Q. After suffering for months with pain between my shoulder blades, I was told that I have something called fibrositis or fibromyalgia. Treatment with the anti-inflammatory medicine Motrin helped greatly, but if I stop taking it, the pain returns, making me wonder whether the medicine is just covering up the condition, not curing it. I'd like to know more about this problem and how to treat it. Also, my doctor said it might be related to a sleep disorder, saying that students sometimes get it after not sleeping for days. How is sleep related to this problem?
A. The condition you describe has been a little difficult to pin down scientifically. There has been controversy about what it is, what causes it and even what to call it. Fibrositis, meaning inflammation of tissue fibers, is something of a misnomer, because this condition isn't primarily one of inflammation. Fibromyalgia, meaning painful muscles, is probably a better term, though the disorder is also called nonarticular rheumatism and myofascial pain syndrome.
Fibromyalgia is a chronic condition of localized painful areas with aching, muscle stiffness and what's known as trigger points. Trigger points are tender spots that are exquisitely painful when pressed. They commonly occur along the back of the neck and shoulders, between the shoulder blades, on the front of the chest, along the lower back and at the elbows and knees.
Fibromyalgia is more common in women and usually first develops before age 35. Other symptoms associated with this condition are fatigue, anxiety, poor sleep, headaches and irritable bowel syndrome. Doctors aren't sure whether the sleep disturbance seen in people with fibromyalgia is a cause of the problem, an effect or merely a related symptom.
Cool temperatures, high humidity and rapid changes in weather make the symptoms worse. Exercise after being inactive and stress also aggravate the condition. Hot showers, regular exercise and warm, dry weather seem to improve symptoms.
For immediate relief of pain, your doctor can inject a local anesthetic into one or several trigger points. For more widespread pain, some doctors use what's called the stretch and spray technique. This involves stretching stiff, painful muscles while the overlying skin is being sprayed with a cooling spray.
Long-term treatment includes muscle stretching exercises, anti-inflammatory drugs like Motrin, regular exercise, adequate rest and relaxation techniques.
For more information about fibromyalgia, write for a reprint of a recent medical article that most non-medical people should be able to understand: "Primary Fibromyalgia" by Dr. John L. Coulehan, Department of Community Medicine, M-200 Scaife Hall, University of Pittsburg School of Medicine, Pittsburgh, Pa. 15261.
Q. I've been suffering from seborrheic dermatitis for 20 years. My scalp is continually scaly and itchy. Over the years, I've consulted several dermatologists, only to be told time and again that there is no "cure." I had resigned myself to using a tar-based shampoo supplemented by cortisone cream when necessary. This treatment is fairly effective for a couple of days.
Recently, I underwent treatment by a "dermato-allergist," who believes the condition is an allergy. Injections for a dust allergy (over about six months) did not seem to work, nor did treatment with progesterone (for the possibility that the seborrheic dermatitis was a reaction to my body's monthly hormonal cycle). He would now like to try treatment for a yeast allergy.
I'm about to give up and resign myself to living with the condition -- again. Is there any known cause or cure for this condition?
A. Seborrhea is a very common skin condition that most people know in its milder form, ordinary dandruff. More severe cases cause redness, itching, scaling, and pimples that can look like acne.
I'm not aware of any scientific evidence that seborrhea is helped by allergy shots, progesterone or anti-yeast therapy.
The cause of seborrhea is unknown, but it can strike all ages, from infants, who get what's called cradle cap on the scalp, to the elderly. Seborrhea commonly occurs on the scalp, behind the ears, along the eyebrows and creases of the nose and on the front of the chest. Although infants outgrow cradle cap, there is no cure for seborrhea, but there are many remedies to help keep it under control.
For dandruff or seborrhea of the scalp, medicated shampoos generally work well. You might try several types to see which you like best. In roughly decreasing order of effectiveness are selenium sulfide, in 2.5 percent prescription strength (Selsun, Exsel) and 1 percent over-the-counter strength (Selsun Blue); zinc pyrithione 2 percent (Head and Shoulders) and 1 percent (Danex, Zincon); salicylic acid and sulfur (Sebulex, Vanseb) and tar (Denorex, Tegrin).
For flare-ups of inflammation, you can use a topical steroid cream such as cortisone.