal low levels of red and white blood cells. Your kidney and liver function also will be checked.
• Urinalysis. This may reveal kidney involvement.
• Imaging tests. A chest x-ray can reveal whether fluid is building up in your lungs due to lupus.
• Other procedures. Arthrocentesis, lumbar puncture (which uses a needle to remove a sample of the fluid that surrounds the spinal cord and brain), and a kidney biopsy may be necessary.

Treating Lupus

Treatment for lupus varies according to the pattern of disease. Protocols may include the use of NSAIDs or antimalarials like hydroxychloroquine (Plaquenil), which reduces the risk of flare-ups. Keeping your doctor informed about how your symptoms are manifesting will help you both ensure that your treatment regimen is keeping pace with your needs (see “Reporting Lupus Symptoms in Real Time”).

If lupus is resistant to treatment, your doctor may prescribe corticosteroids, such as prednisone (Deltasone, Sterapred); disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (Rheumatrex, Trexall); or biologics, such as rituximab (Rituxan) or abatacept (Orencia). A recent study suggests that the biologic drug ustekinumab (Stelara), which is approved to treat psoriasis, psoriatic arthritis, and Crohn’s disease, may ease lupus flare-ups (see “Ustekinumab Shows Promise for Lupus”).

Psoriatic Arthritis

About 5 percent of people with the skin condition psoriasis develop psoriatic arthritis. In 60 to 80 percent of psoriasis sufferers, arthritis develops after the skin condition, but occasionally arthritis appears first, or they occur simultaneously. Psoriatic arthritis can affect any joint in the body and may affect multiple joints.

Psoriatic Arthritis Risk Factors

The main risk factor for psoriatic arthritis is psoriasis, an autoimmune condition that causes skin cells to build up and form scaly, sore patches. People with psoriasis who develop the condition on their fingernails are more susceptible to psoriatic arthritis.

Other risk factors for psoriatic arthritis include:

• Genetics. About 40 percent of people with psoriatic arthritis have a first-degree relative with the condition. Multiple genetic variations associated with psoriatic arthritis have been identified, most notable of which are human leukocyte antigen (HLA) and interleukin genes.
• Infections. In some cases, a viral or bacterial infection precedes the development of psoriatic arthritis. Individuals with human immunodeficiency virus (HIV) are at greater risk.

Psoriatic Arthritis Symptoms

Psoriatic arthritis symptom severity is variable, and progression may involve flare-ups and periods of remission. Prominent symptoms include joint pain, stiffness, and swelling of two to four joints in any part of the body, including the fingertips and spine. Inflammation occurs at tendon or ligament insertions into bone, most commonly in the Achilles tendon and plantar fascia (fibrous tissue along the sole of the foot that connects your heels to your toes).

Other psoriatic arthritis symptoms include dactylitis, which causes the fingers to become swollen (this develops in up to 35 percent of people with psoriatic arthritis). Red, scaly lesions also are common and may itch and ooze pus. Eye lesions occur in 30 percent of people with psoriatic arthritis, and pink eye (also known as conjunctivitis) is another potential symptom.

Diagnosing Psoriatic Arthritis

There is no definitive test for psoriatic arthritis, but your doctor can use the following testing methods:

• Blood tests. These will check your erythrocyte sedimentation rate (ESR) to determine the presence of inflammation. Levels of C-reactive protein (CRP) and immunoglobulin-A may be abnormally high.
• Imaging tests. X-rays may detect a specific pattern of joint change, while magnetic resonance imaging (MRI) can detect sacroiliac joint involvement.
• Arthrocentesis. In psoriatic arthritis, joint fluid usually contains an elevated number of white blood cells.

Psoriatic Arthritis Treatment

Medical treatment regimens for psoriatic arthritis are similar to those used for RA, and include the use of NSAIDs and DMARDs.

Some research suggests that a low-calorie and/or low-gluten diet may be beneficial. Other treatment options, such as physical therapy, may alleviate symptoms. A European study determined that being overweight is associated with psoriatic arthritis severity, which suggests that lifestyle approaches may be appropriate in managing the condition (see “Weight Associated with Greater Psoriatic Arthritis Severity”).

Surgical treatment is occasionally required when joint damage is severe.

Reactive Arthritis

Reactive arthritis (ReA) is an autoimmune disease triggered by generalized infection. It usually resolves in three to 12 months, but recurrence is seen in 15 to 50 percent of cases. It is sometimes triggered by stress or a new infection. Up to 30 percent of people with ReA develop chronic, destructive arthritis.

Reactive Arthritis Risk Factors

ReA most commonly develops from gastrointestinal infections, such as Salmonella enterica, Shigella, and Campylobacter, and sexually transmitted infections, such as Chlamydia trachomatis.

Other risk factors include:

• Gender. Although it isn’t clear why, men are more likely than women to develop ReA after having a sexually transmitted infection.
• Genetics. While there is a specific genetic marker associated with ReA, most people who have the marker don’t develop the disease.

Reactive Arthritis Symptoms

ReA symptoms usually develop within a month of exposure to the bacteria. The most prominent symptoms—known as the “triad of ReA”—are inflammation of the urethra (the tube through which urine exits the body) that makes urination painful, asymmetrical joint pain (most commonly in the legs, fingers, and sacroiliac joints), and conjunctivitis. Other symptoms include fatigue, fever, a skin rash, and swollen fingers.

Diagnosing Reactive Arthritis

It is important to accurately identify ReA, since some medications are not suitable for people with the condition. Blood tests, imaging, and arthrocentesis may aid in the diagnosis.

• Blood tests. Your blood will be checked for signs of a previous infection that might have triggered ReA and for antibodies that might indicate inflammation or a genetic marker linked to ReA.
• X-rays may reveal signs of ReA or point to another type of arthritis.
• Arthrocentesis. A sample of synovial fluid will be examined for markers that might indicate another condition—for example, uric acid or calcium pyrophosphate (CPP) crystals may signal gout or pseudogout (see Chapter 5 for more on these).

Reactive Arthritis Treatment

ReA management is medical. It involves a combination of NSAIDs, corticosteroids (oral, topical, and injectable), and antibiotics that target the confirmed or suspected primary infection.

Septic Arthritis

Septic arthritis—also called infectious arthritis—is an infection within the joint cavity. Septic arthritis commonly occurs as arthritis in one joint (monoarthritis), and it involves the knee joint in 50 percent of cases.

The joint cavity is a sealed, sterile space, but in septic arthritis, bacteria from nearby soft tissue spread to the joint via the bloodstream. Once introduced to the joint, the infectious agent causes a cascade of inflammation and hyperplasia (overgrowth) of the synovial membrane. Inflammatory proteins are released, destroying the cartilage and, eventually, the bone. Excess synovial fluid also is released, and this results in significant swelling. Eventually, the blood supply to the bone may be impaired, leading to aseptic necrosis (bone death due to lack of blood).

Significant destruction of the joint may occur in as little as three days, and septic arthritis also raises the risk of death. For this reason, septic arthritis is considered a medical emergency.

