Sorry you are feeling so bad. Keep working with your doctors. Good luck with your visit with the pain specialist. The pain specialist would be an ideal person to discuss where you go from here.
I prescribe topical pain relievers often. Some patients do very well with this treatment and others didn't notice any benefit. I'm not sure what type of medicine you tried but make sure your doctor knows of any side effects you had.
Hopefully you will have other treatments available to you soon and they will help you!
Sorry about being diagnosed with fibromyalgia. A common complaint of those with fibro is joint pain, usually widespread joint pain. There are many other common complaints in fibro, including swelling.
Swelling in painful joints often indicates joint inflammation, but it is not necessary to have swelling in order to have joint pain, arthritis, or fibromyalgia. Lack of swelling is usually good; I don't want my patients to have swelling! I'm not aware of any medical concerns related to the absence of swelling.
Work with your doctor for any questions or concerns about your diagnosis. I hope you are feeling better.
I wanted to chime in here with a few thoughts. It would be unusual for a male to first develop fibro symptoms in one's late 50's or early 60's, but not impossible. I would consider a number of causes of new onset of muscle pains in someone who describes your situation. A clinical evaluation by your doctor is necessary to determine what condition you may have and what treatment options are available.
A number of people develop increased pain after becoming sober because the pain nerves are not being blunted anymore by the alcohol/drugs. The underlying painful condition (ie arthritis, fibromyalgia, neuropathy etc) may have been chronically masked by the effects of the drug and/or alcohol. Once sobriety occurs, these conditions can freely "express" themselves. As a result, the pain is noticed more, which may not be so bad because that means one is sober.
Congratulations on your sobriety. I hope your pain and lack of energy have improved since you first posted.
I'm sure your Pain Management Clinic will explain the suggested treatmetn in more detail on your next visit. I use IV lidocaine therapy in my practice to help manage certain fibro patients with central pain or central neuropathy symptoms such as widespead skin sensitivity and burning, extreme pain to touch, and numbness & tingling esp in the hands and feet. I call this feeling like a "live wire."
IV Lidocaine works differently than when injected into the muscles. Locally injected lidocaine is a local anesthetic, it numbs the area. IV lidocaine works on the central nerves, specifically it blocks the sodium channels responsible for propagating nerve signals to the brain. Thus, the mechanism of action is different than the locally injected form. In fibro, this treatment helps slow down or block the transmission of pain.
The IV lidocaine protocol I use involves a lot of monitoring (heart rhythm, pulse ox, blood pressure, nurse supervision during treatment) so it's not offered in a lot of places. I consider it "successful" if it gives 30% or more improvement in overall pain that lasts at least 3 weeks or longer. It wears off over time so it is not a permanent fix or cure. In my experience, about 55% of patients get at least 3 weeks benefit from this IV treatment.
Hope this info helps. Good luck with this therapy if you get to try it!
I've been asked to respond to your question on how to manage the nerve pain and swelling.
Neuropathic pain can be brutal. Nerve injuries are a common cause of nerve pain or neuropathic pain. Swelling is common because the nerve injury affects blood flow, and because weakened/inactive muscles can't pump back the blood. The swelling can further aggravate the neuropathic pain because of increased mechanical pressure, and the vicious cycle continues...
Please continue to work with your doctor regarding your specific pain. What exactly is causing your pain? What nerve or nerves are affected? Are your nerves repairing themselves? (this is a good thing, but reinnervation is painful). Sometimes a complication occurs called complex regional pain syndrome that your doctor could check for.
I treat neuropathic pain and swelling with oral medicines, compounded creams, TENS unit trial, pressure garments and more. Your doctor can prescribe specific treatments based on your specific situation.
I bet your hunch is right: most of my patients who have researched fibro and feel it fits them are usually right!
100% of those with fibro also have myofascial pain syndrome. This basically means that in addition to the generalized fibro symptoms, there are regions of worse pain and muscle spasms/trigger points that constitute myofascial pain syndrome. However, the reverse is not true: that is, not everyone with MPS has fibro.
I'm a big fan of manual therapy, including active release in those with fibro. This therapy is probably working on the MPS component of the fibro esp, but I don't really make a big deal about trying to "separate" fibro and MPS in someone who I've diagnosed fibro. The therapy goal is to individualize the program to the patient's specific needs and problem areas and get the best outcome.
Different health professionals can be trained in manual therapy and specific myofascial releases, strain/counterstrain, massage, nueromuscular techniques, manipulation, craniosacral therapy etc. The key is to find someone trained and experienced in manual therapy and fibro.
