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Diagnosing Spinal Stenosis

Medical history‚ the patient tells the doctor details about symptoms and about any injury, condition, or general health problem that might be causing the symptoms.

Physical examination‚ the doctor (1) examines the patient to determine the extent of limitation of movement, (2) checks for pain or symptoms when the patient hyperextends the spine (bends backwards), and (3) checks for normal neurologic function (for instance, sensation, muscle strength, and reflexes) in the arms and legs.

X ray‚ an x-ray beam is passed through the back to produce a two-dimensional picture. An x-ray may be done before other tests to look for signs of an injury, tumor, or inherited problem. This test can show the structure of the vertebrae and the outlines of joints, and can detect calcification.

MRI (magnetic resonance imaging)‚ energy from a powerful magnet (rather than x- rays) produces signals that are detected by a scanner and analyzed by computer. This produces a series of cross-sectional images ("slices") and/or a three-dimensional view of parts of the back. An MRI is particularly sensitive for detecting damage or disease of soft tissues, such as the disks between vertebrae or ligaments. It shows the spinal cord, nerve roots, and surrounding spaces, as well as enlargement, degeneration, or tumors.

Computerized axial tomography (CAT)‚ x-rays are passed through the back at different angles, detected by a scanner, and analyzed by a computer. This produces a series of cross-sectional images and/or three-dimensional views of the parts of the back. The scan shows the shape and size of the spinal canal, its contents, and structures surrounding it.

Myelogram, a liquid dye that x-rays cannot penetrate is injected into the spinal column. The dye circulates around the spinal cord and spinal nerves, which appear as white objects against bone on an x-ray film. A myelogram can show pressure on the spinal cord or nerves from herniated disks, bone spurs, or tumors.

Bone scan‚ an injected radioactive material attaches itself to bone, especially in areas where bone is actively breaking down or being formed. The test can detect fractures, tumors, infections, and arthritis, but may not tell one disorder from another. Therefore, a bone scan is usually performed along with other tests.

Common Causes of Spinal Stenosis

Spinal stenosis most often results from a gradual, degenerative aging process. Either structural changes or inflammation can begin the process. As people age, the ligaments of the spine may thicken and calcify (harden from deposits of calcium salts). Bones and joints may also enlarge: when surfaces of the bone begin to project out from the body, these projections are called osteophytes (bone spurs).

When the health of one part of the spine fails, it usually places increased stress on other parts of the spine. For example, a herniated (bulging) disk may place pressure on the spinal cord or nerve root. When a segment of the spine becomes too mobile, the capsules (enclosing membranes) of the facet joints thicken in an effort to stabilize the segment, and bone spurs may occur. This decreases the space (neural foramen) available for nerve roots leaving the spinal cord.

Aging with secondary changes is the most common cause of spinal stenosis. Two forms of arthritis that may affect the spine are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is the most common form of arthritis and is more likely to occur in middle-aged and older people. It is a chronic, degenerative process that may involve multiple joints of the body. It wears away the surface cartilage layer of joints, and is often accompanied by overgrowth of bone, formation of bone spurs, and impaired function. If the degenerative process of osteoarthritis affects the facet joint(s) and the disk, the condition is sometimes referred to as spondylosis. This condition may be accompanied by disk degeneration, and an enlargement or overgrowth of bone that narrows the central and nerve root canals.

Rheumatoid arthritis usually affects people at an earlier age than osteoarthritis does and is associated with inflammation and enlargement of the soft tissues (the synovium) of the joints. Although not a common cause of spinal stenosis, damage to ligaments, bones, and joints that begins as synovitis (inflammation of the synovial membrane which lines the inside of the joint) has a severe and disrupting effect on joint function. The portions of the vertebral column with the greatest mobility (for example, the neck area) are often the ones most affected in people with rheumatoid arthritis.

