Anxiety Disorders – Types, Causes and Symptoms

What are Anxiety Disorders?


Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or making an important decision. Anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. These feelings can interfere with daily activities such as job performance, school work, and relationships.There are a variety of anxiety disorders. Collectively they are among the most common mental disorders.

Types of Anxiety Disorders

There are three types of anxiety disorders discussed on this website:

Signs and Symptoms

Unlike the relatively mild, brief anxiety caused by a specific event (such as speaking in public or a first date), severe anxiety that lasts at least six months is generally considered to be problem that might benefit from evaluation and treatment. Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread.

Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other problems need to be treated before a person can respond well to treatment for anxiety.

While some symptoms, such as fear and worry, occur in all anxiety disorders, each disorder also has distinctive symptoms. For more information, visit:

Diagnosis and Treatment

Anxiety disorders are treatable. If you think you have an anxiety disorder, talk to your doctor.

Sometimes a physical evaluation is advisable to determine whether a person’s anxiety is associated with a physical illness. If anxiety is diagnosed, the pattern of co-occurring symptoms should be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety should wait until the coexisting conditions are brought under control.

With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives. If your doctor thinks you may have an anxiety disorder, the next step is usually seeing a mental health professional. It is advisable to seek help from professionals who have particular expertise in diagnosing and treating anxiety. Certain kinds of cognitive and behavioral therapy and certain medications have been found to be especially helpful for anxiety.

You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a clinician with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder together.

In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the type of disorder, the person’s preference, and the expertise of the clinician.

People with anxiety disorders who have already received treatment should tell their clinician about that treatment in detail. If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether the dosage was increased or decreased while they were under treatment, what side effects occurred, and whether the treatment helped them become less anxious. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions, and whether the therapy was useful.

Often people believe that they have “failed” at treatment or that the treatment didn’t work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try different treatments or combinations of treatment before they find the one that works for them.

Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out. If you don’t have insurance, the Health and Human Services division of your county government may offer mental health care at a public mental health center that charges people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.

For additional resources for getting information and assistance, please visit NIMH’s Help for Mental Illness webpage

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Federal Study Will Pay You $3,000 Per Week to Consume Cannabis

The United States National Research Center (NRC) has been commissioned by the National Institute of Drug Abuse(NIDA) to conduct comprehensive research evaluating the effects of cannabis on the human body.

The research, which will take part in seven facilities across the nation, is intended to determine whether or not cannabis can be used to relieve stress and stress-related disorders, while allowing consumers of the plant to maintain normal function in their lives.

“This is one of the first, very promising studies, that will finally reveal the answer of the age old acquisition that stoners are ‘Just Lazy’,” says lead researcher Michael Gregory. “It’s an exciting new study that may push the legality of marijuana to all 50 states.”

For the research, participants will be required to stay at the facility for six months (making it immediately un-doable for many if not most people), while performing various everyday activities such as cleaning, watching TV and reading, while also regularly consuming cannabis. During all of this, participants will be evaluated by medical staff.


Researchers looking to gather over 300 recruits into their facilities before the study begins; these recruits will be paid $3,000 for every week they take part in the study.

At the moment, the NRC isn’t accepting new applicants for those wanting to take part in the study, though that’s expected to change in the near future; we’ll update this article when it does.

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How many ways to treat Chronic Pain?

Treating Chronic Pain

Recognizing that chronic pain is a problem is the first step in finding treatment — you shouldn’t have to deal with the difficulties it brings.


Talk to your doctor about chronic pain symptoms. Together you can identify the source of the pain and come up with a comprehensive treatment plan that takes into account your overall health and lifestyle needs.

Over-the-counter (OTC) and prescription medications are often used to manage pain. However, for many people, a combination of treatments is most effective for relieving chronic pain.

Medications may be combined with:

  • physical therapy
  • exercise
  • acupuncture
  • relaxation techniques
  • psychological counseling

Micke Brown, BSN, RN, is the Director of Communications for the American Pain Foundation (APF). Micke believes that a “multi-modality” treatment is the best approach to managing chronic pain. “Pain and its treatment are complex, and what works best for one may not work for another,” says Micke. “The secret to creating an effective pain treatment plan is adding the right ingredients to find the recipe that works for the individual.”

