How to Treat Near-Syncope in the Fibromyalgia Patient

Have you ever felt lightheaded where you feel like you are going to faint, but don't? As a person who suffers from Fibromyalgia Syndrome, I know that my autonomics have gone awry. The autonomic nervous system (ANS) operates the involuntary bodily functions. The ANS system consists of motor nerves, which maintains the cardiac muscle, glands, such as the gastric, sweat and salivary glands, the adrenal gland and other smooth muscles in the body. Along with the pain and fatigue that I have with fibromyalgia, I also have a dysfunctional and hypersensitive ANS, which cause many other symptoms that are related to fibromyalgia, one of which is near-syncope.

Patients with fibromyalgia often have issues where their blood pressure fluctuates up and down. When going from a sitting to standing position, some patients get what is called orthostatic intolerance where the blood pressure drops. Since the ANS system is hypersensitive, this change in position makes the body feel in a state of fainting, although we do not lose consciousness (true syncope). Many people with fibromyalgia tend to feel that near-syncope feeling of weakness and lightheadedness. A physician should evaluate anyone having these symptoms. Blood pressure and pulse are checked in both the standing and sitting positions. Other tests would include an electrocardiogram, cardiac stress testing and tilt table testing. The tilt-table test is one way to diagnose orthostatic hypotension and confirm the dysfunctional autonomic nervous system. This test is not routinely done in doctors' offices, but most major hospitals or university setting hospitals will include this informative testing.

The treatment of near-syncope includes the following and these measures can easily be managed by patients at home.

Drink plenty of water and fluids. A person who doesn't drink enough per day becomes dehydrated. This causes blood volume to drop presenting a risk for near-syncope. Drink eight 8-ounce glasses of water a day, which has been recommended for fibromyalgia patients.

Consume more salt. Sodium is an electrolyte that helps to maintain blood pressure and prevents a serious drop in pressure, which can result in near-syncope. Too much salt can lead to higher blood pressure, however for a person who suffers from near-syncope, adding salt to the diet usually keeps the blood volume up, which decreases the risk of hypotension or near-syncope.

Special diuretics can be used. Your physician may order Florinef (fludrocortisones) for major cases of near-syncope. This is a salt-restricting diuretic, which increases blood volume and keeps blood pressure in normal limits.

Wear compression garments. These are used to help minimize orthostatic blood pressure drops by decreasing the amount of pooled blood in the legs. Gravity does this. By wearing these tight-fitting leg stockings helps the blood in the legs move upward and stay in the body's trunk.

Be cautious of posture changes. A sudden change from sitting to standing triggers the autonomic nervous system (ANS) to cause a drop in blood pressure. To eliminate the feeling of near-syncope when getting out of bed, sit up for 15-30 seconds first, then bring the legs over the edge and sit again for 15-30 seconds. Next plant your feet on the floor and stand up slowly but stay near the bed for support. Begin walking slowly. This method should help eliminate near-syncope episodes.

Beta-blockers are used as an aid. It may seem ironic to use a blood pressure medicine to treat low pressure. Beta-blockers simply block the beta nerve signals from the autonomic nerves. So, if a person has hypertension, blocking the beta nerves helps to reduce blood pressure. Now, these same beta nerves are thought to play a role in causing low blood pressure in near-syncope episodes, so blocking these beta nerves with these medications can help to reduce near-syncope by stabilizing the blood pressure. Two drugs that have been studied and used are atenolol and metoprolol.

Sources:

Fibromyalgia and Dizziness: Understanding the Link

Those Dysfunctional Autonomics -- by Mark J. Pellegrino, M.D.