Fibromylagia and Hepatitis C Infection

by V. J. Smith, RN, BSN, MA
Article Date: 1/2/2004



What is Fibromayalgia?
Fibromyalgia (FM) is an increasingly recognized chronic pain illness
which is characterized by widespread musculoskeletal aches, pain and
stiffness, soft tissue tenderness, general fatigue and sleep
disturbances.

The most common sites of pain are called "tender points", and include
the neck, back, shoulders, pelvic girdle and hands, but any body part
can be involved. Fibromyalgia patients experience a range of
symptoms of varying intensities that fluctuate over time.

Patients with Hepatitis C infection often experience a variety of
muscular aches and pains, both before and after treatment.
Researchers have determined that people infected with HCV, especially
women, have a higher incidence of fibromyalgia that the general
population.

Researchers have also examined patients who have cirrhosis from
causes other than HCV, and have found that this group does NOT have a
higher frequency of fibromyalgia, suggesting that the hepatitis C
virus itself may play a specific role in the development of
fibromyalgia.

How Many People Have Fibromyalgia?
According to the American College of Rheumatology, fibromyalgia
affects 3 to 6 million Americans (approximately 3-6% of the U.S.
population). Although a higher percentage of women are affected, it
does strike men, women and children of all ages and races.

Because of its debilitating nature, fibromyalgia has a serious impact
on patients' family, friends, and employers, and society at large.

Symptoms of Fibromyalgia
The most prominent symptom of fibromyalgia is pain, commonly located
in the neck, shoulders, back, and hips. Unlike arthritis, the
discomfort is not in the joints but in the muscles and ligaments.
Fibromylagia pain has been described as deep muscular aching,
throbbing, twitching, stabbing and shooting pain.

The severity of the pain and stiffness is often worse in the
morning. Neurological complaints such as numbness, tingling and
burning are often present and add to the discomfort of the patient.

Fatigue is a frequent complaint associated with fibromyalgia. The
severity of the fatigue can range from mild to incapacitating. No
amount of sleep at night or rest during the day is helpful. Another
common symptom is a mental haziness some people call fibrofog. This
refers to the inability to concentrate, memory loss, and depression.

Many fibromyalgia patients have an associated sleep disorder which
prevents them from getting deep, restful, restorative sleep. During
sleep, individuals with fibromyalgia are constantly interrupted by
bursts of awake-like brain activity, limiting the amount of time they
spend in deep sleep.

Additional symptoms may include irritable bowel and bladder,
headaches and migraines, restless legs syndrome, impaired memory and
concentration, skin sensitivities and rashes, dry eyes and mouth,
anxiety, depression, ringing in the ears, dizziness, vision problems,
raynaud's syndrome, neurological symptoms and impaired coordination.

Diagnosing Fibromyalgia
Fibromyalgia is difficult to diagnose because many of the symptoms
mimic those of other disorders. Currently there are no laboratory
tests available for diagnosing Fibromyalgia. Doctors must rely on
patient histories, self-reported symptoms, a physical examination and
an accurate manual tender point examination.

The American College of Rheumatology (ACR) has developed criteria for
fibromyalgia that physicians can use in diagnosing the disorder.
According to ACR criteria, a person is considered to have
fibromyalgia if he or she has:

a.. widespread pain in combination with tenderness in at least 11
of 18 specific tender point sites, and
b.. widespread pain in all four quadrants of the body for a minimum
duration of three months.
Because many symptoms overlap with the symptoms of other conditions,
extensive diagnostic investigation is often necessary. Fibromyalgia
is not a diagnosis of exclusion and the presence of other diseases,
such as rheumatoid arthritis or lupus, does not rule out a
fibromyalgia.

What Causes Fibromyalgia?
While the underlying cause or causes of fibromyalgia still remain a
mystery, many researchers agree that fibromyalgia is a disorder of
the neuroendocrine system and neurotransmitter regulation. The
fibromyalgia patient experiences pain amplification due to abnormal
sensory processing in the central nervous system.

