Fibromyalgia is a relatively new diagnosis even in humans and has evolving diagnostic criteria, often subtle symptoms that can also be caused by other issues, and little in the way of effective treatment. It hasn't even begun to be studied in horses yet, and even if it was suspected that a horse had it, it would be difficult or impossible to treat. Not to mention any symptom that would be identifiable in a horse (since the main diagnostic tool in humans is hypersensitivity in certain points, which does not carry over into horses as far as I know) would be as likely or more so to be caused by other diseases that do have veterinary diagnostic criteria and treatments, so fibromyalgia would be the absolute last thing to look into.
Even if one did have a horse that was consistently NQR and one suspected that fibromyalgia was the cause, about the only thing I could think of to do would be make sure the horse had a healthy balanced diet and appropriate exercise for their physical condition, which most of us do for our horses anyway.
There was a thread on this topic not that long ago, IIRC. Tried a search?
It is pretty much a diagnosis of exclusion, with no firm or agreed-upon criteria for making the diagnosis other than subjective things like pain threshold, fatigue, and muscle tenderness. I can't imagine how one would go about making this diagnosis in a non-verbal animal. And there is no "cure", only a minimal number of truly and consistently beneficial therapies anyhow. I'd probably not choose to beat my head against this particular wall.
I realize that fibromyalgia is a relatively new disease in people, and is virtually unstudied in horses. But we ARE, literally, out of ideas in regards to this particular mare. She's seen several vets, with no answers. I also have a sneaky suspicion that some level of SAD (seasonal affective disorder) is occurring as well. I've only schooled this particular mare twice, but have received a backlog of information from her owner. She is perfect in the summer, but was virtually unridable last winter, and is putting up a valiant fight this winter. She isn't out for blood or anything, but a buck every few strides to laps, is inevitable. She mostly expresses her discomfort when being asked to collect or transition. She's been adjusted on a regular basis and is not usually extraordinarily out. She DOES have a history of particularly bad ulcers, but her owner currently has them under control. Her owner takes a more holistic stance on things, and several doctors have recommended hormone therapy (Regimate), to which her owner is not keen on, understandably. I have suggested light therapy, in case, we are, indeed dealing with some level of SAD. There are also some studies linking SAD (in humans) to hormonal imbalance, which could go hand in hand with the doctors' recommendation to add hormone therapy. The mare IS hypersensitive from the withers back over the winter months, as in you touch her hair, and not her skin with your fingertips and she becomes grumpy. I'm just putting some feelers out there because this owner desperately wants her mare to be happy. And as an outsider, maybe I can offer a new and different perspective. I almost feel as if the mare is resisting being framed up, due to pain, somewhere, possibly even in the front end, from the lone two rides that I have had. I will search the previous threads, I tried searching before I "joined" the forums, but after I'd "joined" the website, which is maybe why I didn't catch past posts the 1st time around. Thanks to anyone that can offer any additional advice and/or suggestions!
Why wouldn't the owner investigate the far-more-common sources of discomfort first, like plain old garden-variety lameness? Or maybe this has already been done? How does she know the ulcers are "under control"? What, precisely, do you mean by "hormonal imbalance" in terms of possible SAD?
Could the horse just be bored and sour? After 2-3 months of being ridden only in the indoor arena, which is the only realistic option in the winter, mine are sometimes a little grumpy, less-than-enthusiastic, and generally slightly cranky, too. The ones that are boarded in the winter to stay in full work are also confined to stalls more than they're used to during the nicer months, too. Maybe she's blanket lame from an ill-fitting blanket? Maybe she's used to more turnout and playtime? (bad weather and footing can make turnout a real drag for horses if they just slosh from one mud puddle to another instead of being able to really roam and roll and wander freely)
I could think of about 20 different possibilities for a horse with the symptoms you describe before I got to esoteric, anthropomorphic zebras like FM and SAD. Neither of which are at all "new" diagnoses; they have just been called by different names, dating back a couple of centuries.