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Anxiety Disorders and Anxiety Attacks Signs, Symptoms, and Treatment Options


It’s normal to feel anxious when facing a challenging situation, such as a job interview, a tough exam, or a blind date. But if your worries and fears seem overwhelming and interfere with your daily life, you may be suffering from an anxiety disorder. There are many different types of anxiety disorders—and many effective treatments and self-help strategies. Once you understand your anxiety disorder, there are steps you can take to reduce your symptoms and regain control of your life.

Understanding anxiety disorders

Anxiety is the body’s natural response to danger, an automatic alarm that goes off when you feel threatened, under pressure, or are facing a stressful situation.

In moderation, anxiety isn’t always a bad thing. In fact, anxiety can help you stay alert and focused, spur you to action, and motivate you to solve problems. But when anxiety is constant or overwhelming, when it interferes with your relationships and activities, it stops being functional—that’s when you’ve crossed the line from normal, productive anxiety into the territory of anxiety disorders.

Do your symptoms indicate an anxiety disorder?

If you identify with several of the following signs and symptoms, and they just won’t go away, you may be suffering from an anxiety disorder:

  • Are you constantly tense, worried, or on edge?
  • Does your anxiety interfere with your work, school, or family responsibilities?
  • Are you plagued by fears that you know are irrational, but can’t shake?
  • Do you believe that something bad will happen if certain things aren’t done a certain way?
  • Do you avoid everyday situations or activities because they cause you anxiety?
  • Do you experience sudden, unexpected attacks of heart-pounding panic?
  • Do you feel like danger and catastrophe are around every corner?

Signs and symptoms of anxiety disorders

Anxiety Attacks and Disorders: Symptoms, Causes, and TreatmentBecause anxiety disorders are a group of related conditions rather than a single disorder, they can look very different from person to person. One individual may suffer from intense anxiety attacks that strike without warning, while another gets panicky at the thought of mingling at a party. Someone else may struggle with a disabling fear of driving, or uncontrollable, intrusive thoughts. Yet another may live in a constant state of tension, worrying about anything and everything.

Despite their different forms, all anxiety disorders share one major symptom: persistent or severe fear or worry in situations where most people wouldn’t feel threatened.

Emotional symptoms of anxiety

In addition to the primary symptoms of irrational and excessive fear and worry, other common emotional symptoms of anxiety include:

  • Feelings of apprehension or dread
  • Trouble concentrating
  • Feeling tense and jumpy
  • Anticipating the worst
  • Irritability
  • Restlessness
  • Watching for signs of danger
  • Feeling like your mind’s gone blank

Physical symptoms of anxiety

Anxiety is more than just a feeling. As a product of the body’s fight-or-flight response, anxiety involves a wide range of physical symptoms. Because of the numerous physical symptoms, anxiety sufferers often mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is discovered.

Common physical symptoms of anxiety include:

  • Pounding heart
  • Sweating
  • Stomach upset or dizziness
  • Frequent urination or diarrhea
  • Shortness of breath
  • Tremors and twitches
  • Muscle tension
  • Headaches
  • Fatigue
  • Insomnia

The link between anxiety symptoms and depression

Many people with anxiety disorders also suffer from depression at some point. Anxiety and depression are believed to stem from the same biological vulnerability, which may explain why they so often go hand-in-hand. Since depression makes anxiety worse (and vice versa), it’s important to seek treatment for both conditions.

Anxiety attacks and their symptoms

Anxiety attacks, also known as panic attacks, are episodes of intense panic or fear. Anxiety attacks usually occur suddenly and without warning. Sometimes there’s an obvious trigger—getting stuck in an elevator, for example, or thinking about the big speech you have to give—but in other cases, the attacks come out of the blue.

Anxiety attacks usually peak within 10 minutes, and they rarely last more than 30 minutes. But during that short time, the terror can be so severe that you feel as if you’re about to die or totally lose control. The physical symptoms of anxiety attacks are themselves so frightening that many people believe they’re having a heart attack. After an anxiety attack is over, you may be worried about having another one, particularly in a public place where help isn’t available or you can’t easily escape.

