Monday, January 25, 2010

Obesity and Fibromyalgia: a Painful Barrier to Weight Loss?

To anyone regularly dealing with overweight and obese patients, the frequent association between excess weight and chronic musculoskeletal pain is no secret.

This association is particularly true for the rather enigmatic syndrome of fibromyalgia, characterised by the presence of generalized pain in muscle and joints, often associated with fatigue, poor sleep, and depression. Patients typically present with exquisite tenderness over discrete anatomical points, commonly referred to as tender points.  While there is still much debate around the exact etiology or even the exact diagnostic criteria (e.g. number of tender points) for fibromyalgia, there is no doubt that the presence of this syndrome can prove a major barrier to weight management.

Indeed, it is not at all clear whether there may in fact be an etiological link between fibromyalgia and obesity. As outlined in a paper by Akiko Okifuji and colleagues from Salt Lake City, UT, published last year in Clinical Rheumatology, 70% of fibromyalgia patients in their study were overweight or obese and presented with elevated levels of IL-6, catecholamines, cortisol, and CRP, all of which are common findings in obese patients. Furthermore, the patients with fibromyalgia, as do obese patients, presented with reduced sleep duration and efficiency. Based on these commonalities, Okifuji and colleagues concluded that excess weight and obesity may well play a role in fibromyalgia and related dysfunction. 

Interestingly, in 2008, Alan Saber and colleagues published an article in Obesity Surgery describing a significant improvement in pain score and points of tenderness in patients with fibromyalgia who underwent laparoscopic Roux-en-Y gastric bypass surgery. Based on these findings, the authors suggested that weight loss may be an important treatment modality for severely obese patients with this syndrome.

Whether or not less drastic approaches to weight management can provide benefits remains to be seen. Nevertheless, there have been reports of limited response to education, exercise, and psychological interventions. Thus, currently accepted non-pharmacological treatments for fibromyalgia remain rather limited.

Recently, a Cochrane review concluded that duloxetine is efficacious for treating pain in fibromyalgia and another systematic review found evidence that gabapentin and pregabalin can also reduce pain in these patients. 

Nevertheless, fibromyalgia continues to be a common but largely undertreated problem in overweight and obese patients and can often pose a significant barrier to increasing physical activity or modifying ingestive behaviour. 

As blogged before, assessment for muskuloskeletal pain should be a regular and essential feature of any assessment for overweight and obesity. 

I very much look forward to comments from any readers struggling with fibromyalgia or from colleagues on how they manage this debilitating syndrome.

AMS
Edmonton, Alberta

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10 Responses to “Obesity and Fibromyalgia: a Painful Barrier to Weight Loss?”

  1. Arya M. Sharma, MD says:

    In addition to this post, you may want to watch a recent CTS interview with Fibromyalgia Specialist Dr. Alison Bested and Dr. Alan Logan a Naturopathic Doctor, discuss managing fibromyalgia and the role of inflammation.

    I am not sure I fully agree with all of these views and could probably have a long discussion with both these colleagues, but here, for what it is worth, is the link:

    http://ctstv.com/ontario/player.php?ctsvidID=17298&show=On%20The%20Line

  2. Gillian says:

    I have been diagnosed with FM, but it appears to be minimal. It’s been more than 10 yrs now. I am slightly overweight, but have been able to stay very active. I do weight training and get a lot of satisfaction from it. Pushing the cardio side is harder, as is losing 10 lbs.

  3. Rebecca says:

    I became ill at 49 in 1990 with what was diagnosed in 1997 to be fibromyalgia and chronic fatigue syndrome. Prior to becoming ill, I was basically healthy and active, walking almost four miles a day, and enjoying fairly strenuous outdoor activities (wood cutting and splitting, carpentry, hiking, canoeing, gardening). After I became ill, I could hardly walk around the block. In the intervening years, my body size has doubled. Efforts to exercise have left me exhausted and in worse pain. I am so miserable and in so much pain that life has become a tremendous struggle. I have received no treatment from my HMO other than prescriptions for amitriptyline or trazodone.

    A couple of weeks ago, I decided to try the program outlined in Dr, Mark Hyman’s UltraSimpleDiet, which appears to be remarkably similar to the ideas outlined by Drs.
    Bested and Logan in the linked interview above. I lost 6 pounds in the five days in the preparation phase, in which you are asked to give up sugar and white flour, and nothing else. I am currently finishing the fourth day of the detoxification program itself and believe that some of my symptoms have improved slightly, more specifically the brain fog and pain. I recently heard from someone newly diagnosed that she feels much better after having made similar dietary changes.

    The medical establishment seems to have little idea how to deal with some of these debilitating conditions, other than to repress the symptoms with medication. I’m appalled at how little is known about nutrition and its effect upon various illnesses. And I view my illness and the resultant inability to be active as the reason why I have become so large, as I have for the most part eaten reasonable amounts through the years.

  4. kickerboxer says:

    fibro does cause weight gain.the pills have side effect of weight gain and also for the lack of excersise.i have gained 25 pounds in 2 years.

  5. Obesity Compounds Pain in Fibromyalgia | Dr. Sharma's Obesity Notes says:

    [...] Compounds Pain in Fibromyalgia As blogged before, overweight and obese patients frequently present with fibromyalgia, characterized by chronic pain, fatigue and depressed [...]