The following conditions, not related to degenerative disease, are causes of acquired spinal stenosis:

  • Tumors of the spine are abnormal growths of soft tissue that may affect the spinal canal directly by inflammation or by growth of tissue into the canal. Tissue growth may lead to bone resorption (bone loss due to over activity of certain bone cells) or displacement of bone.
  • Trauma (accidents) may either dislocate the spine and the spinal canal or cause burst fractures that produce fragments of bone that penetrate the canal.
  • Paget's disease of bone is a chronic (long-term) disorder that typically results in enlarged and abnormal bones. Excessive bone breakdown and formation cause thick and fragile bone. As a result, bone pain, arthritis, noticeable bone structure changes, and fractures can occur. The disease can affect any bone of the body, but is often found in the spine. The blood supply that feeds healthy nerve tissue may be diverted to the area of involved bone. Also, structural problems of the involved vertebrae can cause narrowing of the spinal canal, producing a variety of neurological symptoms.Other developmental conditions may also result in spinal stenosis.
  • Fluorosis is an excessive level of fluoride in the body. It may result from chronic inhalation of industrial dusts or gases contaminated with fluorides, prolonged ingestion of water containing large amounts of fluorides, or accidental ingestion of fluoride-containing insecticides. The condition may lead to calcified spinal ligaments or softened bones and to degenerative conditions like spinal stenosis.
  • Ossification of the posterior longitudinal ligament occurs when calcium deposits form on the ligament that runs up and down behind the spine and inside the spinal canal. These deposits turn the fibrous tissue of the ligament into bone. (Ossification means "forming bone.") These deposits may press on the nerves in the spinal canal.

Spinal Stenosis

Spinal stenosis is a narrowing of areas in the lumbar (back) or cervical (neck) spine, which causes pressure on the spinal cord or one or more of the spinal nerves. It may be caused by a number of things including:
- Arthritis involving the spine, usually in middle-aged or elderly people
- Herniated or slipped disk
Injury that causes pressure on the nerve roots or the spinal cord itself
- Defect in the spine that was present from birth (congenital defect)
- Tumors in the spine
- Paget's disease of bone
- Achondroplasia

Most often, symptoms will be on one side of the body or the other and will include: numbness, cramping, or pain in the back, buttocks, thighs, or calves, or in the neck, shoulders, or arms, weakness of a portion of a leg or arm.

Symptoms are more likely to be present or get worse when you stand or walk upright. They will often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period of time.

More serious symptoms include:
Difficulty or imbalance when walking
Problems controlling urine or bowel movements
Problems urinating or having a bowel movement

In order to pinpoint the location of the pain and figure out how it affects your movement, a physical exam will be given by the doctor. Patients may be asked to: sit, stand, and walk, bend forward, backward, and sideways, lift legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength, as well as your ability to move.

To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well you feel). Your doctor will instruct you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.

A brain/nervous system (neurological) examination can confirm leg weakness and decreased sensation in the legs. The following tests may be done: EMG, spinal MRI or spinal CT scan, X-ray of the spine.

Even when your back pain does not go away completely, or if it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery. Your doctor and other health professionals are partners with you to manage your pain and keep you as active as possible.

Generally, conservative management is encouraged. This involves the use of medications, physical therapy, and lifestyle changes.

If the pain is persistent and does not respond to these measures, surgery is considered to relieve the pressure on the nerves or spinal cord. Surgery is performed on the neck or lower back, depending on the site of the nerve compression.

Many people with spinal stenosis are able to carry on active lifestyles for many years with the condition. Some change in activities or work may be needed.

Spine surgery will often provide full or partial relief of symptoms. However, future spine problems are still possible after spine surgery. The area of the spinal column above and below a spinal fusion is more likely to be stressed when the spine moves. Also, if you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may be more likely to have future problems.

Sciatica

Sciatica is a symptom of a problem with the sciatic nerve, a large nerve that runs from the lower back down the back of each leg. It controls muscles in the back of your knee and lower leg and provides feeling to the back of your thigh, part of your lower leg and the sole of your foot. When you have sciatica, you have pain, weakness, numbness or tingling. It can start in the lower back and extend down your leg to your calf, foot, or even your toes. It's usually on only one side of your body.

Sciatica may be due to a ruptured intervertebral disk, narrowing of the spinal canal that puts pressure on the nerve called spinal stenosis, or an injury such as a pelvic fracture. In many cases no cause can be found.

Sometimes sciatica goes away on its own. Treatment, if needed, depends on the cause of the problem. It may include exercises, medicines, and surgery.