Symptoms of anxiety attacks include:

  • Surge of overwhelming panic
  • Feeling of losing control or going crazy
  • Heart palpitations or chest pain
  • Feeling like you’re going to pass out
  • Trouble breathing or choking sensation
  • Hyperventilation
  • Hot flashes or chills
  • Trembling or shaking
  • Nausea or stomach cramps
  • Feeling detached or unreal

Types of anxiety disorders

There are six major types of anxiety disorders, each with their own distinct symptom profile: generalized anxiety disorder, obsessive-compulsive disorder, panic disorder (anxiety attacks), phobia, post-traumatic stress disorder, and social anxiety disorder.

Generalized anxiety disorder

Generalized anxiety disorderIf constant worries and fears distract you from your day-to-day activities, or you’re troubled by a persistent feeling that something bad is going to happen, you may be suffering from generalized anxiety disorder (GAD). People with GAD are chronic worrywarts who feel anxious nearly all of the time, though they may not even know why. Anxiety related to GAD often shows up as physical symptoms like insomnia, stomach upset, restlessness, and fatigue.

Anxiety attacks (Panic disorder)

Anxiety attacks (Panic disorder)A panic disorder is characterized by repeated, unexpected panic attacks, as well as fear of experiencing another episode. A panic disorder may also be accompanied by agoraphobia, which is the fear of being in places where escape or help would be difficult in the event of a panic attack. If you have agoraphobia, you are likely to avoid public places such as shopping malls, or confined spaces such as an airplane.

Obsessive-compulsive disorder

Obsessive-compulsive disorderObsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or behaviors that seem impossible to stop or control. If you have OCD, you may be troubled by obsessions, such as a recurring worry that you forgot to turn off the oven or that you might hurt someone. You may also suffer from uncontrollable compulsions, such as washing your hands over and over.


PhobiaA phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals (such as snakes and spiders), fear of flying, and fear of heights. In the case of a severe phobia, you might go to extreme lengths to avoid the thing you fear. Unfortunately, avoidance only strengthens the phobia.

Social anxiety disorder

Social anxiety disorderIf you have a debilitating fear of being seen negatively by others and humiliated in public, you may have social anxiety disorder, also known as social phobia. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia.

Post-traumatic stress disorder

Post-traumatic stress disorderPost-traumatic stress disorder (PTSD) is an extreme anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event. PTSD can be thought of as a panic attack that rarely, if ever, lets up. Symptoms of PTSD include flashbacks or nightmares about what happened, hypervigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event.

Self-help for anxiety, anxiety attacks, and anxiety disorders

Not everyone who worries a lot has an anxiety disorder. You may be anxious because of an overly demanding schedule, lack of exercise or sleep, pressure at home or work, or even from too much coffee.

The bottom line is that if your lifestyle is unhealthy and stressful, you’re more likely to feel anxious—whether or not you actually have an anxiety disorder. So if you feel like you worry too much, take some time to evaluate how well you’re caring for yourself.

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Chronic Pain Management – Very Effective Tips from Experts

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What Is Chronic Pain?
What Are the Symptoms of Chronic Pain?
What Is Chronic Pain?
About 100 million Americans suffer from chronic pain, defined as pain that lasts longer than six months. Chronic pain can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating.

With chronic pain, signals of pain remain active in the nervous system for months or even years. This can take both a physical and emotional toll on a person.

The most common sources of pain stem from headaches, joint pain, pain from injury, and backaches. Other kinds of chronic pain include tendinitis, sinus pain, carpal tunnel syndrome, and pain affecting specific parts of the body, such as the shoulders, pelvis, and neck. Generalized muscle or nerve pain can also develop into a chronic condition.