Even if one has already tried numerous therapies for fibro with less than optimal results, working with someone experienced in manual therapy is often very helpful. It's not a cure, of course, but it can help you manage better.
Psoriasis does not seem directly linked to fibro, but one can certainly have both. There are some indirect relationships, however.
For example, many with psoriasis have psoriatic arthritis, a generalized inflammatory arthritis. Many with psoriatic arthritis can develop a reactive or secondary fibromyalgia. Thus, psoriasis and fibro are indirectly linked, in this situation.
Here's how I view this: If someone has an underlying autoimmune or inflammatory condition, both fibro and/or psoriasis can be "complications" of this condition. This isn't the same as saying psoriasis causes fibro, or everyone with psoriasis has fibro too.
There is a known link between FM and autonomic nerve dysfunction or dysautonomia. Some of the more well known associated conditions thought to be due to the dyfunctional autonomics include IBS, irritable bladder, anxiety disorder, migraines, and near-fainting spells (near-syncope). Rapid heart rate, fatigue, poor sleep, temperature changes and many other of our fibro symptoms are linked to our dysfunctional autonomic nerves.
One test used to measure for dysautonomia is tilt-table testing, a way to measure the autonomic abnormalities in the blood pressure and pulse in response to tilting "stresses."
The reason for the dyautonomia in FM: it's felt to be part of the hypersensitive nerves and central sensitization that occurs in FM. Autonomic nerves, especially the sympathetics are closely connected to the pain and sensory processing nerves so anything the activates the pain will activate the sympathetics as well. Thus,we don't just feel pain, we feel sweaty, anxious, tachy, short of breath, crampy, fatigued etc etc etc!
Muscle relaxants can decrease pain in people with fibro. I have found that muscle relaxants do not really decrease muscle spasms or "relax" muscles, because the painful areas still have palpable spasms. Rather, the medicine appears to help by a central neurological mechanism that reduces muscle pain.
Medicines in this family include Flexeril, Robaxin, Skelaxin, and Soma. The most common side effect is drowsiness. If drowsiness occurs, the medicine should be taken only in the evening if it helps, so it doesn't interfere with driving or concentration. The drowsiness side effect may be useful at night if it helps improve sleep.
Medicines in the antispasticity category can be considered "muscle relaxants" and be used to treat pain. These meds, ie Baclofen, Zanaflex, can help spasticity in those with certain conditions that result in pathological increased muscle tone. Fibro doesn't cause this, but these meds seem to help some with fibro by working on central nerve pathways to reduce pain.
So sorry you've had those leg injuries that put you at a low activity level. Hopefully your bones have healed. Any nerve damage needs to be evaluated. Your doctor may want to do nerve testing (called electrodiagnostic teating) to evaluate any nerve damage, and to determine if any damage is repairing itself.
Any nerve damage and associated weakness, numbess, or pain has to be factored into your PT program when planning your treatment goals.
You're right about overdoing it as a risk for fibro-flare, but don't assume you will automatically flare-up when you begin your PT program. Another risk for flares is "underdoing it" which you experienced when you had to lower your activity level after your fractures. Fibro doesn't like any change from what it's used to activity-wise, whether it's too much activity or too little activity, compared to the usual baseline. And with any change it doesn't like, it talks to us...painfully.
It sounds like you made it through the "underactivity" phase without a flare-up, so if that's the case so far, good job!
I believe the best way to reduce the flare-up risk when you begin to intrduce more activity into your fibro world is to progress your overall activity gradually with frequent rest /recovery periods.
Your PT prescription will already have this strategy built into it, even though it may not be specifically addressing your fibro. You will probably begin therapy gradually, 2-3 times a week, so you have rest days in between therapy. Your emphasis will be gradually regaining strength, stamina and ambulation abilities. Hopefully as you continue with your leg PT program, your fibro will be cooperative and "goes along" with the progress you will make.
It would be great if your physical therapist was knowledgable in fibro. Usually the PT script has to be written for only one problem at a time, in your case, for your leg injuries. But if your fibro should flare-up in areas other than your legs, then perhaps your PT would be able to incorporate some measures to address the fibro flare. There are restricitions based on treatment times, insurance coverage, number of areas/diagnoses treated that may limit what you can actually have done for a fibro flare while treating for your leg conditions.
But if you and your therapist are aware of all this, then I think your proactive strategy will enable you to quickly notice any percolating flare-up and take measures to comfort the affected fibro areas and hopefully prevent a full blown flare-up. Be thinking about modalities (such as heat, ice, electric stim, water), massage/soft tissue work, meds, stretches and anything that works for you.
Good luck with your reactivation project! Work with your doctors and therapists. I'm confident you will do great.
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