Piriformis Syndrome

Piriformis syndrome is a rare neuromuscular disorder that occurs when the piriformis muscle compresses or irritates the sciatic nerve-the largest nerve in the body. The piriformis muscle is a narrow muscle located in the buttocks. Compression of the sciatic nerve causes pain-frequently described as tingling or numbness-in the buttocks and along the nerve, often down to the leg. The pain may worsen as a result of sitting for a long period of time, climbing stairs, walking, or running.

Generally, treatment for the disorder begins with stretching exercises and massage. Cessation of running, bicycling, or similar activities may be advised. Anti-inflammatory drugs may be prescribed and in some cases a corticosteroid injection near where the piriformis muscle and the sciatic nerve meet may be given to provide temporary relief. In extreme cases, surgery is recommended.

The prognosis for most individuals with piriformis syndrome is good. Once symptoms of the disorder are addressed, individuals can usually resume their normal activities. In some cases, exercise regimens may need to be modified in order to reduce the likelihood of recurrence or worsening.

Within the NINDS research programs, piriformis syndrome is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as piriformis syndrome.

Cervical Spinal Surgery

Cervical spinal surgery is used to correct the part of the spine in the neck, including problems with the bones (vertebrae), disks, and nerves.

The cervical spine is the part of the spine that runs through the neck area. It consists of seven vertebrae and eight pairs of spinal nerves (called C1 to C8). The two most common problems people have with the cervical spine are herniation and stenosis.

The specific cervical spine surgery depends on what is causing the problem. If there is a single herniated disk, then the disk may simply be removed through a surgical cut that is made in either the front or the back of the body. If more than one disk needs to be removed, the spine usually needs to be fused to keep it from becoming unstable.

Spinal stenosis is a more difficult problem to treat and generally requires more extensive surgery. Pressure needs to be taken off the spinal nerves and cord. This can be done through a surgical cut in the front or the back of the body. If removing the bone causes the spine to become unstable, spinal fusion may be needed.

Cervical spine surgery is generally used when rest, medication, and physical therapy do not work, and the pain and weakness gets worse.

The health care provider should give you solid information on the expected course of your neck pain and self-care options before discussing surgery. Make sure you ask your doctor about the pros and cons of surgery and how long symptom relief will last. Surgery does not always improve outcome and, in some cases, can even make it worse.

You should always try all possible non-surgical treatments before opting for surgery. When appropriate, surgery can provide great relief for patients whose pain does not go away with other treatments.

Surgery may also be performed if there are signs that the spinal cord is being compressed.

There are risks associated with any surgery including bleeding and infection. Additional risks specific to spinal surgery include injury to the spinal nerves or spinal cord, injury to the blood vessels feeding the spine, and failure of the bone to fuse. Fortunately, these complications are rare but they are serious and you should discuss them with your doctor before undergoing surgery.

More than 90% of patients who have surgery on a single herniated disk have complete or near-complete relief from their symptoms.

The results of more complex surgeries on multiple disks vary, and depend on the technique and the particular case. Spinal stenosis is more difficult to treat. About 50 - 90% of patients can expect good to excellent results.

The hospital stay may be up to about 7 days. You will be encouraged to walk the first or second day after surgery to reduce the risk of blood clots (deep venous thrombosis) and complete recovery takes about 5 weeks. Heavy work is not recommended until several months after surgery, if at all.

Minimally Invasive Surgery Not Better for Sciatica

HealthDay TUESDAY, July 7 (HealthDay News) -- Minimally invasive surgery for the excruciating back pain that can be caused by sciatica didn't work as well as the conventional procedure in a Dutch study.

"The expected treatment benefit of a faster rate of recovery from sciatica after tubular diskectomy could not be reproduced by this double-blind study," according to a report in the July 8 issue of the Journal of the American Medical Association.

Orthopedic surgeons at the Medical Center Haaglanden studied 328 people who underwent surgery for sciatic pain, and found that "the overall differences in pain intensity and recovery rates favored the conventional microdiskectomy."