Septic Arthritis Risk Factors

In most cases, the infection underlying septic arthritis is caused by a single bacterial pathogen. Staphylococcus aureus (a skin bacteria) is implicated in nearly half of cases. Other causes of septic arthritis include skin and genitourinary tract infections, Lyme disease, fungi, and tuberculosis. Additional risk factors include:

• Age. About 45 percent of cases occur in people age 65 and older.
• Joint injections, surgeries, or procedures. These involve entering or opening the joint space and run the risk of introducing bacteria (often from the skin) into the joint. The incidence of septic arthritis following joint replacement is between 2 and 10 percent. Infection of a prosthetic joint may occur in the weeks or months following surgery, and the joint remains at elevated risk of infection.
• Damaged joints due to trauma and/or medical conditions like gout, lupus, and RA (the incidence of septic arthritis is seven times higher in people with RA).
• Immunosuppression. Septic arthritis is more common in people with HIV and in those receiving immunosuppressive therapy for cancer or autoimmune diseases, including RA.
• Recreational drug users. Drug users who inject with non-sterile needles may introduce bacteria into their bloodstream that then spread to the joint.

Septic Arthritis Symptoms

Septic arthritis usually presents with a single swollen, painful joint that feels hot to the touch. Common sites include the knees, wrists, ankles, and hips. The joint usually will be stiff, with a reduced range of motion. In up to 19 percent of patients, more than one joint is affected.

Other symptoms include low-grade fever, which occurs in 20 percent of cases, bursitis (inflammation of the fluid-filled sacs that cushion joints), and swellings behind the knee (called Baker’s cysts). If septic arthritis occurs after joint replacement, a sinus tract (a channel between the joint and the skin) may develop and leak infected fluid.

Diagnosing Septic Arthritis

Several conditions mimic septic arthritis, including RA, gout, pseudogout, Lyme disease, and ReA. Your doctor will likely rule out these conditions with the following tests:

•  Blood tests. In septic arthritis, your white blood cells and ESR may be high.
• Imaging. X-rays can help your doctor monitor the progression of joint damage in septic arthritis.
• Arthrocentesis. Synovial fluid will be examined for bacteria and white blood cells that may indicate an infection, and for uric acid or CPP crystals that may indicate gout or pseudogout. A new technique may provide faster results than standard synovial fluid screening (see “mPCR Technique May Rapidly Diagnose Septic Arthritis”). If there are no crystals and infection screening is negative, a biopsy of the synovial membrane may be needed.

Septic Arthritis Treatment

A hospital stay of several days is usually required with septic arthritis. Treatment involves a three-pronged approach: drainage of the infected synovial fluid, treatment of the underlying infection, and immobilization of the joint. These strategies will be followed by physical therapy to rehabilitate the joint.

Drainage of the synovial fluid will likely involve needle aspiration two to three times per day for the first few days. Surgical or arthroscopic drainage and debridement (cleaning away debris in the joint) may be needed if the infection is resistant to antibiotic therapy, if there is soft tissue involvement, or if the infection is in a difficult-to-reach joint, such as the hip, shoulder, or sacroiliac joint.

Prompt treatment of the underlying infection is essential. Laboratory testing will guide treatment, but antibiotics will be prescribed on a best-guess basis until your lab results are received. If a bacterial infection is confirmed, antibiotics will be administered via an IV or central line for at least two weeks.

Joint immobilization with splints is required for at least five days. If there is a good response to treatment, gentle mobilization by a physical therapist may begin, followed by intensive physical therapy for several weeks.

If septic arthritis is linked to a prosthetic joint, the implant may need to be removed. A new joint will be inserted either immediately (which has a success rate of 39 to 91 percent) or later, when the infection has been completely controlled (this option has a greater success rate: 73 to 100 percent).

Ankylosing Spondylitis

The Arthritis Foundation defines spondyloarthritis as a general term for inflammatory diseases that involve the joints and the sites where ligaments and tendons attach to the bone. The most common of these diseases is ankylosing spondylitis, a chronic inflammatory condition that affects the vertebrae in the upper and lower spine and the sacroiliac joints. Over time, ankylosing spondylitis can cause the vertebrae to fuse, resulting in a hunched posture.

Ankylosing Spondylitis Risk Factors

Most people with ankylosing spondylitis share a common genetic marker called HLA-B27. This gene increases in incidence with distance from the equator. While 8 percent of the general population carry it, only 1 percent of HLA-B27-
positive individuals develop ankylosing spondylitis. The risk increases to 15 to 20 percent if a first-degree relative with ankylosing spondylitis carries the gene. Other risk factors include:

• Age. Onset is most common between the late teens and early 40s, but due to its slow onset, ankylosing spondylitis may go undiagnosed for some time.
• Gender. Men are more likely than women to develop ankylosing spondylitis, and the condition also tends to be more severe in men.
• Infection. There is evidence that the bacteria Klebsiella pneumoniae may trigger ankylosing spondylitis in people with the HLA-B27 gene.

Ankylosing Spondylitis Symptoms

Key features of ankylosing spondylitis include low back pain of slow, insidious onset, lasting more than three months. The pain is worse on waking or after a period of inactivity but is relieved by exercise. The spine will feel stiff, and some degree of kyphosis (“hunchback”) may develop. Other symptoms include inflammation in the hands and feet, fatigue, fragile vertebrae that are more likely to fracture, and extra-articular inflammation in the eyes, heart, aorta (the main artery that supplies oxygenated blood from the heart to the body), kidneys, lungs, nervous system, and gastrointestinal tract.

Diagnosing Ankylosing Spondylitis

Your doctor will perform a physical examination to check the flexibility of your spine. He or she also may order blood tests and imaging.

• Blood tests will check for inflammatory markers, including elevated ESR and CRP, as well as the HLA-B27 gene (keep in mind that having the gene does not necessarily indicate that you have ankylosing spondylitis).
• Imaging. X-rays may show inflammatory changes and erosion in the sacroiliac joints and spine. MRI and computed tomography scans may reveal early disease.

Ankylosing Spondylitis Treatment

Drug treatment for ankylosing spondylitis includes NSAIDs, corticosteroids, DMARDs, and biologics. The latter especially may help you live better with ankylosing spondylitis (see “Biologic Drug Eases Pain, Improves Quality of Life in People with Ankylosing Spondylitis”).

Physical therapy and range-of-motion exercises can improve strength and flexibility in your spine, while exercises that target the abdominal muscles can help with maintaining good posture. Some people have reported symptom relief from spinal manipulation.

Lifestyle changes, such as stopping smoking and staying physically active, may slow the progression of ankylosing spondylitis, ease its symptoms, and reduce your risk of complications from the condition. Surgery may be needed to fuse spinal vertebrae, stabilize fractures, and/or replace hip joints.

Your doctor may suggest genetic counseling to discuss the risk of passing on ankylosing spondylitis to any children you may have.

The post 6. Other Types of Arthritis appeared first on University Health News.

The common denominator of severe arthritis is pain, and some medications focus solely on relieving pain. Opioids, for example, are designed specifically to reduce moderate-to-severe pain, and in most cases they do that very effectively, although they come with some potentially serious side effects. Other medications fight the underlying inflammation of arthritis, or slow or halt its progression—for example, the disease-modifying antirheumatic drugs (DMARDs) and biologics that are used for treating rheumatoid arthritis (RA).

Combining the anti-seizure drug pregabalin (Lyrica) with the antidepressant duloxetine (Cymbalta) has been shown to improve physical function in fibromyalgia patients. Other drugs address quality of life. Three studies have shown that etanercept (Enbrel) improves quality of life for people with RA.

Hundreds of other over-the-counter (OTC), prescription, and off-label drugs also have been used to treat arthritis. Understanding the pain process that specific drugs address may help you work out which options are best for you.