The horse passes all of the typical lameness testing, such as sensitivity, flexion, etc. She also has clean films. I don't suppose that anyone can truly know that the uclers are "under control" since scoping can only go so far, but from what we can see, there's been a vast improvement. SAD in people is said to be possibly related to a hormonal imbalance, is more prominent in females & can result in irritability. The fact that she works beautifully in the summer & progressively worse in the winter & becomes super sensitive to touch, no matter what your doing-bringing her in/turning her out, tacking, riding, cleaning her stall, etc. Inclines me a bit in this direction. But I'm not attached to one dx or another, just tryin to get ideas that might make her a lil more confortable.
She is only ever worked lightly (any season), in an indoor, during the winter months, but on nicer days, even if there's snow on the ground, her mom tries to get her out & about for a change of scenery. Her grumpiness doesn't seem like sourness to me, it seems more like pain. Any other horse that acted the same way without the same history I would immediately implicate training. She gets turned out adequately, she is often out overnight even, blanket-less the whole time.
What are your other suspicions? It's been a little frustrating for the owner to have already been to several doctors, one of which was a university, and have no answers.
Fibromyalgia does not have much of a seasonal course, AFAIK. Why not put her under some bright lights if you think the lack of daylight is affecting her mood? Can't hurt, although she will probably start shedding immediately. Most of them are going to be doing that within the next week or two anyhow. Maybe she's unlike some mares and is happier when she's in her estrous phase as opposed to the wintertime anestrous cycle.
Still not sure what you mean by "hormonal imbalance". We operate with the aid of easily several dozen different hormones on any given day. 99% of the time our bodies "balance" them just swell.
LauraKY-please forgive my misuse of the word disease as opposed to diagnosis.
Deltawave-I was thinking more along the lines of 2 diff possibilities, FM &/or SAD. Several articles that I pulled off of pubmed in regards to SAD in humans suggest that SAD could be related to hormone/chemical imbalance. Of course I've only scanned the liturate & am not overly familiar w/ it. I see that you're a cardiologist (like the user name relation), so I assume that you are much more well versed in any type of human medicine than I could ever hope to be, for I am only a lowly pharm research scientist.
What about nuclear scintigraphy? It sounds like the owner has spent a lot of money already on working this up, another thousand or so might get you an answer. It might also be worth doing an ultrasound of her reproductive tract to make sure that's all in order.
If money is an issue, then maybe it's time to try empirically treating with Bute/Equioxx/Adequan/Legend/etc. for general arthritis/synovitis/pick-your-itis issues that may flare up in the winter due to colder temperatures and less activity. She could have arthritis in the facet joints of her vertebrae, her hips, her SI, or her shoulder, all of which are hard to impossible to image completely without nuclear scintigraphy. It might also be worth keeping her on a low dose of UG/GG if the owner can afford it and giving her Tums before rides (deltawave has posted about this in the past). You might get the ulcer meds on board first and see if that makes a difference before treating for pain; this will also help decrease the probability of side effects from any NSAID's.
I am assuming that the mare is fit enough to do the amount of work and collection that you are asking her to do.
Also vitamin D could be an issue--deficiency can cause vague aches and pains and "NQR" type stuff. Maybe she's missing her sunshine in the winter months. An easy thing to supplement. (vitamin D, not sunshine)
We here in the Pacific Northwest have found the soils, and thus the feedstuffs grown here, sadly lacking in selenium and a few other minerals - so much so that certain horses can take more than the usually prescribed dose without any danger of selenium toxicity. Low selenium levels in particular can lead to body pain.
My trainer has a young mare who was 'ouchy and grouchy' on her body -- didn't like being brushed, acted like it hurt to be touched.
She was started on a proprietary mineral supplement (manufactured locally) containing increased selenium, copper etc. After 2 weeks, this is a completely different horse! This mare now can't get enough brushing, petting, etc. She is now a real sweetie. And she is moving better too.
I do not know if Fibromyalgia occurs in horses. Having Fibromyalgia myself, I can relate to the broad areas of pain and the feeling of not wanting to be touched. I can also relate to feeling much better after using certain vitamin/mineral supplements.
If I were you I would take a close look at your horses' diet. Do a complete analysis of vitamin and (especially) mineral levels provided by any and all feedstuffs, including a hay analysis.
Or, you could start with a commercially prepared supplement of E, Selenium, and magnesium and see if her situation improves.
Linda D with Whirl Wind aka "Whirly", 15 year old School Master