Surgery is done to remove the portion of a disk that has ruptured and causes pain by pressing on the sciatic nerve. The older method, microdiskectomy, is done through a larger incision than that used for transmuscular tubular diskectomy, the minimally invasive technique that was introduced in 1997 and has gained wide popularity. But only a few studies comparing results of the two techniques have been reported.

"The reason why it [minimally invasive surgery] did not work could be because our conventional technique uses a small incision as well," said study author Dr. Mark P. Arts.

Minimally invasive surgery might still be recommended in some cases, Arts noted. "We are still working on our subgroup analysis, but possibly the tubular diskectomy is indicated in obese patients in whom a large incision and exposure is inevitable," he said.

But more patients probably will prefer the conventional approach, Arts said. "We will discuss the results of our study with our patients and their prejudiced opinion of small being better will probably change into, 'Do what's best for me,'" he said.

The results of the Dutch study were no surprise to Dr. Todd J. Albert, director of the department of orthopedic surgery at the Rothman Institute of Thomas Jefferson University in Philadelphia.

"We have people in our unit who did a similar study and found very similar results," Albert said. That study has been submitted to a medical journal for publication, he noted.

Any minimally invasive surgical technique is bound to be popular "because the public wants a less invasive procedure if it accomplishes the same thing," Albert said. "Sometimes it pans out and sometimes it doesn't. With knee surgery it has, but minimally invasive hip surgery, which was a big rage a few years ago, is not necessarily better."

In his practice, Albert said, surgery for sciatic pain is done with a procedure halfway between the conventional and minimally invasive methods. "Maybe my incision is a half a centimeter longer than for microdiskectomy," he said. "We find the window where the disk is pressing on the nerve and push it out. It is much more like the open-surgery approach."

In practical terms, the real question about surgery for sciatica is not which technique should be used but whether surgery should be done, said Dr. Michael Y. Wang, an associate professor of neurological surgery and rehabilitation medicine at the University of Miami Miller School of Medicine.

"In general, the answer is, when you have a neurological deficit or intractable pain or a problem threatening loss in terms of neurological function," Wang said. The most common reason is to ease pain, he said.

The differences shown in the Dutch study are not great enough to say that one procedure is clearly preferable over the other, Wang noted. "I use the conventional technique even though I'm a minimally invasive surgeon," he said. "For sciatica, the minimally invasive method is too complicated and involved."

The Dutch results are not directly transferable to the United States for several reasons, Wang said. For example, those who had surgery in the study stayed an average of 3.3 days in the hospital. Such a long stay is virtually unheard of in the United States, where hospital discharge is almost always done a day or two after surgery, Wang said.

SOURCES: Mark P. Arts, M.D., neurosurgeon, Medical Center Haaglanden, the Hague, Netherlands; Todd J. Albert, M.D., director, department of orthopedic surgery, Rothman Institute of Thomas Jefferson University, Philadelphia; Michael Y. Yang, M.D., associate professor, neurological surgery and rehabilitation medicine, University of Miami Miller School of Medicine; July 8, 2009, Journal of the American Medical Association

HealthDay Copyright (c) 2009 ScoutNews, LLC. All rights reserved.

Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a rare condition that involves a combination of pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip. The thoracic outlet is the area between the rib cage and collarbone.

So what are the causes of TOS?

Blood vessels and nerves coming from the spine or major blood vessels of the body pass through a narrow space near the shoulder and armpit on their way to the arms. As they pass by or through the collarbone and upper ribs, they may not have enough space. Pressure or compression on these blood vessels or nerves can cause symptoms in the arms or hands. Problems with the nerves account for almost all cases of thoracic outlet syndrome.

Compression can be caused by a number of things including an extra cervical rib (above the first rib) or an abnormal tight fibrous band connecting the spinal vertebra to the rib. Patients often have a history of injury to the area or overuse of the shoulder.

Symptoms of TOS may include pain, numbness, and tingling in the last three fingers and inner forearm, pain and tingling in the neck and shoulders (carrying something heavy may make the pain worse), signs of poor circulation in the hand or forearm, weakness of the muscles in the hand.