Pain Signals

The pain pathway begins in the peripheral nerves of the skin, bone, soft tissue, or joint capsule (cartilage has no nerve endings, so it does not produce pain). Pain signals travel along nerve fibers via the spinal cord to an area of gray matter called the dorsal horn. This area acts as a gatekeeper for pain, sometimes blocking minor pain but allowing the transmission of more significant pain signals up into the brain, where they are processed and a response is initiated.

Perceived Pain: It’s Real

Tissue overgrowth, bone erosion, soft tissue inflammation, bony spurs catching on soft tissue, and debris within the joint are just some of the physical causes of arthritis pain. Your doctor will attempt to determine the origin of your pain to better guide your diagnosis and treatment. But even when there is a specific physical cause for pain, people experience it very differently.

Factors that may influence how you perceive arthritis pain include:

• Which joint or joints are affected. The site, tissue involved, and how much you use the joint play a role.
• Aging. Older people experience more chronic pain than younger people. This may be because of increased incidence of disease or injury, or due to increased pain perception.
• Gender. Women are more likely than men to report chronic pain.
• Genes. Hundreds of genes have been identified that may impact pain sensitivity and tolerance.
• Other health conditions, such as heart disease and respiratory diseases, influence pain perception.
• Mental health. Anxiety, depression, negative thinking, and a history of trauma and/or abuse all come into play.
• Smoking. Smokers report greater pain intensity than non-smokers.
• Weight. Being overweight not only puts greater pressure on stressed joints, but also may increase pain sensitivity.
• Sleep problems. Because pain disrupts sleep, and lack of sleep increases pain perception, a cycle of pain can develop.
• Alcohol. Alcohol may cause temporary pain reduction, but it’s not recommended to treat pain because of its overall negative health effects.
• Nutrition. A healthy diet may reduce inflammation levels, decreasing pain in the process.
• Employment. Occupations that involve repetitive or strenuous work can make pain worse.
• Vitamin D. There is a possible relationship between low vitamin D levels and increased pain sensitivity.

Osteoarthritis Medications

Pain-relieving drugs (analgesics) are available in oral, topical, and injectable formulations. Other conservative pain treatment options for osteoarthritis (OA) include viscosupplementation, platelet-rich plasma (PRP), and prolotherapy injections. Stem-cell therapy is currently under investigation (see “Stem Cells May Relieve Knee Osteoarthritis”).

Analgesics include OTC acetaminophen (Tylenol), and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).

Keep in mind that even low-dose OTC painkillers are associated with side effects, and they also have risky drug and food interactions. Stronger analgesics are available by prescription only, as are corticosteroids and opioids.

Acetaminophen

Acetaminophen blocks pain signals and can be useful as a stand-alone treatment for mild joint pain in people who can’t take NSAIDs. Acetaminophen does not treat inflammation.

At the recommended dose, acetaminophen is relatively safe for long-term use except in people with liver disease. Acetaminophen is metabolized in the liver, and taking too much of the drug can cause irreversible liver damage. Keep track of how much you are taking, and remember that acetaminophen is the active ingredient in many other medications, including cold and flu remedies.

Acetaminophen Side Effects. Acetaminophen side effects are rare, but you should immediately report them if they occur. They may include:

• Skin rash and itching
• Fatigue and headaches
• Decreased urine output/dark urine
• Lower back pain
• Jaundice (a yellow tinge to the skin and whites of the eyes)
• Nausea and vomiting, diarrhea, and cramping stomach pain may indicate an acetaminophen overdose. Treat these symptoms as an emergency, and seek immediate medical help.

NSAIDs

OTC NSAIDs, such as ibuprofen and naproxen, reduce inflammation and ease pain. Stronger NSAIDs, such as diclofenac (Cataflam, Zorvolex), indomethacin (Indocin, Tivorbex), and celecoxib (Celebrex), require a prescription.

Celecoxib is in a class of NSAIDs called COX-2 inhibitors. It is less likely than traditional NSAIDs to cause gastric irritation, but it is associated with increased cardiovascular risk.

NSAIDs interact with many other drugs, especially blood thinners like warfarin (Coumadin). If you take any other drugs, check with your pharmacist or doctor to ensure that NSAIDs are safe for you. People with asthma and/or stomach ulcers, and women who are pregnant or breastfeeding, also should check with their doctor before taking NSAIDs.

NSAIDs should be taken at the lowest effective dose and for the shortest duration possible. If you have to take NSAIDs long-term, your doctor may recommend an antacid to help prevent stomach irritation. Options include proton-pump inhibitors such as omeprazole (Prilosec) and H2 blockers like ranitidine (Zantac) and cimetidine (Tagamet). At the time this report was published, some retailers had stopped selling ranitidine and Zantac because traces of a carcinogen were found in the drugs. However, the U.S. Food and Drug Administration (FDA) had not, at that point, taken the drugs off the market.

NSAID Side Effects. NSAID side effects tend to be dose-related. You may be able to avoid them by taking enteric (coated) options and taking the pills with food. Never mix NSAIDs with cough and cold medications that contain NSAIDs.

NSAID side effects may include:

• Inflammation of the stomach, leading to indigestion or mild discomfort and, in severe cases, ulcers and bleeding. This is more common with long-term NSAID use, and in people who take oral corticosteroids, smokers, people with pre-existing stomach problems, and older adults
• Headaches and dizziness
• Drowsiness
• Elevated blood pressure, and an increased risk of heart attack and stroke with prolonged use
• Kidney damage, especially in cases of prolonged use and overdose.

Injectable Corticosteroids

OA patients may gain short-term symptom relief from injectable corticosteroids like triamcinolone (Kenalog, Zilretta). Oral corticosteroids are not used to treat OA—they are more effective for managing systemic forms of arthritis, like RA.

Injectable Corticosteroid Side Effects. Due to side effects associated with these drugs, most experts recommend limiting corticosteroid injections to a maximum of three per year, with a lifetime total of 10. Exceptions to these guidelines depend on which joint is being treated and the patient’s individual circumstances.

Possible side effects include:

• Bone loss
• Increased risk of fractures
• Weakened cartilage and tendons
• Nerve damage, joint irritation
• Joint infections.

Opioids

Opioids like hydrocodone (Vicodin, Norco, Lortab), oxycodone (Percocet, Oxycontin) and tramadol (Ultram) are powerful enough to cut through severe pain. However, research suggests they may be no better than non-opioid analgesics when it comes to easing OA pain. They also carry significant risks.

Opioid Side Effects. Opioid tolerance increases over time, and you may find yourself taking higher and higher doses to achieve pain relief. Regular opioid use can lead to dependence, and unpleasant withdrawal symptoms make it extremely difficult to stop taking the drugs.

If your doctor prescribes opioids, take them strictly as directed. All medications should be safely stored out of the reach of children, but in the case of opioids, it is advisable to take extra precautions if you have teenage children or grandchildren who regularly visit you.

Opioid side effects include:

• Shallow breathing, leading to low oxygen levels in the blood
• Nervous system depression (drowsiness, sedation, confusion, impaired judgment, falls, death)
• Atrial fibrillation (an abnormal heart rhythm)
• Stroke
• Itching
• Constipation
• Severe withdrawal symptoms, including anxiety, nausea, vomiting, and abdominal pain
• Decreased awareness, constricted pupils, and seizures may indicate an overdose of opioids and should be treated as a medical emergency.

