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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 45759
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Looking for a second opinion. I have a diagnosis of

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I have a diagnosis of fibromyalgia and am currently taking tramadol 400mg per day and amitriptyline 125mg per day. These drugs help with pain around 75% of the time but my GP states that there is nothing else they can give me for breakthrough pain when I have a flare up which although it is all overmy body, it particularly effects my hips and lower back to the point that I am stuck in bed. Is there anything else I could take?
Assistant: Have you had any recent injuries? What seems to make the pain better or worse?
Customer: no recent injuries - have tried tens machine, hot and cold, baths etc - nothing helps during a flare up. 75% of the time my current prescribed drugs work to make my Iain manageable (they don’t take it away but I can manage).
Assistant: Anything else in your medical history you think the Doctor should know?
Customer: I have complex-PTSD and take 225mg of lamotrigine and have been diagnosed with chronic migraines and I take topiramate daily for these.I have previously tried Gabapentin with no success, GP stopped my Duloxetine/ Cymbalta when I was put on amitriptyline and I take diazepam 2x 2mg up to 3 times per day.Is there anything else I could take for break through pain?

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The treatment of fibromyalgia is comprehensive and a single guideline for an individual is difficult to make. The treatment has to be individually tailored;

1) Aerobic exercise; low-impact aerobics, walking, water aerobics, stationary bicycle.

2) Heat, massage, and other treatments like the sauna, hot baths and showers, hot mud, and massage.

3) Trigger-point injections,

4) Acupuncture,

5) Chiropractic manipulation,

6) Myofascial release

7) Neural pulse stimulation (CNP) device

8) Cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT)

9) Relaxation training and biofeedback

10) Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen

11) Opioid analgesics (hydrocodone, oxycodone, fentanyl, morphine),

12) Anxiolytics/hypnotics

13) Estrogen receptor modulator raloxifene

14) St. John's wort, ginseng, valerian, botanical oil, melatonin, magnesium, dehydroepiandrosterone

A combination of above is tried for an individual to relieve the symptoms.

The goal of fibromyalgia treatment is to improve physical and mental health and quality of life. This goal implies helping manage distressing symptoms, but with decreased dependence on the medical care system. The common recommendations of education, exercise, and pharmacotherapy are often appropriate. Comorbid conditions, such as arthritis and obesity, should be treated because they can contribute to increasing physical and mental symptoms. In fibromyalgia; you are the best person to guide your physician, as there are no set rules or standard of the protocol which can be effective. The treatment which has been best and efficacious for you in the past can be repeated. Because medical therapy is unsatisfactory, patients find their way to alternative therapies. Some of these therapies may be helpful to individual patients, such as massage, water therapy, spa treatment, and acupuncture. So, your decision to choose them to supersede the physician's recommendations. The research, in addition to the clinical experience, indicates that the addition of education and a behavioral or cognitive-behavioral component to fibromyalgia treatment protocols is warranted. A combination of the Patient Education, Cognitive-Behavioral Therapy, Relaxation Techniques, and Complementary and Alternative Medicine is supposed to bring the best outcome in quality of life.

The management of fibromyalgia using the principles of comprehensive nonpharmacologic pain management represented by the acronym ExPRESS; has been suggested.

1) Ex is for exercise.

2) P is for psychiatric comorbidity because depression and anxiety disorders are common in chronic pain conditions and contribute significantly to pain and disability.

3) R is for regaining function; this often involves helping patients with activity pacing so that they do not do too much on days when they feel good and do too little on days when they feel bad.

4) E is for education; Web sites hosted by the Arthritis Foundation and the National Fibromyalgia Association are the best education sites.

5) S is for sleep hygiene, which is necessary for many who have developed counterproductive habits.

6) Finally, S is for stress management, which includes any number of elements, such as CBT, relaxation techniques, hydrotherapy, and gentle exercise to name just a few.

Wishing you a speedy resolution and all the very best in life.




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Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 45759
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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