The diagnosis of TOS is typically made after the doctor takes a careful history and performs a physical examination. Sometimes tests are done to confirm the diagnosis including: electromyography (EMG), MRI, Nerve conduction velocity study, and an x-ray. Tests may also be performed to make sure there are no other problems, such as carpal tunnel syndrome or a damaged nerve due to problems in the cervical (neck) spine.

There are several options when treating TOS. Physical therapy may help strengthen the shoulder muscles, improve the range of motion, and promote better posture. Treatment may also include pain medication. Conservative approaches using physical therapy are helpful for many patients.

In severe cases surgery may be recommended if physical therapy and changes in activity do not improve your symptoms. The types of surgical procedures that may be performed may include; an extra rib is removed and certain muscles are cut, a section of the first rib is removed to release pressure in the area, bypass surgery is done to re-route blood around the compression or remove the area that is causing the symptoms. It is estimated that surgery can be successful in 50-80% of patients.

Tips for Good Sleep - 7/14/2011

Do you have trouble going to sleep or staying asleep? Do you wake up tired and feel like you have to nap during the day? Even with a top-of-the-line memory foam or latex mattress, sleep can still be difficult for a number of reasons such as stress and poor day-to-day habits. Whatever it is, bad sleep does more than just make you tired; it aversely affects your health and cognitive capacity. 

Fortunately, there are numerous methods to improve your sleep that are simple, easy, and do not involve a prescription.

Try out these suggestions and start experiencing a deeper, more fulfilling nights sleep.

 

  • Try to keep a regular sleep pattern by habitually going to bed and waking at the same time every day‚ even on weekends and vacations. After some time, your body will naturally get accustomed to your sleep cycle and it will become easier to have a good nights rest.
  • Avoid consuming caffeine and alcohol in the late afternoon and evening. Coffee, soft drinks, chocolate, and medications that contain caffeine stimulate your body and mind and can keep you from falling asleep and sleeping soundly. Even though alcohol can make you feel sleepy, drinking around bedtime can also disturb sleep.
  • Regular daytime exercise can improve nighttime sleep, but since it too can be stimulating and keep you up, avoid exercising within 3 hours of bedtime.
  • Avoid daytime naps, which can skew your body’s notion of sleep and thus interfere with nighttime sleep. If you feel you cannot get by without a nap, set an alarm for 1 hour or less and get up immediately when it goes off.
  • Reserve your bed for sleeping. Your body and mind need to associate your bed with healthy sleep, and watching late news, reading a suspense novel, or working on your laptop in bed can keep you up later than expected and stimulate your mind, making it hard to fall asleep. If you want to perform late night activities in bed, try utilizing a backrest or leg rest to put your body in an optimal position for comfort and health.
  • Keep your bedroom dark, quiet, and cool. There are specialized mattresses available, such as our Healthy Back Pure Latex line, which are designed to cool your body a crucial few degrees if you get too hot during the night.
  • Sleep with a ‘Hot Water Bottle’. This method, popular in the United Kingdom and Europe, provides comfort and warmth in your bed, and can help alleviate sore joints and muscles. The Hotties Micro Hottie is the market leader for hot water bottle type products, and is available at the Healthy Back Store.
  • Avoid liquids and spicy meals before bed. Heartburn and late night trips to the bathroom are not conducive to good sleep.
  • Instead of working right up to bedtime, try performing relaxing activities such as listening to soft music or taking a warm bath to get you ready to sleep. These processes help your body and mind wind down from a hectic day, and a warm bath also may soothe aching muscles.

 


A deep nights sleep is truly life changing. Before you consider any medicinal options to help improve your sleep, try these natural, proven tips and see the difference they make for you.

 


The Healthy Back Store is a specialty retailer that provides high-end comfort solutions and ergonomic products for back pain and other physical conditions. The company offers pain relieving products for sleeping, working, exercising and relaxing including back and neck supports, specialty mattresses, office chairs, exercise and therapy equipment, recliners and massage chairs. Healthy Back sells recognizable name brands such as Herman Miller and Tempur-Pedic, but also represents smaller, specialized manufacturers offering a growing selection of house-branded goods. Healthy Back has 23 stores in 6 states across the United States, and also sells through its website and call center, making it the largest privately owned back care retailer.