Topical Analgesics

These are applied to the skin and have less risk of side effects. They include:

• Counterirritants. These interrupt the perception of pain. Active ingredients may include menthol, eucalyptus, camphor, and wintergreen.
• Capsaicin creams. Capsaicin—the active ingredient in hot peppers—interferes with pain signals.
• Lidocaine patch. Lidocaine (Lidoderm) is a local anesthetic used to relieve pain in the back and larger joints.
• NSAIDs. Topical NSAIDs like diclofenac (Voltaren Gel) and the diclofenac patch (Flector) may ease arthritis pain and inflammation without causing the gastrointestinal side effects that can accompany oral NSAIDs.
• Fentanyl patch. This topical version of the opioid fentanyl (Duragesic) has similar side effects to those that can accompany oral opioids.

Rheumatoid Arthritis Medications

Your doctor may prescribe oral corticosteroids to help ease RA pain and inflammation, but RA treatment mainly involves DMARDs and/or biologics.

Oral Corticosteroids

Oral corticosteroids like prednisone (Sterapred, Deltasone) have potent anti-inflammatory properties and can provide quick relief during RA flare-ups.

Oral Corticosteroid Side Effects. Oral corticosteroids come with significant side effects. Take the lowest dose possible to control your symptoms, with the goal of stopping the drugs as DMARDs and/or biologics take effect.

The most common side effects are:

• Bone loss and an increased risk of osteoporosis and fractures
• Elevated blood sugar and an increased risk of diabetes
• High blood pressure
• Weight gain
• Stomach ulcers
• Easy bruising
• Increased risk of infection
• Cataracts, glaucoma
• Fatigue
• Mood changes
• Weakness, especially on withdrawal from the drugs.

DMARDs

These drugs interfere with the immune response, slowing the course of RA and potentially reducing or preventing joint destruction. They are now recommended as the first-line treatment for people with RA and should be considered as soon as the diagnosis is confirmed. It takes up to six weeks before any effect is seen, and up to 12 weeks for full benefits, so NSAIDs or corticosteroids may be given until DMARDs take effect.

Initially, DMARDs are taken orally, with injections and/or combinations of DMARDs (and, possibly, biologics) being used if needed. The American College of Rheumatology (ACR) recommends that if RA is in remission, DMARDs should be tapered off, either by reducing the dose or spacing the doses.

DMARDs include oral methotrexate (Rheumatrex, Trexall), injectable methotrexate (Otrexup), leflunomide (Arava), and sulfasalazine (Azulfidine).

• Methotrexate is the most widely used non-biologic DMARD for the long-term control of RA, though it doesn’t work for everybody and may interfere with the flu vaccine.
• Leflunomide is almost as effective as methotrexate and may be given with it.
• Sulfasalazine has anti-inflammatory properties and may be used alone or with other DMARDs when RA is severe.

DMARD Side Effects. DMARDs have an excellent safety record and may reduce cardiovascular risk. However, the drugs are not safe in pregnancy and may diminish male fertility. Alcohol intake should be stopped or limited during therapy and for three months after cessation.

Since DMARDs suppress the immune response, they increase your susceptibility to infections. Therefore, the ACR recommends vaccination against pneumococcus (the most common cause of penumonia and meningitis), hepatitis, influenza, human papillomavirus, and varicella zoster (the virus that causes shingles) before starting DMARDs.

Mild side effects of DMARDs include nausea, vomiting, drowsiness, swollen gums, dizziness, decreased appetite, and hair loss. More serious side effects may cause life-threatening complications, and should be reported to a doctor immediately. These may include:

• Sore throat and mouth sores
• Pale skin and/or unusual bruising
• Shortness of breath
• Fatigue
• Fever, chills
• Cough
• Nausea, vomiting, diarrhea
• Dark-colored stools
• Dark-colored urine and/or reduced urine volume
• Severe headache
• Muscle weakness and/or bone pain
• Jaundice.

Biologics

Biologics (also called biological response modifiers or biologic DMARDs) are the most powerful RA drugs, but because they have the potential to cause significant side effects, they are reserved for people with severe RA that does not respond to conventional DMARDs. Biologics also are expensive—hence the development of more affordable “biosimilars” that closely resemble biologics.

Some biologics modify the immune response by interfering with specific pro-inflammatory agents, including tumor necrosis factor (TNF), interleukin-1 (IL-1), and interleukin-6 (IL-6). Others block the activation of immune system cells and enzymes that cause inflammation.

• Anti-TNF. These drugs block the action of TNF. They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), and certolizumab (Cimzia). Up to 70 percent of RA patients respond well to anti-TNFs, which are given via injection or intravenous infusion.
• Anti-IL-1. Only one anti-IL-1 drug is currently used in the United States to treat RA: anakinra (Kineret), which is given via injection.
• Anti-IL-6. IL-6 is present in the synovial fluid of people who have RA. Anti-IL-6 drugs include sarilumab (Kevzara) and tocilizumab (Actemra), and they are given via injection or IV infusion.
• Cell blockers. These drugs block activation of the T- and B-cells that play a key role in the immune response. Options include abatacept (Orencia) and rituximab (Rituxan).
• Janus kinase (JAK) inhibitors. These synthetic biologics interfere with substances called kinases, which help regulate the immune response. JAK inhibitors are approved for use in people with moderate-to-severe RA who have not responded to anti-TNFs. Options include tofacitinib (Xeljanz) and baricitinib (Olumiant).

Biologic Side Effects. Because biologics weaken the immune system, they may increase the risk of upper respiratory tract infections, shingles, and tuberculosis, among others (see “Lower Risk of Infections with Abatacept”). This means it is important to discuss with your doctor whether you need to update any vaccinations before you start taking biologics. The drugs also come with an increased risk of cardiovascular disease, and some are associated with the development of certain cancers, such as nonmelanoma skin cancers and lymphoma.

Anti-TNF biologics raise the risk of long-term neurological side effects that mimic multiple sclerosis (MS). People with MS should not take anti-TNFs, and those who have heart failure should not take infliximab.

Side effects that should be reported to your doctor include headaches, a runny nose, sore throat, flushing, nausea, heartburn, and muscle pain. Call your doctor immediately if you suffer these more serious side effects:

• Hives, skin rash, itching
• Cellulitis (a potentially serious bacterial skin infection that typically affects the lower legs)
• Swelling of the eyes, face, lips, tongue, or throat
• Fever, chills
• Shortness of breath and/or difficulty breathing
• Diffculty swallowing
• Abnormal heart rhythms
• Low blood pressure (signs may include dizziness, blurred vision, and nausea)
• Persistent dry cough
• Weight loss
• Night sweats
• Frequent urination and/or a burning sensation when urinating.

Fibromyalgia Medications

OTC painkillers such as acetaminophen and NSAIDs can be used to ease fibromyalgia symptoms. The FDA also has approved three drugs specifically for treating the condition: pregabalin (Lyrica), milnacipran (Savella), andduloxetine (Cymbalta).

Lyrica is an anti-seizure medication; Savella and Cymbalta are both antidepressants. All have been shown to reduce fibromyalgia pain and improve function, and all have been associated with a wide variety of mild-to-severe side effects, ranging from drowsiness to an increased risk of suicide.

As mentioned in Chapter 6, the diabetes drug metformin (Glucophage) has shown success in reducing fibromyalgia pain. Other relatively familiar drugs used off-label to treat fibromyalgia include the sedative-hypnotic zolpidem (Ambien), the antidepressants fluoxetine (Prozac) and sertraline (Zoloft), and the muscle relaxant cyclobenzaprine (Flexeril).

Gout Medications

At least 12 drugs are used for the treatment of gout. Among them is colchicine (Colcrys, Mitigare), which relieves pain and reduces inflammation. It is used in the acute phase of gout, and in low doses to prevent flare-ups.

