Please remember, this column is designed to help the consumer seeking behavioral-health information, and not intended to be any form of psychotherapy or a replacement for professional, individualized services. Opinions expressed in the column are those of the columnist and do not represent the position of other SelfhelpMagazine.com staff.

Question

I developed Fibromyalgia after an accident and several operations. I have trigger points, but in the area near the accident and where the operations were done. I would like to known more information about fibromyalia and any treatment programs. Does amtripline help or prozac? What is a good medicine to help you sleep? Why do hormone pills make my muscles ache, is this due the Fibromyalia?

Answer

Anything that disturbs sleep for more than a couple of nights can trigger fibromyalgia (FM) in people who are susceptible to it. Current thinking is that the susceptibility runs in families. Your physicians are probably correct in their assessment of the cause of your fibromyalgia.

Your mention of trigger points raises a question. Fibromyalgia is associated with _tender_ points, which are exquisitely sore when pressed. These tender points, when they exist, are at very specific locations on the body, in most cases about two inches from the point where a muscle attaches to a bone. _Trigger_ points, on the other hand, are a manifestation of myofascial pain syndrome, which may or may not be related to fibromyalgia, depending on the person.

Trigger points, when pressed, refer pain to another part of the body; they are not sore themselves. The locus of the referred pain may be quite near to the trigger point, or quite distant from it. The nice thing about trigger points, as distinct from tender points, is that they can often be relieved by pressure on the trigger point.

Massage therapists trained in myofascial release are often of great help when the pain comes from trigger points. Fibromyalgia tender points are not relieved in this way, but anything that helps relieve fibromyalgia is likely to lessen the pain of the tender points.

Although we are not licensed to give out information to the general public, I can tell you that some people find that amitriptyline helps their fibromyalgia. Others find the side effects outweigh any benefit they get from amitriptyline. Prozac has been shown in a clinical trial to provide have no more benefit than a placebo to people with fibromyalgia. Don Goldenberg, M.D., a prominent fibromyalgia researcher, recently published a paper in which he says that the combination of amitriptyline and Prozac has good results. There are many other drugs and non-drug preparations that are helping people with FM -- too many to list here. If you want another opinion about medication and how to use it, you could check with your pharmacist.

Unfortunately, each FM patient is unique in her responses to drugs, and it often takes quite a bit of fine-tuning before the proper combination of medications and nutrients is found. You might want to visit the Usenet newsgroup alt.med.fibromyalgia and read what others are doing to help themselves. There is a wealth of information there. Another resource is the book I've just completed on this subject, available through our Amazing Bookstore Catalog..

03/13/98

Miryam Williamson, a contributing editor to SelfhelpMagazine, is a technical journalist and author of "Fibromyalgia: A Comprehensive Approach What You Can Do About Chronic Pain and Fatigue," published by Walker and Company, New York, 1996, ISBN 0-8027-7484-9. At bookstores in early June, or from the publisher at 800-289-2553.