  6. Walter says:

    My wife has full blown rheumatoid arthritis. She was also the past president of the arthritic society and is still deeply involved with disseminating information about the disease.

    She maintains that rheumatoid arthritis is a for real physical disease that destroys the body inch by inch and day by day and you die from pain whereas FM is an illness of the mind that is impossible to measure.

    Regardless of the opinions and arguments for and against having or not having FM it is a physical fact that being overweight is not caused by either having or not having FM but at the same time it is not healthy to be overweight regardless of what other disease a person may have.

    Now if there was an operation to sew the mouth shut I would not be overweight from compulsive over eating.

  7. Kelly says:

    6 years post op rue n y gastric bypass 5 years post op gallbladder removal 3 years post op open triple abdominal ventrial hernia surgery. Before i was over weight but healthy not one health issue. after hernia surgery i have had nothing but health issues one after another first was sudden onset ADHD. now i have been told i have fibromyalgia. Can hardly walk in the morning can not sleep at night breathing issues memory issues. so many health problems that now i am on SSI Disability and hate it . I had a well paying Job and alot of things i wanted to do and work for Now am gaining weight for not reason i still eat health and do as i was told to for the weight loss surgery.
    do not always look at the scale. it will make you crazy.eat healthy cook more at home, stay active and away from tv. get a hobby, unless it is life or death Never have any weight loss surgery or any type of surgery.

  8. pat smith says:

    In other words…nothing has changed in the 20 years since I was told that is what I have had..after a long question-aire from York Un..the path of the answers….I have always had this..as a child I did not sleep well,,always had pain..the Dr. would do blood work all the time..could not figure this out..growing pains when I was very young?..go to bed early?
    concentration? As I got older more stress..operations..stress knowing it was so hard to get through a day. thyroid disease..up and down..other health issues hysterectomy and yes after 45 started to gain weight. Car accidents whip lash .would go to Y, water aerobics swim..exercise 5 days a week for 6 lost maybe 12 lbs.. months..end up .rotator problem…therapy for months..meodpause . can lose 10-15 lbs..but it is not easy..then down again..and back come the lbs..nothing changes.. same problems as Kelly..finally had to go on CCP disability..stress again..Hate It… How is thyroid get by…until my thyroid goes completely out of control does it really show …look into that..last time it was 16..

  9. kelly says:

    Walter:
    please do not take this wrong but no one really knows what causes FM they are all speculations there is no strong evidence of what FM even is or why it happens. No one can pin point one specific cause. I am just posting my opinion due to so many Doctors and insurances passing out this type of surgery like candy. It took me 2 ½ years before I could even have my surgery I had to take classes on risks it was also required that people have physiological testing done and counseling I did all of it. I thought I know all about it. I was only seeing what they wanted me to see the good, I would love to see a commercial that showed both the true good side and the bad side instead of the ones that are out there now. I still say unless your life is at risk of death and there is nothing else that you can do Never have surgery.

    Arya M. Sharma, MD:
    I have been looking into all of this since I was first diagnosed with ADHD because things did not sound right to me.
    I know about fibromyalgia
    Main Symptoms Started After open triple abdominal ventrial hernia surgery
    First Symptoms started within a month Post op ventrial hernia surgery
    Symptoms in order:
    First:
    Sleeping Problems
    Sudden severe Body Acne And Large body Cysts (which I still deal with today and have Permanent holes on my breast from them and scars everywhere)
    Memory issues ( almost lost Job Due to them)
    Awful Lower back Pain
    Awful arm / Hand Pain ( pain that would wake me up so bad all I wanted to do was crawl out of myself to get ways from it, Have Been told I do not have Corporal tunnel)
    I went to My Doctor because of my Memory I thought I was going crazy she sent me to a pathologist who diagnosed with sudden onset ADHD (never had before) let me tell you all if you ever think that ADHD is not a big deal you are wrong, I feel bad for kids that really have it is sucks. But getting it as a Adult slowly feeling yourself changing over a month or two is awful. I wish I would have had ADHD as a kid then at least as an adult I would have learned how to deal with it a adjust to it. I was told MY ADHD was a cause of the Anethesia, to 2 last surgeries were to close together. I have now found out that what he told me is crap.
    I still have every small meal portions and do not snack, we have not junk food in the house not even soda. I eat healthy always have I am not even a fan of Chocolate. But my weight continues to risk also over half of the time I eat I get sick and it come out anyway ( Just a FYI it is not Dumping Syndrome I know what that feels like and this is not that at all).

    Becky:
    Check out link below, maybe they can help also I just got one of there books last week it is good. These Doctors have FM so they know. I have not looked into this treatment because I have no insurance and I truly live check to check at this point I am not on SSI Disability but in my state you have to wait 2 years from dated determined disabled to get health coverage. But if you can afford it or have health coverage never hurts to check it out

    http://fibromyalgiatreatment.com

  10. Jen says:

    I was in great shape and in the military before I started having fibro symptoms. Since then I have gained 40 lbs. Excercise makes it worse so I do not excercise unless I am feeling particularly well that day and then I am usually in severe pain the following day after light excercise. I would look more into fibro causing obesity instead of the other way around.

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