Patients with chronic gout may need first-line drugs such as allopurinol (Aloprim, Zyloprim) and febuxostat (Uloric). In 2019, the FDA mandated strong warnings for febuxostat due to an increased risk of death in people taking the drug. It should be used only after treatment with allopurinol has failed, or if allopurinol is not tolerated.

Second-line drugs include probenecid (Benemid), lesinurad (Zurampic), and pegloticase (Krystexxa).

Pseudogout Medications

The American Academy of Family Physicians suggests using NSAIDs to treat pain and swelling due to pseudogout. For severe attacks, a prescription-strength NSAID, such as indomethacin, may be used. People with kidney problems or a history of stomach ulcers should not take NSAIDs, nor should those who are taking blood thinners. If you cannot take NSAIDs, colchicine can reduce pain and swelling. Injectable corticosteroids also may be appropriate.

Lupus Medications

The most commonly used drugs to treat lupus are NSAIDs, and they may be the only medication needed for some people. Other drugs that may be used include corticosteroids, such as prednisone; antimalarials, such as hydroxychloroquine (Plaquenil); immunosuppressives, such as methotrexate, cyclophosphamide (Cytoxan), and azathioprine (Imuran); and blood thinners, such as warfarin.

Belimumab (Benlystra) is the only drug specifically developed to treat lupus, and disrupts the process that causes the immune system to attack the body. Another treatment option, corticotropin (Acthar), is hormone-based, and is thought to work by helping the body produce its own steroid hormones.

Psoriatic Arthritis Medications

Medical treatment for psoriatic arthritis includes NSAIDs, along with DMARDs and biologics, which may slow or stop joint damage and disease progression. Newer treatments involve small-molecule oral medications that selectively target molecules inside immune cells that cause inflammation. Apremilast (Otezla) is an example.

Reactive Arthritis Medications

Reactive arthritis (ReA) treatments depend on the stage of the disease. The early (acute) stage can be treated effectively with NSAIDs, while inflamed joints may benefit from corticosteroid injections. Late stage (chronic) ReA may require treatment with the DMARDs sulfasalazine or methotrexate. Severe cases may respond to biologics, such as etanercept or adalimumab.

Septic Arthritis Medications

Septic arthritis treatment depends on symptom severity as well as your age and general health status. The condition is an emergency and often needs immediate treatment with intravenous antibiotics. Which drug is used depends on the results of joint fluid analysis. A combination of antibiotics may be prescribed for as long as four to six weeks. Infections caused by fungi need treatment with antifungal medications.

Ankylosing Spondylitis Medications

The most commonly used medications for ankylosing spondylitis are NSAIDs. It can take several weeks for the drugs to take effect, and high doses may be needed in some cases. Unfortunately, this does raise the risk of NSAID side effects, such as heartburn, gastritis, ulcers, and gastrointestinal bleeding.

If symptoms are not alleviated by NSAIDs, sulfasalazine may control pain, swelling, and bowel inflammation. Anti-TNF drugs—etanercept, infliximab, adalimumab, golimumab, and certolizumab—can reduce pain, stiffness, and swollen joints. The FDA also has approved the biologic drug secukinumab (Cosentyx) for treating ankylosing spondylitis.

The post 7. Condition-Specific Arthritis Medications appeared first on University Health News.

Differences in Sensory Processing in Fibromyalgia Patients

Brain imaging studies have shown that sensory processing might be impaired in patients with fibromyalgia and other similar disorders like chronic fatigue syndrome._[2] One theory is that there is a lack of parasympathetic activity in fibromyalgia patients. The parasympathetic nervous system is a branch of the nervous system responsible for stimulating activities that occur when our body is at rest, and helps to down-regulated negative emotion and painful experiences. This deficit in parasympathetic activity may lead to increased reactivity to stimuli and ultimately higher levels of pain. One of the keys to fibromyalgia pain management may be to help stimulate parasympathetic activity._[3] 

Natural Fibromyalgia Pain Management Strategies

Many relaxation techniques activate the parasympathetic nervous system_[4] and can help to manage fibromyalgia symptoms. For example, slow breathing produces changes in the body that encourage parasympathetic activity,_[3] while mindfulness practices are even associated with changes in specific brain areas._[2] So what strategies can you try to help manage your fibromyalgia pain?

1. Slow breathing can affect our reaction to pain stimuli. A study in the journal Pain found that the pain intensity and unpleasantness reported by subjects given painful heat pulses were decreased if the subjects were guided to breath at a slow pace. Although the study found that fibromyalgia patients had a harder time using breathing to modulate their pain reaction, it suggests that reduced breathing rates may be a good adjunctive therapy for managing pain in fibromyalgia patients._[3]
2. Mindfulness practice. A study in 2013 investigated the effects of incorporating a mindfulness-based stress reduction group program into treatment of patients with somatization disorders. These included fibromyalgia and chronic fatigue syndrome. The study found that mental training promoting “non-judgmental awareness of moment-to-moment experience” was a feasible and acceptable treatment for these disorders._[2]
3. Meditation. A review article found that most results from previous studies resulted in improvements in fibromyalgia symptoms in patients who were given a meditation-based practice as an intervention._5]
4. Tai chi incorporates deep, diaphragmatic breathing into a gently whole-body exercise that promotes flexibility, balance, and overall health. Many studies have shown that tai chi is beneficial in helping to relieve symptoms of fibromyalgia, including pain and mental health-related symptoms._[6]
5. Qigong is a traditional Chinese exercise that combines physical movement, breathing exercises, and meditation. Many people use qigong as a therapy for fibromyalgia, and although there have been many promising research studies, reviews have so far been unable to confirm the efficacy of this therapy. Authors of one review do conclude, however, that “qigong has proved effective for physical conditions and psychological well-being, which could make it a valuable treatment option for fibromyalgia patients.”_[7]

Taken together, this research suggests that finding ways to relax, breath deeper, and calm your mind and body are likely to help your fibromyalgia symptoms. Try these strategies today to find relief from your pain.

Share Your Experience

What are your favorite relaxation techniques? Do you find that any of these strategies help to relieve your fibromyalgia symptoms? Share your story in the comments section below.

For related reading, visit these posts:

• Fibromyalgia Natural Treatment: Meditation and Mindfulness Techniques for Chronic Pain Management
• Infrared Sauna Therapy Shows Impressive Chronic Pain-Reducing Results
• A Natural Treatment for Fibromyalgia and Rheumatoid Arthritis

This article was originally published in 2014. It is regularly updated. 

[1] J Pain Res. 2013;6:247-60.

[2] J Psychosom Res. 2013 Jan;74(1):31-40.

[3] Pain. 2010 Apr;149(1):12-8.

[4] Complement Ther Med. 2013 Oct;21(5):481-6.

[5] Curr Pain Headache Rep. 2012 Oct;16(5):383-7.

[6] Evid Based Complement Alternat Med. 2013;2013:502131.

[7] Evid Based Complement Alternat Med. 2013;2013:635182.

The post 5 Relaxation Techniques for Fibromyalgia Pain Management appeared first on University Health News.

But researchers at Massachusetts General Hospital (MGH) have new insight into fibromyalgia that could lead to the development of more effective treatments. Working with a team from Sweden’s Karolinska Institutet MGH researchers documented for the first time widespread inflammation in the brains of people with fibromyalgia. Their research was published in the journal Brain, Behavior andÊImmunity.

