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Focusing on Fibromyalgia A Puzzling and Painful Condition You’ve probably heard of fibromyalgia, but you may not know what it is. Fibromyalgia is a long-term (chronic) pain condition that affects 5 million or more Americans ages 18 and older. For unknown reasons, most people diagnosed with fibromyalgia are women, although men and children also can be affected. People with certain disorders, such as rheumatoid arthritis or lupus, may also have fibromyalgia, which can affect their disease course and treatment. Fibromyalgia can take a powerful toll on health, well-being, and quality of life. “People with fibromyalgia suffer from severe, daily pain that is widespread throughout the body,” says Dr. Leslie J. Crofford, an NIH-supported researcher at Vanderbilt University. “Their pain is typically accompanied by debilitating fatigue, sleep that does not refresh them, and problems with thinking and memory.” People with fibromyalgia often see many doctors before finally receiving a diagnosis. The main symptoms – pain and fatigue – overlap with those of many other conditions, which can complicate the diagnosis. “To make things more challenging, there are no blood tests or X-rays that are abnormal in people with the disorder,” says Crofford. With no specific diagnostic test, some doctors may question whether a patient’s pain is real. “Even friends, family, and coworkers may have a difficult time understanding the person’s symptoms,” Crofford says. Inside This Issue: A doctor familiar with fibromyalgia can make a diagnosis based on the criteria established by the American College of Rheumatology. Diagnostic symptoms include a history of widespread pain lasting more than 3 months and other symptoms such as fatigue. In making the diagnosis, doctors consider the number of areas throughout the body where the patient had pain in the past week, and they rule out other causes of disease. What causes fibromyalgia isn’t fully understood. Many factors likely contribute. “We know that people with fibromyalgia have changes in the communication between the body and the brain,” Crofford says. These changes may lead the brain to interpret certain sensations as painful that might not be bothersome to people without the disorder. Researchers have found several genes that may affect a person’s risk of developing fibromyalgia. Stressful life events may also play a role. cont'd. on page 2 Focusing on Fibromyalgia..................................................................................................................................1 When Your Back Hurts ........................................................................................................................................2 Soothing a Sore Throat.......................................................................................................................................3 Researchers Examine the Structure of Zika Virus.............................................................................................4 Avoid Mosquito Bites! ........................................................................................................................................4 Focusing on Fibromyalgia, cont'd. FEELING BETTER WITH FIBROMYALGIA Fibromyalgia isn’t a progressive disease, so it doesn’t get worse over time and may even improve. It’s never fatal, and it won’t harm the joints, muscles, or internal organs. Medications may help relieve some – but not all – symptoms of fibromyalgia. “Drug treatments by themselves don’t result in remission or cure of fibromyalgia,” says Crofford. “We’ve learned that exercise may work as well as or better than medications. In addition, therapies such as tai chi, yoga, and cognitive behavior therapy can also help to reduce symptoms.” People with fibromyalgia often have the best results when treated with multiple therapies. “It’s critically important for health care providers to help patients develop an understanding of fibromyalgia, and to provide realistic information about treatments, with an emphasis on using exercise and other physical therapies in conjunction with medications,” Crofford says. Get enough sleep. Getting the right kind of sleep can help ease pain and fatigue. Discuss any sleep problems with your doctor. • Exercise. Research has shown that regular exercise is one of the most effective treatments for fibromyalgia. • Try a complementary health approach. Practices such as tai chi, qi gong, yoga, massage therapy, and acupuncture may help relieve some symptoms. • Consider medicines. Talk to your health care provider about an approved medication for treating fibromyalgia. more comfortably and reduce pain. She and other NIHfunded teams are also seeking markers of fibromyalgia in the blood that might ultimately lead to more targeted and effective treatments. Crofford and her colleagues are exploring whether a treatment called TENS (transcutaneous electrical nerve stimulation) can help people with fibromyalgia exercise When Your Back Hurts • imaging scans. But such changes to the back are also seen in a lot of people who don’t have back pain. So it’s hard to know if the changes are actually what’s causing the pain. Don’t Let Back Pain Knock You Flat People with obesity are more likely to have low back pain, as are people who smoke. Back pain is also more common in people who don’t exercise much, or in people who are mostly inactive but have occasional bursts of exercise. Is your back hurting? You’re in good company. In any 3month period, about 1 in 4 adults in the U.S. has at least one day of back pain, mostly in the lower back. What doctors do about chronic pain depends on the source of the pain. Some chronic back pain requires prolonged medical attention. If the pain comes from a fracture or tumor, those problems can be treated. Surgery can help if the pain is caused by a ruptured (herniated) disc or certain other conditions like spinal stenosis (narrowing of the spinal column, which can put pressure on the nerves) or degenerative spondylolisthesis (when one vertebra slips over another). But surgery isn’t the right choice for everyone. The back is a complicated structure. Its center is the spine, which is made up of 33 bones called vertebrae, stacked in a column. The nerves of the spinal cord run in a tunnel through the middle of those bones. Spongy discs between the vertebrae act as cushions. Ligaments and tendons hold everything together. A lot of things can go wrong with your back. A strained muscle or a problem with a disc or a bone can cause pain. Back pain might also arise from a fracture or tumor. Your back naturally changes as you age. Discs degenerate and arthritis may develop in the small joints