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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