“We don’t have good treatment options for fibromyalgia, so identifying a potential treatment target could lead to the development of innovative, more effective therapies,” says study co-author Marco Loggia, PhD, with the Martinos Center for Biomedical Imaging at MGH. “And finding objective neurochemical changes in the brains of patients with fibromyalgia should help reduce the persistent stigma that many patients face, often being told their symptoms are imaginary and there’s nothing really wrong with them.”

What is Fibromyalgia?

Fibromyalgia is believed to alter the way the brain processes pain signals. One of the effects is to amplify painful sensations. Some researchers also believe that the brain’s pain receptors may develop a type of memory to the pain, which makes them more sensitive to pain signals.

However, doctors don’t know what causes fibromyalgia, though it could be a combination of a few key factors.

Fibromyalgia tends to run in families, so a genetic mutation may at least raise the risk of developing the condition. Fibromyalgia often develops after an infection or after physical trauma, such as a car accident. Psychological stress is also associated with developing fibromyalgia.

Other risk factors include having conditions such as rheumatoid arthritis, lupus, and osteoarthritis. Women are also more likely than men to develop fibromyalgia, though there is no obvious reason why.

Because fibromyalgia can cause both pain and sleep problems, people with the condition may be more likely to miss work or withdraw from social interactions. Complications of the disease can also lead to depression and health-related anxiety, in large part because the course of the disease is unpredictable and most people don’t understand the symptoms or much about the disease itself.

Whether brain inflammation sparks fibromyalgia symptoms or whether the disease contributes to inflammation is still unclear. But it is an exciting area of study, carrying with it the possibility of a treatment that has eluded researchers for many years.

The Role of Inflammation

In the MGH-Karolinska study, researchers used a highly detailed imaging process called magnetic resonance/positron emission tomography (MR/PET) to document neuroinflammation. The focus was on inflammation in the glial cells, which have important roles in the brain and spinal cord. Among their jobs are to protect and support neuronsÑcells that transmit nerve signals.

Researchers observed greater glial cell activation in the brains of fibromyalgia patients compared with people who did not have fibromyalgia. Cell activation is the triggering of a cell to perform its function. While glial cells normally help protect neurons, when they are activated, they can also cause the release of chemicals that promote chronic pain.

“The activation of glial cells we observed in our studies releases inflammatory mediators that are thought to sensitize pain pathways and contribute to symptoms such as fatigue,” says Dr. Loggia.

What’s Ahead?

Further research will be needed to better understand the triggers of inflammation associated with fibromyalgia. It’s not yet known whether reducing neuroinflammation in someone with fibromyalgia would actually reduce symptom severity.

Current treatments focus primarily on reducing pain and improving function. These include pain relievers as well as antidepressants to help with sleep problems and psychological complications. The anti-seizure medication pregabalin (Lyrica) was the first drug approved by the U.S. Food and Drug Administration to treat fibromyalgia. Pregabalin works in the central nervous system, but isn’t effective for everyone.

But inflammation in the brain does present a possible target for medications, vaccines or other treatments. For those who struggle with fibromyalgia, any type of relief would be a welcome development. MMM

The post MGH Study Discovers Brain Inflammation-Fibromyalgia Connection appeared first on University Health News.

Italian researchers found the best treatment for fibromyalgia symptoms includes a multidisciplinary approach combining pharmacological and non-pharmacological treatments. One very promising non-pharmacological option, they believe, is a fibromyalgia diet. This includes adding certain nutrient-rich foods (i.e. fish and green, leafy veggies) and subtracting those that can damage the central nervous system (i.e. MSG and soy sauce).

What Foods Trigger Fibromyalgia Pain?

Certain foods may do more harm to the fibromyalgic body than good. To feel better, it may be necessary to cut them out. As stated by the Italian researchers mentioned above, “it seems reasonable to eliminate some foods from the diet of FM patients, for example excitotoxins.” These excitotoxins, a group of neurotransmitters, can cause injury or death to brain and nerve cells if consumed in high enough quantities. Examples include glutamate (i.e. MSG) and aspartame (i.e. the sweetener of the same name).

Foods which contain glutamate can enhance pain in those who suffer from fibromyalgia, says Kathleen Holton, PhD, MPH, a Nutritional Neuroscientist, Assistant Professor in Health Studies, and member of the Center for Behavioral Neuroscience at American University. “This includes processed foods with food additives, as well as some naturally occurring sources of free glutamate like soy sauce, fish sauces, and aged cheeses such as parmesan,” she says.

Another fibromyalgia diet no-no is gelatin. Since some gelatin-containing medications can’t be avoided, Holton recommends opening the gelatin capsule and mixing the medicine with a food like apple sauce instead.

What Foods Should You Avoid on a Fibromyalgia Diet?

Other foods that may increase symptoms include processed foods that contain a long list of ingredients. “A good rule of thumb is that ingredient labels should be short, easy to read, and should only contain things you can add to a food,” says Holton. “For example, can you add ‘natural flavor’ to a food? Another example would be yeast. You can easily add yeast to a bread recipe but wouldn’t use ‘autolyzed yeast extract.’ Additives like ‘monosodium glutamate’ and all ‘hydrolyzed proteins’ should also be avoided.”

Multiple studies have found a link between eating gluten and increased fibromyalgia symptoms. This non-celiac gluten sensitivity, as it is referred to by Spanish researchers, may be an underlying cause of fibromyalgia, so it’s best to cut it out while on a fibromyalgia diet.

What Foods are Good for Fibromyalgia?

Now for the good news. You can still enjoy yummy things while keeping fibromyalgia symptoms at bay. The most important foods to eat on a fibromyalgia diet are nutrient-packed whole foods, says Holton. “Certain nutrients can protect against the over excitation caused by glutamate additives,” she explains. Here are a few nutrients she recommends boosting:

1. Omega-3 fatty acids (e.g. from fish, cod liver oil, walnuts, canola oil, and flax seeds)
2. Magnesium (e.g. from nuts, seeds, green, leafy vegetables, fish, and whole grains)
3. Zinc (e.g. from meat, shellfish, nuts, and seeds)
4. Antioxidants (e.g. from lemons, garlic, onions, various fruits, and greens)

Basically, the ideal fibromyalgia diet, according to Holton, “would be something like the Mediterranean Diet, where a person is consuming fish, a little meat, lots of vegetables and fruit, and including green leafy vegetables, beans, nuts, and seeds.”

Fibromyalgia Diet Food List

While this list is by no means inclusive, here are a few of the foods you should and shouldn’t eat while on a fibromyalgia diet.

Fibromyalgia Diet Recipes

The following fibromyalgia diet recipes are from The Fibromyalgia Treatment Group.

PUMPKIN SEED GRANOLA MIX 

Ingredients:

• • ¼ cup unsalted butter
  • ¼ cup extra virgin olive oil
  • 2 tbsp honey
  • 4 cups oats
  • 2 cups almonds
  • ¾ cup pumpkin seeds
  • ½ cup sunflower seeds
  • 1 tsp cinnamon
  • Heat oven to 350 degrees.

Directions:

1. Combine butter, oil and honey in small saucepan and cook over low heat.
2. Combine remaining ingredients in large bowl.  Pour butter & oil mixture over granola mixture and stir together. Spread mixture onto large baking sheet and bake for approximately 1 hour or until granola is golden brown. Gently stir and turn mixture every 20 minutes during baking.