Some scientists believe that the syndrome may be caused by an injury
or trauma. This injury may affect the central nervous system.
Fibromyalgia may be associated with changes in muscle metabolism,
such as decreased blood flow, causing fatigue and decreased strength.

Others believe the syndrome may be triggered by an infectious agent
such as a virus in susceptible people, but no such agent has been
identified.

One of the leading theories is that low levels of serotonin may lead
to the illness. Serotonin is found throughout the body and plays an
important role in controlling pain and regulating sleep. Blood tests
have confirmed that people with fibromyalgia have low serotonin
levels.

Other researchers believe fibromyalgia is caused by a lack of deep
sleep. Sleep studies show that as people with fibromyalgia enter
stage 4 sleep, they become more aroused and stay in a lighter form of
sleep. Even though they may sleep for a long period of time, they get
poor quality sleep.

Also, when researchers took normal volunteers and did not allow them
to enter into stage 4 sleep, they developed symptoms similar to
fibromyalgia.

Treatment for Fibromyalgia
Patients with fibromyalgia may benefit from a combination of
exercise, medication, physical therapy, and relaxation. Low-impact
aerobic exercise, such as swimming and walking, improves muscle
fitness and reduces muscle pain and tenderness. Heat and massage may
also give short-term relief. Antidepressant medications may help
elevate mood, improve quality of sleep, and relax muscles.

Medications for Fibromyalgia
There are no medications specifically for the treatment of
fibromyalgia, but two drugs are being studied for the treatment of
the condition's multiple symptoms. Interferon alpha (Veldona) shows
promise as a treatment for fibromyalgia pain and stiffness, and
Pregabalin, has been show to ease pain, promote sleep and relieve
fatigue.

Patients with liver disease must be closely monitored by their
physicians when taking any medications, as an impaired liver may not
efficiently metabolize medications and possibly result in toxic or
overdose conditions.

Currently, doctors prescribe a wide variety of medications to treat
specific symptoms of fibromyalgia. In addition to the drugs listed
below, people with fibromyalgia may also benefit from pain-relieving
drugs such as NSAIDs and analgesics.

Tricyclic antidepressants, as well as selective serotonin reuptake
inhibitors (SSRIs) may be taken along with the tricyclics to increase
energy.

Tricyclic Antidepressants
Amitriptyline hydrochloride (Elavil, Endep)
Doxepin (Adapin, Sinequan)
Nortriptyline (Aventyl, Pamelor)

SSRI Antidepressants
Citalopram (Celexa)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)

Other Antidepressants
Bupropion (Wellbutrin, Zyban)
Trazodone (Desyrel, Trazon, Trialodine)
Venlafazine (Effexor)
Nefazodone (Serzone)
Mirtazapime (Remeron)

Tranquilizers called benzodiazepines can promote deep, restorative
sleep when taken at bedtime.

Temazepam (Restoril)
Aprazolam (Xanax)
Clonazepam (Klonopin)
Lorazepam (Ativan)

Muscle relaxants and other medications may be used to decrease muscle
pain and spasms experienced by many people with the condition, and a
seizure medication called gabapentin (Neurontin) may ease the leg
pain, numbness and tingling sensations that come with the condition.

Cyclobenzaprine (Cycloflex, Flexeril)
Carisoprodol (Soma)
Gabapentin (Neurontin)
Modafinil (Provigil)
Orphenadrine (Norflex)
Tizanidine (Zanaflex)
Zaleplon (Sonata)
Zolpidem (Ambien)


Sources:

Questions and Answers About Fibromyalgia. The National Institute of
Arthritis and Musculoskeletal and Skin Diseases Information
Clearinghouse.
http://www.niams.nih.gov/hi/topics/fibromyalgia/fibrofs.htm

About Fibromyalgia. National Fibromyalgia Association (NFA).
http://fmaware.org/fminfo/brochure.htm

Buskila, D et al. Fibromyalgia in hepatitis C virus infection:
another infectious
disease relationship. Archives of Internal Medicine, Nov 24, 1997
v157 n21 p2497(4).