Chronic pain may originate with an initial trauma/injury or infection, or there may be an ongoing cause of pain. Some people suffer chronic pain in the absence of any past injury or evidence of body damage.
The emotional toll of chronic pain also can make pain worse. Anxiety, stress, depression, anger, and fatigue interact in complex ways with chronic pain and may decrease the body’s production of natural painkillers; moreover, such negative feelings may increase the level of substances that amplify sensations of pain, causing a vicious cycle of pain for the person. Even the body’s most basic defenses may be compromised: There is considerable evidence that unrelenting pain can suppress the immune system.

Because of the mind-body links associated with chronic pain, effective treatment requires addressing psychological as well as physical aspects of the condition.

What Are the Symptoms of Chronic Pain?
The symptoms of chronic pain include:

Mild to severe pain that does not go away
Pain that may be described as shooting, burning, aching, or electrical
Feeling of discomfort, soreness, tightness, or stiffness
Pain is not a symptom that exists alone. Other problems associated with pain can include:

Withdrawal from activity and increased need to rest
Weakened immune system
Changes in mood including hopelessness, fear, depression, irritability, anxiety, and stress

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Types, Symptoms & Causes of Anxiety Disorders


What Are the Types of Anxiety Disorders?

There are several recognized types of anxiety disorders, including:

  • Panic disorder : People with this condition have feelings of terror that strike suddenly and repeatedly with no warning. Other symptoms of a panic attack include sweating, chest pain, palpitations (unusually strong or irregular heartbeats), and a feeling of choking, which may make the person feel like he or she is having aheart attack or “going crazy.”
  • Social anxiety disorder : Also called social phobia, social anxiety disorder involves overwhelming worry and self-consciousness about everyday social situations. The worry often centers on a fear of being judged by others, or behaving in a way that might cause embarrassment or lead to ridicule.
  • Specific phobias : A specific phobia is an intense fear of a specific object or situation, such as snakes, heights, or flying. The level of fear is usually inappropriate to the situation and may cause the person to avoid common, everyday situations.
  • Generalized anxiety disorder : This disorder involves excessive, unrealistic worry and tension, even if there is little or nothing to provoke the anxiety.

What Are the Symptoms of an Anxiety Disorder?

Symptoms vary depending on the type of anxiety disorder, but general symptoms include:

  • Feelings of panic, fear, and uneasiness
  • Problems sleeping
  • Cold or sweaty hands and/or feet
  • Shortness of breath
  • Heart palpitations
  • An inability to be still and calm
  • Dry mouth
  • Numbness or tingling in the hands or feet
  • Nausea
  • Muscle tension
  • Dizziness


What Causes Anxiety Disorders?

The exact cause of anxiety disorders is unknown; but anxiety disorders — like other forms of mental illness — are not the result of personalweakness, a character flaw, or poor upbringing. As scientists continue their research on mental illness, it is becoming clear that many of these disorders are caused by a combination of factors, including changes in the brain and environmental stress.

Like other brain illnesses, anxiety disorders may be caused by problems in the functioning of brain circuits that regulate fear and other emotions. Studies have shown that severe or long-lasting stress can change the way nerve cells within these circuits transmit information from one region of the brain to another. Other studies have shown that people with certain anxiety disorders have changes in certain brain structures that control memories linked with strong emotions. In addition, studies have shown that anxiety disorders run in families, which means that they can at least partly be inherited from one or both parents, like the risk for heart disease or cancer. Moreover, certain environmental factors — such as a trauma or significant event — may trigger an anxiety disorder in people who have an inherited susceptibility to developing the disorder.

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Guidelines For Treating Fibromyalgia In Primary Care Physical Therapy

Guidelines are so in aren’t they?  I guess this is what happens when evidenced based medicine begins to take hold. Broadly speaking, I reckon it is a good thing.  There are caveats of course – see the furore that can emergewhen powerful groups don’t like the guidelines – all the more likely when there is not much evidence around on which to base guidelines, or when the evidence that does exist comes from a different health care setting to our own.  That last problem has prompted the development of guidelines for treating fibromyalgia in a physical therapy setting.  It seems a sensible endeavour and we have asked one of the authors of these guidelines to give us a quick run-down.  Fortunately for us, Jo from Belgium has taken the time to put down his chocolate and beer and write this:


How Should Primary Care Physiotherapists Treat Fibromyalgia?