KALE CHIPS

Ingredients:

• 1 head of kale
• 1 tbsp olive oil½ tsp turmeric (or other seasoning powder)

Directions:

1. Preheat oven to 275 degrees F and line a cookie sheet with parchment paper
2. Using a knife or kitchen shears, remove kale leaves from their stems. Tear leaves into chip-sized pieces. Wash leaves and allow them to thoroughly dry (wet leaves will result in a steaming effect when in the oven – leaving you with soggy leaves).
3. Spread kale leaves in a single layer across cookie sheet lined with parchment paper, being careful not to pile them up. Drizzle olive oil over leaves and sprinkle with turmeric.
4.  Bake for 10 mins, then rotate the sheet and bake for another 10-15 minutes or until the edges are brown (but not burned).
5. Remove from oven allow to cool for 3 minutes.

HOT QUINOA CEREAL 

Ingredients:

• 1 cup unsweetened almond or rice milk
• 1/3 cup quinoa flakes
• 1/4 cup pomegranate seeds
• Pinch of sea salt
• Optional Toppings: Maple syrup or raw honey and toppings such as toasted walnuts, toasted almonds, granola, fresh blueberries, goji berries, mulberries, etc.

Instructions:

1. In a small or medium saucepan set over medium-high heat, bring the milk to a boil.
2. Once milk comes to a boil, add the quinoa flakes, pomegranate seeds, and a pinch of salt. Turn off the heat and give the cereal a stir.
3. Allow cereal sit for 3 minutes. Stir cereal one last time to make it thicker.
4. Scoop cereal into bowl and drizzle with maple syrup or honey. Add desired toppings.

For related reading, please visit these posts:

• Fibromyalgia Symptoms and Pathways Vary
• Fibromyalgia: Shedding Light on a Mysterious Condition
• 5 Relaxation Techniques for Fibromyalgia Pain
• One of the Best Fibromyalgia Supplements, 5-HTP Benefits Pain, Sleep Quality, and More

The post Fibromyalgia Diet May Help Control Pain appeared first on University Health News.

Women More Susceptible

It isn’t clear what causes fibromyalgia, but research suggests it may result from an imbalance of brain chemicals that causes the brain to experience pain more intensely. “Over time, this phenomenon renders the brain more sensitive to pain that most people would consider relatively minor,” says David Thomas, MD, PhD, professor of medicine and rehabilitation medicine at Mount Sinai.

Fibromyalgia tends to be more prevalent in women, though men can also develop it. “There seems to be a genetic predisposition to the condition,” Dr. Thomas notes. “It also is more likely in people with sleep disorders like restless legs syndrome, and in those with autoimmune conditions like rheumatoid arthritis and systemic lupus erythematosus, although fibromyalgia itself is not classified as an autoimmune condition.” Traumatic emotional events (for example, a car accident), repetitive joint injuries, illness, and obesity are also believed to raise the risk of fibromyalgia.

Difficult to Diagnose

Fibromyalgia symptoms typically appear first in middle age, but the incidence of the disorder increases with age—about 8 percent of people aged 80 and older meet the American College of Rheumatology classification of fibromyalgia. Since the symptoms of fibromyalgia are vague and occur with other health conditions, it often takes a long time for fibromyalgia to be diagnosed. At one point, doctors relied on the presence of tender points to guide their diagnosis, but the American College of Rheumatology now recommends consideration of three criteria:

• Pain and symptoms over the previous week, based on the total number of painful areas out of 19 parts of the body, plus the level of severity of fatigue, waking feeling unrefreshed, cognitive (memory or thought) problems, and the number of other general physical symptoms.
• Symptoms having lasted for at least three months at a similar level.
• No other health problem that might explain the symptoms.

Tai Chi Helpful

Although you may not feel like doing exercise if you have fibromyalgia, it is one of the best therapies for easing symptoms. The study we reference (BMJ, March 21) evaluated how effective tai chi was at helping fibromyalgia patients cope. The study included 226 participants who had suffered from fibromyalgia for an average of nine years. They were randomized to take part in twice-weekly supervised aerobics sessions or tai chi (one session each week for a period of 12 weeks, or two sessions per week for 24 weeks). At the end of follow-up, participants completed a standard questionnaire that assesses fibromyalgia patient status. Those who had practiced tai chi had better pain scores than those who had taken part in the aerobics sessions, but their scores didn’t reach the estimated minimal clinically important difference of 8.1 points when compared with aerobics. However, those who had done tai chi twice a week for 24 weeks had the lowest pain scores: a 16.2 difference from the aerobics group. Another follow-up, at one year, found an 11-point difference in scores between the high-intensity tai chi group and the aerobics group. Medication usage (including opioids) declined in both groups during the study.

Dr. Thomas says that tai chi is the perfect form of exercise for fibromyalgia sufferers because it is low-impact, meaning it shouldn’t aggravate muscle discomfort in the way that high-impact exercise might. “Tai chi involves slow, controlled movements that build muscle strength and flexibility,” he explains. “Plus, tai chi is a ‘mind-body’ exercise that focuses on deep breathing and relaxation. Its meditative component means that it may help alleviate the stress and anxiety that typically accompany fibromyalgia.”

Other Therapies

Other non-drug therapies that may ease the discomfort of fibromyalgia include cognitive behavioral therapy and mindfulness, which can help you learn how to manage pain. “Many people also gain relief from acupuncture and gentle massage,” Dr. Thomas adds. When it comes to drug treatment, anti-seizure medications such as gabapentin (Neurontin) and pregabalin (Lyrica) inhibit the activity of nerve cells involved in the transmission of pain. Antidepressants also can help, and may result in better sleep. “If you think you have depression due to fibromyalgia, don’t suffer in silence,” Dr. Thomas adds. “Seek help from your doctor. Depression can cause potentially severe complications, but is a treatable illness.”

The post Exercise Can Help Ease the Discomfort of Fibromyalgia appeared first on University Health News.

Postmenopausal women who eat Mediterranean-style have healthier bones and muscles, according to research presented in March 2018 at the Endocrine Society’s annual meeting. The researchers found that women whose dietary patterns most closely adhered to a Mediterranean-style eating pattern had higher bone mineral density and muscle mass than women whose diets were least similar to a Mediterranean-style diet. In their postmenopausal years, women are susceptible to decreasing bone density and muscle mass, which puts them at higher risk of falls and fractures. Eating Mediterranean-style means plenty of whole foods, including whole grains, vegetables, fruits, legumes, and nuts, and using olive oil as the primary cooking fat. The diet includes some fish, poultry, and dairy foods, and it’s low in red meat and processed foods that are frequently high in unhealthy saturated fat, sodium, added sugar, and refined grains. A Mediterranean-style diet has also been linked to a lower risk of heart disease, diabetes, and cancer.

Try Treating Fibromyalgia Symptoms With Tai Chi

Fibromyalgia, which is much more common in women than in men, is a chronic condition that causes widespread pain and fatigue, among other symptoms. Doctors often recommend exercise as part of a treatment strategy for fibromyalgia, but symptoms can make exercising difficult. Tai chi, which includes a series of flowing, gentle movements, may produce better results for fibromyalgia patients than other commonly prescribed forms of exercise, and it may be as or more effective at easing symptoms. Researchers who compared the effects of aerobic exercise and tai chi on fibromyalgia found that study participants who did tai chi twice a week for 24 weeks reported greater symptom improvement than those who did aerobic exercise twice a week—and the participants attended tai chi more often than they attended the aerobics classes. The study findings were published March 21, 2018 in The BMJ.