of the back. Those changes may show up on an MRI or other types of The good news is most back pain goes away by itself. But for some people, the pain continues. If your back hurts most of the time for more than 3 months, you have chronic back pain. There are many treatment options for back pain, so be sure to talk to your health care provider about which approach is right for you. For most people, even chronic pain eventually clears up without surgery. Research has shown that patients who stay active are better off. Just be sure to avoid activities that might strain the back. 2 Soothing a Sore Throat What To Do When Your Throat Hurts We’ve all had sore throats. Your throat feels scratchy and may hurt when you swallow. What can you do to soothe a sore throat? And when is it a sign of a more serious infection? Most sore throats are caused by viral infections such as the common cold or the flu. These throat problems are generally minor and go away on their own. To soothe your irritated throat, keep it moist. “Ever notice that a sore throat seems worse in the morning? It’s because your throat gets so dry overnight,” says Dr. Valerie Riddle, an infectious disease expert at NIH. “Having lozenges or hard candies – or anything that stimulates saliva production – will keep your throat moist. It’s also important to drink plenty of fluids.” Strep is highly contagious. Treat it quickly to prevent it from spreading to others. Riddle says, “Not only can the infection be transmitted, but there are potential complications from untreated strep throat.” These include ear infections, rheumatic fever and kidney problems. Another fairly common throat infection is tonsillitis, which occurs when you have sore, swollen tonsils. It’s caused by many of the same viruses and bacteria that cause sore throats. If you have frequent bouts of tonsillitis or strep throat, you may need surgery (called a tonsillectomy) to have your tonsils removed. The best way to protect yourself from the germs that cause these infections is to wash your hands often. Try to steer clear of people who have colds or other contagious infections. And avoid smoking and inhaling second-hand smoke, which can irritate your throat. For young children who might choke on hard candies or lozenges, try cold liquids and popsicles. Throat pain might also be soothed by throat sprays and over-thecounter pain relievers such as acetaminophen, ibuprofen or aspirin, but don’t give aspirin to young children. Contact a doctor if your sore throat is severe, doesn’t feel better after a few days, or is accompanied by a high fever or swollen glands. These symptoms could be signs of a bacterial infection, such as strep throat. Taking antibiotics won’t help at all if your sore throat is caused by viruses, but they’re essential for fighting bacterial infections like strep. Strep is the most common bacterial throat infection. Although it can occur in adults, strep throat is more common in children between ages 5 and 15. Riddle says strep can be harder to detect in younger children, because it can cause a runny nose and other symptoms that make it seem like a cold. “If your child has severe throat pain, a fever above 100.4 degrees, or swollen glands, you should get medical attention right away,” advises Riddle. Children with strep also may experience nausea, vomiting and stomach pain. To see whether you have strep throat, the doctor will take a throat swab. If test results confirm strep, your doctor will prescribe antibiotics. After 24 hours of taking them, you should no longer be contagious. You’ll likely begin feeling better within a couple of days, but to fully recover it’s important to finish all of the medicine. 3 Health Postings AVOID Mosquito Bites! • Use insect repellents. Products containing DEET, picaridin, lemon eucalyptus, paramenthane-diol, or IR3535 can be applied to skin. Follow label instructions. • Cover up. When outside, wear long sleeves, pants, and socks. Mosquitoes may bite through thin fabric, so spray thin clothes with an EPA-registered repellent like permethrin. Don’t apply permethrin directly to skin. Researchers Examine the Structure of Zika Virus • Mosquito-proof your home. Install or repair screens on windows and doors to keep insects out. Use air conditioning if you have it. • Get rid of mosquito breeding sites. Scientists found a structural detail on the surface of the Zika virus that distinguishes it from similar viruses. Continuing to study this tiny difference might help researchers develop targeted therapies and better ways to diagnose Zika infections. Zika virus is mainly transmitted to humans by the bite of infected mosquitoes. It’s in the same family of viruses – called flaviviruses – that can cause the mosquito-borne diseases dengue, yellow fever, or West Nile illness. Most people infected with Zika virus don’t get sick. If symptoms appear, they tend to be mild and go away within a week. Symptoms can include fever, rash, and joint pain. But if a pregnant woman becomes infected with Zika virus, her unborn child may be at risk. Recent evidence confirms that Zika virus can cause severe fetal brain abnormalities, including microcephaly, a rare condition in which an infant’s head is unusually small. To learn more about Zika virus, NIH-funded researchers examined its structure at near-atomic resolution. They used a technique called cryo-electron microscopy. The process involves freezing viruses and firing a stream of high-energy particles through the sample to create tens of thousands of images. These 2-D images are then combined to create a detailed 3-D view of the virus. The 3-D images showed that Zika virus is structurally similar to other flaviviruses. But one difference in a protein on the virus surface may help it attach to and enter human cells. This detail might be something that researchers can take advantage of in efforts to develop Zika drugs or vaccines. “The structure of the virus provides a map that shows potential regions of the virus that could be targeted by a therapeutic treatment,” says study co-author Dr. Richard Kuhn of Purdue University. The structure might also point to new approaches for vaccine development or improved diagnostics for Zika infection, the researchers say. Reference: The 3.8 Å resolution cryo-EM structure of Zika virus. Sirohi D, Chen Z, Sun L, et al. Science. 2016 Mar 31. pii: aaf5316. [Epub ahead of print]. PMID: 27033547. Funding: NIH’s National Institute of Allergy and Infectious Diseases (NIAID). 4 Empty standing water from flowerpots, gutters, buckets, pool covers, pet water dishes, and birdbaths on a regular basis. All articles reprinted from the National Institutes of Health’s NIH News in Health. For more information, visit: www.newsinhealth.nih.gov