Physiotherapists often see patients with fibromyalgia (FM) in primary care. However, guidelines for the treatment of FM are based primarily on outcome from multidisciplinary and tertiary care treatment studies. This leaves primary care physios wondering: can I actually help these patients or should I send them directly to a specialized centre for multidisciplinary care? The latter is not always possible due to the limited availability of such centres and the long waiting lists. Therefore, Physical Therapy Journalpublished practice guidelines on how to treat fibromyalgia patients in primary care. The paper is co-authored by Kaisa Mannerkorpi (Sweden), who is the world leading FM expert of the physiotherapy profession.


Primary care physical therapy for patients with FMS should include (pain physiology) education, aerobic exercise, and strengthening exercise. For other treatment components like passive treatments, activity management and relaxation, less evidence is currently available to advocate its use in primary care physical therapy. Superior results are to be expected when various treatment components are combined. Don’t expect miracles from this. Just try to think positive and try to make your FM patients think positive (of the treatment outcome)! Benefits in terms of improved functioning are to be expected, yet physiotherapy is not a cure for FM.

Information for manual therapists treating patients with FMS in primary care can be found in Manual TherapyJournal. The paper[2] explains how manual therapists can account for the sensitized central nervous system when treating patients with FM.

Jo Nijs holds a PhD in rehabilitation science and physiotherapy. He is a researcher and assistant professor at the Vrije Universiteit Brussel (Brussels, Belgium) and the Artesis University College Antwerp (Belgium), and he is a physiotherapist at the University Hospital Brussels. His research and clinical interests are patients with chronic unexplained pain/fatigue. He has (co-)authored more than 100 peer reviewed publications and served over 40 times as an invited speaker at national and international meetings.

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Causes Of Fibromyalgia – Symptoms, Causes and Cure


It’s not clear why some people develop fibromyalgia. The exact cause is unknown, but it’s likely a number of factors are involved.

Below are some of the main factors thought to contribute to the condition.

Abnormal pain messages

One of the main theories is that people with fibromyalgia have developed changes in the way the central nervous system processes the pain messages carried around the body. This could be due to changes to chemicals in the nervous system.

The central nervous system (brain, spinal cord and nerves) transmits information all over your body through a network of specialised cells. Changes in the way this system works may explain why fibromyalgia results in constant feelings of, and extreme sensitivity to, pain.


Chemical imbalances

Research has found that people with fibromyalgia have abnormally low levels of the hormones serotonin, noradrenaline and dopamine in their brains.

Low levels of these hormones may be a key factor in the cause of fibromyalgia, as they are important in regulating things such as mood, appetite, sleep, behaviour and your response to stressful situations.

These hormones also play a role in processing pain messages sent by the nerves. Increasing the hormone levels with medication can disrupt these signals.

Some researchers have also suggested that changes in the levels of some other hormones may contribute to fibromyalgia, such as cortisol (a hormone released when the body is under stress).

Sleep problems

It’s possible that disturbed sleep patterns may be a cause of fibromyalgia, rather than just a symptom.

Fibromyalgia can prevent you from sleeping deeply and cause fatigue (extreme tiredness). People with the condition who sleep badly can also have higher levels of pain, suggesting that these sleep problems contribute to the other symptoms of fibromyalgia.


Research has suggested that genetics may play a small part in the development of fibromyalgia, with some people perhaps more likely than others to develop the condition because of their genes (the units of genetic material inherited from their parents).

If this is the case, a genetic predisposition (tendency) could explain why many people develop fibromyalgia after some sort of trigger.

Possible triggers

Fibromyalgia is often triggered by a stressful event, including physical stress or emotional (psychological) stress. Possible triggers for the condition include:

  • an injury
  • a viral infection
  • giving birth
  • having an operation
  • the breakdown of a relationship
  • being in an abusive relationship
  • the death of a loved one

However, in some cases, fibromyalgia does not develop after any obvious trigger.

