Question:
Hi, I was diagnosed with fibromyalgia 3 years ago and
I am only 21. I understand that it is a very loosely
defined condition. I stumbled onto your website after
my third night of not sleeping and feeling manic. I
have many symptoms of BPD and I was wondering if you
think there is a connection between fibromyalgia and
this illness. If so, what kind of treatment would you
suggest? I have been taking Zoloft and Valium for
depression and anxiety; hydrocodone for pain. I’m
beginning to feel out of touch and more anxious than
ever.
Thank you so much.
Dr. Heller's Answer:
I treat many patients with fibromyalgia. It’s
virtually always a combination of 5 things:
1) The cognitive generalized anxiety disorder (GAD).
This genetic anxiety disorder causes constant worry,
anxiety, and tense muscles. It’s treated with BuSpar
(buspirone). Benzodiazepine medications like Valium
help slightly but not that well.
2) Depression. Whether the depression was there
before, during or after the fibromyalgia doesn’t
matter. All SSRI medications including Zoloft
(sertraline) can make the GAD worse. Pretreatment
with BuSpar (buspirone) makes all the difference. If
BuSpar causes significant anxiety, Remeron
(mirtazapine) needs to be taken for a few months.
3) Poor posture. Chest out, shoulders back, stomach
in. Americans have terrible posture and it puts the
spine out of alignment. Once you’ve lost your posture
it’s hard to get it back because it hurts. Wearing a
posture support for an hour four times daily will
make a huge difference. Physical therapy helps as
well.
4) Muscle Spasm. Muscle cramps hurt and they block
the flow of blood into the muscles. Muscles need
energy to relax, not contract. That’s why dead
animals have "rigor mortis." The blood flow needs to
be increased and the causes treated. Muscle
relaxants aren't great. I usually prescribe
Skelaxin. Soma (carisoprodol) has addiction and
abuse problems. Flexeril (cyclobenzaprine) can be
dangerous if taken with an SSRI antidepressant.
Massage and moist heat are excellent choices. Anger
and anxiety cause muscle cramps and spasm.
5) Pinched nerves. Many nerves pass through
muscles. When the muscle is in spasm, the nerves get
pinched creating a painful sensation, usually
burning. It feels like hitting your funny bone.
Once the other 4 are treated I’ll usually prescribe a
rapidly tapering course of steroid medication
(prednisone, Medrol dose pack, etc.) every 3 months
if needed. It works very quickly and effectively.
Traditional anti-inflammatories like Advil
(ibuprofen) or Vioxx don’t work well for nerve pain.
The BPD causes depression, anxiety, and anger - all
of which contribute to the muscle spasm and the pain
of fibromyalgia. Benzodiazepine medications like
Valium, Xanax, Klonopin, etc., can worsen the
severity of self-destructive behaviors when an
individual with BPD experiences dysphoria (anxiety,
rage, depression and despair). When someone with BPD
also has the cognitive generalized anxiety disorder
and takes an SSRI medication like Zoloft (sertraline)
before taking BuSpar (buspirone), it will increase
anxiety. Increasing a borderline’s anxiety usually
makes their overall condition worse with for frequent
and severe dysphoria. The worsening dysphoria can
cause dissociative symptoms like deja vu and
unreality, which may explain your feeling "out of
touch."
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