Fibromylagia and Hepatitis C Infection
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:

widespread pain in combination with tenderness in at least 11 of 18 specific
tender point sites, and


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)

Source

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).

Gaupp, F. Fibromyalgia. http://www.emedicine.com/aaem/topic196.htm

Questions and Answers About Fibromyalgia. The National Institute of Arthritis
and Musculoskeletal and Skin Diseases Information Clearinghouse.

About Fibromyalgia. National Fibromyalgia Association (NFA).

Fibromyalgia Medications. Arthritis Foundation.





Sandra Tara Balduf (Ane)

Frontline Hepatitis Awareness

Support for patients and educational materials

http://frontline-hepatitis-awareness.com

1-866-Hep-GoGo 866-437-4646




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