Associated conditions

There are several other conditions that are often associated with fibromyalgia. Generally, these are rheumatic conditions (conditions affecting the joints, muscles and bones), such as:

  • osteoarthritis – where damage to the joints causes pain and stiffness
  • lupus – where the immune system mistakenly attacks healthy cells and tissues in various places in the body
  • rheumatoid arthritis – where the immune system mistakenly attacks healthy cells in the joints, causing pain and swelling
  • ankylosing spondylitis – swelling and pain in the joints and tissues occurring in parts of the spine
  • temporomandibular disorder (TMD) – a condition that can cause pain in the jaw, cheeks, ears and temples

Conditions such as these will usually be tested during the diagnosis of fibromyalgia. Read more about diagnosing fibromyalgia here

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What Is Chronic Pain ? What are the Symptoms?


  • Chronic pain is often defined as any pain lasting more than 12 weeks. Whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is very different. Chronic pain persists—often for months or even longer.
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  • Chronic pain may arise from an initial injury, such as a back sprain, or there may be an ongoing cause, such as illness. However, there may also be no clear cause. Other health problems, such as fatigue, sleep disturbance, decreased appetite, and mood changes, often accompany chronic pain. Chronic pain may limit a person’s movements, which can reduce flexibility, strength, and stamina. This difficulty in carrying out important and enjoyable activities can lead to disability and despair.
  • Types-Of-Pain


  • Pain is a very personal and subjective experience. There is no test that can measure and locate pain with precision.  So, health professionals rely on the patient’s own description of the type, timing, and location of pain. Defining pain as sharp or dull, constant or on-and-off, or burning or aching may give the best clues to the cause of the pain. These descriptions are part of what is called the pain history, taken during the start of the evaluation of a patient with pain.
  • Since chronic pain may occur in a variety of locations in the body and for many different reasons, patients and their health professionals need to work together to identify the causes and symptoms of that pain and how it can be relieved.
  • Although technology can help health professionals form a diagnosis, the best treatment plans are tailored to the person, with input from healthcare team members, who each have different training backgrounds and understand chronic pain. The person with pain and his or her loved ones also must be actively involved in the treatment.


With chronic pain, the goal of treatment is to reduce pain and improve function, so the person can resume day-to-day activities. Patients and their healthcare providers have a number of options for the treatment of pain. Some are more effective than others. Whatever the treatment plan, it is important to remember that chronic pain usually cannot be cured, but it can be managed. The following treatments are among the most common ways to manage pain.

Medications, acupuncture, electrical stimulation, nerve blocks, or surgery are some treatments used for chronic pain. Less invasive psychotherapy, relaxation therapies, biofeedback, and behavior modification may also be used to treat chronic pain. These methods can be powerful and effective in some people. When it comes to chronic pain treatment, many people find adding complementary or alternative  medicine (CAM) approaches can provide additional relief. These may include tai chi, acupuncture, meditation, massage therapies, and similar treatments.

Self-management of chronic pain holds great promise as a treatment approach. In self-management programs, the individual patient becomes an active participant in his or her pain treatment—engaging in problem-solving, pacing, decision-making, and taking actions to manage their pain. Although self-management programs can differ, they have some common features. Their approach is that the person living with pain needs help learning to think, feel, and do better, despite the persistence of pain. Improving communication with the healthcare provider is part of that empowerment.
Through NIH-supported research, starting successful self-management programs has reduced many barriers to effective pain management, regardless of the underlying conditions. Individuals who participate in these programs have significantly increased their ability to cope with pain. They improve their ability to be active, healthy, and involved members of their communities. In fact, new research suggests that the best self-management programs teach people different ways of thinking about and responding to pain, making their actions to relieve it more effective.

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Living With Fibromyalgia, FDA Approved Drugs To Manage Pain

After meeting on the Internet in 1997, Lynne Matallana and Karen Lee Richards discovered they had a lot in common. They both had seen numerous doctors before being diagnosed with fibromyalgia, a chronic condition characterized by fatigue and widespread pain in muscles and joints. They both had trouble finding medical information and support for coping with the illness. Seven months after meeting, they started gathering with five other people with fibromyalgia who also wanted to bring awareness to the issue.