Treating and Diagnosing Fibromyalgia

Research shows that people with fibromyalgia typically see many doctors before receiving the diagnosis. One reason for this may be that pain and fatigue, the main symptoms of fibromyalgia, overlap with those of many other conditions. Therefore, doctors often have to rule out other potential causes of these symptoms before making a diagnosis of fibromyalgia. Another reason is that there are currently no diagnostic laboratory tests for fibromyalgia; standard laboratory tests fail to reveal a physiologic reason for pain. Because there is no generally accepted, objective test for fibromyalgia, some doctors unfortunately may conclude a patient’s pain is not real, or they may tell the patient there is little they can do.

A doctor familiar with fibromyalgia, however, can make a diagnosis based on criteria established by the American College of Rheumatology (ACR): a history of widespread pain lasting more than 3 months, and the presence of diffuse tenderness. Pain is considered to be widespread when it affects all four quadrants of the body, meaning it must be felt on both the left and right sides of the body as well as above and below the waist. ACR also has designated 18 sites on the body as possible tender points. To meet the strict criteria for a fibromyalgia diagnosis, a person must have 11 or more tender points, but often patients with fibromyalgia will not always be this tender, especially men. People who have fibromyalgia certainly may feel pain at other sites too, but those 18 standard possible sites on the body are the criteria used for classification.

Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Many family physicians, general internists, or rheumatologists (doctors who specialize in arthritis and other conditions that affect the joints or soft tissues) can treat fibromyalgia.

Treatment often requires a team approach, with your doctor, a physical therapist, possibly other health professionals, and most importantly, yourself, all playing an active role. It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these various professionals can help you improve your quality of life.

Only three medications, duloxetine (Cymbalta1), milnacipran (Savella), and pregabalin (Lyrica) are approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia. Cymbalta was originally developed for and is still used to treat depression. Savella is similar to a drug used to treat depression, but is FDA approved only for fibromyalgia. Lyrica is a medication developed to treat neuropathic pain (chronic pain caused by damage to the nervous system).

Following are some of the most commonly used categories of drugs for fibromyalgia.

Analgesics are painkillers. They range from over-the-counter acetaminophen (Tylenol) to prescription medicines, such as tramadol (Ultram), and even stronger narcotic preparations. For a subset of people with fibromyalgia, narcotic medications are prescribed for severe muscle pain. However, there is no solid evidence showing that for most people narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential that the person taking them will become physically or psychologically dependent on them.

As their name implies, non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Anaprox, Aleve), are used to treat inflammation. Although inflammation is not a symptom of fibromyalgia, NSAIDs also relieve pain. The drugs work by inhibiting substances in the body called prostaglandins, which play a role in pain and inflammation. These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.

Perhaps the most useful medications for fibromyalgia are several in the antidepressant class. These drugs work equally well in fibromyalgia patients with and without depression, because antidepressants elevate the levels of certain chemicals in the brain (including serotonin and norepinephrine) that are associated not only with depression, but also with pain and fatigue. Increasing the levels of these chemicals can reduce pain in people who have fibromyalgia. Doctors prescribe several types of antidepressants for people with fibromyalgia.

Benzodiazepines can sometimes help people with fibromyalgia by relaxing tense, painful muscles and stabilizing the erratic brain waves that can interfere with deep sleep. Benzodiazepines also can relieve the symptoms of restless legs syndrome, a neurological disorder that is more common among people with fibromyalgia. The disorder is characterized by unpleasant sensations in the legs and an uncontrollable urge to move the legs, particularly when at rest. Doctors usually prescribe benzodiazepines only for people who have not responded to other therapies because of the potential for addiction.

In addition to the previously described general categories of drugs, doctors may recommend or prescribe others, depending on a person’s specific symptoms or fibromyalgia-related conditions. For example, for people with irritable bowel syndrome (IBS), doctors may suggest fiber supplements, laxatives or other prescription drugs to relieve constipation.

Antispasmodic medications may be useful for relieving intestinal spasms and reducing abdominal pain. Other symptom-specific medications include sleep medications, muscle relaxants, and headache remedies.

People with fibromyalgia also may benefit from a combination of physical and occupational therapy, from learning pain management and coping techniques, and from properly balancing rest and activity.