Feminine Hygiene Products Linked With Higher Infection Rates

Using wipes, washes, and other products that purportedly keep your vagina cleaner may backfire and put you at higher risk of infections, researchers say. The researchers’ findings, published March 23, 2018 in the journal BMC Women’s Health, are based on reports from nearly 1,500 Canadian women who provided information about their vaginal health practices. The most commonly used products included feminine wipes, lubricants, anti-itch creams, and moisturizers. Women using feminine washes or gels were more than three times as likely to have a bacterial infection and more than twice as likely to report a urinary tract infection than women who didn’t use these products. Women who used feminine wipes were twice as likely to have a urinary tract infection, and those using lubricants or moisturizers had more than double the number of yeast infections. The study’s authors noted that feminine hygiene products may be preventing the growth of the healthy bacteria required to fight off infection. The study did not establish if the products caused the infections, or if the women used the products to address symptoms of the infections.

The post Frontline: Mediterranean Diet; Tai Chi for Fibromyalgia; Feminine Hygiene Products appeared first on University Health News.

A: The majority of cases of Alzheimer’s disease (AD) appear to be the result of a complex interaction between genetic influences and other risk factors. It is true, however, that individuals with a family history of AD may have a somewhat higher risk for developing the disorder, especially if the relative(s) with AD is a first-degree relative such as a parent or sibling. In a study published online April 17 in the journal PLoS ONE, researchers conducted brain scans and analysed spinal fluid for genetic biomarkers associated with AD in a group of more than 250 healthy adults ages 55 to 89. The researchers found that, in brain scans of participants with no signs of thinking or memory difficulties, those with a family history of AD showed twice the rate of silent brain changes as those without a family history of the disease. Moreover, these changes were occurring along pathways associated with AD. It’s important to remember that having a slightly higher risk for AD doesn’t mean that an individual will necessarily develop the disease. Addressing other risk factors by pursuing a healthy lifestyle with plenty of physical and mental activity, a nourishing, low-calorie diet, and adequate sleep and relaxation, as well as managing medical conditions such as high blood pressure and diabetes that can adversely affect the brain, are concrete steps individuals can take to significantly reduce the likelihood of developing AD.

Q: My 67-year-old brother has been battling insomnia for more than a year now, and I’m concerned that he’s becoming depressed about his inability to sleep, and even suicidal. Is there something that can be done to help him?

A: In depressed individuals, chronic insomnia is associated with double the risk of suicide, according to research published in the February 2013 Journal of Clinical Sleep Medicine. The study found that depressed participants with insomnia were more likely than those without insomnia to experience negative and dysfunctional thoughts about sleep, feel that they could no longer control their sleep, and lose hope that they will ever be able to achieve normal sleep. The suicide/insomnia connection adds to the potential risks of sleeplessness experienced by many older individuals, in whom insomnia is also known to increase the risk for memory difficulties, low mood, problems with attention, habituation to sleep medications, falls, and other problems. I would advise that your brother contact his medical care provider for a thorough examination to rule out medical conditions that might be causing his sleeplessness, and for help in finding an effective treatment for his sleep problems.

Q: I have fibromyalgia, and deal with constant fatigue, depression, and considerable pain in my joints. I have heard that exercise may help reduce my symptoms. Won’t exercise make my joint pain worse?

A: Research suggests that regular, long-term exercise—building up gradually from short, 10-minute sessions to about four days per week of 30-minute sessions of moderate exercise that achieves 60 percent of maximum heart rate—may help reduce fibromyalgia symptoms without pain. A study of 170 people with fibromyalgia found that participants who worked up to that level of exercise and sustained it for about nine months reported reduced physical impairment and greater well-being. According to a report on the study published online in the Feb. 11, 2013 issue of Arthritis Care and Research, participants reported that engaging in any increase in physical activity—even if it was not sustained—resulted in positive effects on symptoms and no increase in pain. Recommended exercise forms for people with fibromyalgia include walking, swimming, water aerobics, and biking.

—Editor-in-Chief Maurizo Fava, MD

The post Ask the Doctor: Genetics & AD Risk; Insomnia & Depression; Fibromyalgia & Exercise appeared first on University Health News.

Fibromyalgia symptoms described by patients always include widespread muscular pain that can be debilitating. In fact, fibromyalgia pain is real, not something that is “in a person’s head.” Fibromylagia symptoms in women usually begin between the ages of 35 and 60. It does occur in men, too, and there is something you can do about it. An accurate diagnosis and helpful treatment are out there.

The Wide Range of Fibromyalgia Symptoms

Fibromyalgia symptoms include multiple tender points on the neck, shoulders, back, hips, and upper and lower extremities. More than 75 percent of patients report chronic fatigue as a major symptom and impairment, according to the Johns Hopkins Arthritis Center.

The tender spots vary in severity from one day to another. One day they can be more severe in the shoulders; another day more severe in the lower back and legs. Pain can interfere with sleep.

New evidence suggests that fibromyalgia is related to how the body processes pain and the body’s hypersensitivity to factors that don’t normally cause pain. Most people are diagnosed during middle age, but symptoms can develop earlier. People with rheumatoid arthritis, lupus, and spinal arthritis are more likely to develop fibromyalgia than people without these conditions.

Fibromyalgia also has been associated with physically or emotionally stressful events, such as car accidents, repetitive-use injuries, and illnesses.

Fibromyalgia symptoms include pain and fatigue, but the syndrome does not inflame or damage joints, muscles, or other tissues. In addition to pain and fatigue, other symptoms of fibromyalgia include:

• Headaches
• Irritable-bowel syndrome
• Memory problems
• Morning stiffness
• Sleep disturbances
• Numbness or tingling in the extremities
• Painful menstrual periods
• Restless leg syndrome
• Temperature sensitivity
• Depression
• Dizziness

Fibromyalgia Treatment

People typically see several doctors before getting a diagnosis. Once the condition has been identified, a team approach (doctor, pharmacist, physical therapist, and other specialists) seems to work best.

The U.S. Food and Drug Administration (FDA) has approved only three medications—duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica)—for the treatment of fibromyalgia. Other drugs often recommended for fibromyalgia include analgesics, antidepressants, and benzodiazepines, such as Valium.

Nonsteroidal anti-inflammatory drugs, such as ibuprofen, aspirin and naproxen, are not particularly effective in treating fibromyalgia when taken alone, says the AAFP.

A Queen’s University scientist found that combining pregabalin (an anti-seizure drug) with duloxetine (an antidepressant) can improve pain relief, physical function, and overall quality of life in fibromyalgia patients.

Complementary and alternative therapies (massage, chiropractic techniques, acupuncture, and dietary supplements) produce varying degrees of success. Getting adequate, quality sleep can improve the symptoms of pain and fatigue, and an increasing body of evidence suggests that exercise is an effective treatment.

Managing Fibromyalgia

The most important thing to remember is for you to take an active role in managing your condition. Follow your doctor’s recommendations, make lifestyle changes that can help you feel better, and focus on short-term, realistic goals. Among the lifestyle changes are an increase in moderate, low-impact, planned exercise. Another is to recognize stress and take steps to deal with it. Third, follow a daily routine that includes going to bed, getting up, and eating at regularly scheduled times.

There isn’t one treatment plan that is effective for every person. You know how you feel, what you can and cannot do, and how fibromyalgia affects your life. Work with your pain management team to develop a strategy that fits your situation and personality.

This article was originally published in 2017. It has since been updated. 

The post Fibromyalgia Symptoms and Pathways Vary appeared first on University Health News.