“We called ourselves ‘the pillow posse’ because we would meet and have our pillows to support our aching bodies,” Matallana says. Those gatherings grew into the National Fibromyalgia Association (NFA), an organization that now provides support, research information, medical education, and messages of hope to millions.

Fibromyalgia affects 2 to 4 percent of the population, according to the American College of Rheumatology (ACR). It mostly affects women, and tends to develop in early to middle adulthood. But men and children also can have it.

“One of the challenges is that fibromyalgia hasn’t always been recognized as a specific illness,” says Jeffrey Siegel, M.D., clinical team leader in FDA’s Division of Anesthesia, Analgesia, and Rheumatology Products. “In 1990, the American College of Rheumatology developed criteria for diagnosing it, and this marked a major step forward in helping more people understand how to recognize the symptoms and how to treat them.”

Approved Drugs

People with fibromyalgia are typically treated with pain medicines, antidepressants, muscle relaxants, and sleep medicines. In June 2007, Lyrica (pregabalin) became the first FDA-approved drug for specifically treating fibromyalgia; a year later, in June 2008, Cymbalta (duloxetine hydrochloride) became the second; and in January 2009, Savella (milnacipran HCI) became the third.

Lyrica, Cymbalta and Savella reduce pain and improve function in some people with fibromyalgia. While those with fibromyalgia have been shown to experience pain differently from other people, the mechanism by which these drugs produce their effects is unknown. There is data suggesting that these drugs affect the release of neurotransmitters in the brain. Neurotransmitters are chemicals that transmit signals from one neuron to another. Treatment with Lyrica,  Cymbalta, and Savella may reduce the level of pain experienced by some people with fibromyalgia.

Lyrica, marketed by Pfizer Inc., was previously approved to treat seizures, as well as pain from damaged nerves that can happen in people with diabetes (diabetic peripheral neuropathy) and in those who develop pain following the rash of shingles. Side effects of Lyrica including sleepiness, dizziness, blurry vision, weight gain, trouble concentrating, swelling of the hands and feet, and dry mouth. Allergic reactions, although rare, can occur.

Cymbalta, marketed by Eli Lilly and Co., was previously approved to treat depression, anxiety, and diabetic peripheral neuropathy. Cymbalta’s side effects include nausea, dry mouth, sleepiness, constipation, decreased appetite, and increased sweating. Like some other antidepressants, Cymbalta may increase the risk of suicidal thinking and behavior in people who take the drug for depression. Some people with fibromyalgia also experience depression.

Savella, marketed by Forest Pharmaceuticals, Inc., is the first drug introduced primarily for treating fibromyalgia. Savella is not used to treat depression in the United States, but acts like medicines that are used to treat depression (antidepressants) and other mental disorders. Antidepressants may increase suicidal thoughts or actions in some people. Side effects include nausea, constipation, dizziness, insomnia, excessive sweating, vomiting, palpitations or increased heart rate, dry mouth and high blood pressure.

Studies of both drugs showed that a substantial number of people with fibromyalgia received good pain relief, but there were others who didn’t benefit.

Lyrica and Cymbalta are approved for use in adults 18 years and older. The drug manufacturers have agreed to study their drugs in children with fibromyalgia and in breastfeeding women.

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Debilitating Effects

Matallana, who is now president of NFA, says she was a partner in an advertising firm when her life turned completely upside down because of her symptoms. “I finally had to stop working in 1995 and spent most of the next two years in bed,” she says. Her husband quit his job and became a consultant working from home so that he could care for her.

“I had a yoga instructor coming to my house three times a week to help me get out of bed. The pain and exhaustion were so bad that there were days that the only activity I was able to do was walk from my bed to the mailbox and back to bed. Each day seemed like an eternity and so I had to focus on just getting through one day at a time.”

People with fibromyalgia can experience pain anywhere, but common sites of pain include the neck, shoulders, back, hips, arms, and legs. In addition to pain and fatigue, other symptoms include difficulty sleeping, morning stiffness, headaches, painful menstrual periods, tingling or numbness of hands or feet, and difficulty thinking and remembering. Some people with the condition may also experience irritable bowel syndrome, pelvic pain, restless leg syndrome, and depression.

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