What is Fibromyalgia?

Fibromyalgia Syndrome (FMS) is an underdiagnosed disabling disorder affecting 2-4% of the population (Wolfe 1993), women more often than men. Despite the condition's frequency, the diagnosis is often missed. Patients with fibromyalgia generally ache all over, sleep poorly, are stiff on waking, and are tired all day. They are prone to headaches, memory and concentration problems, dizziness, numbness and tingling, itching, fluid retention, crampy abdominal or pelvic pain and diarrhea, and other symptoms.

FMS is not new. It was first described by William Balfour, a surgeon at the University of Edinburgh, in 1816. The medical profession called it many different names, including chronic rheumatism, myalgia, pressure point syndrome, and fibrositis. The condition was also thought to be psychological by some physicians, but that notion must now be relegated to the Dark Ages of medicine. (1)

In 1987, the American Medical Association (AMA), recognized FMS as a true illness and a majorcause of disability. Now, nearly ten years later, it is still, unfortunately, too often dismissed as the "newest fad disease", and most physicians still lack the knowledge to diagnose and treat it.

Who is affected?

It is estimated that approximately 2-4% of the U.S. population has FM. It primarily occurs in women of childbearing age, about 80% are Women, it does strike men, women and children of all ages and races. Because of its debilitating nature, Fibromyalgia has a serious impact on patients' family, friends, and employers, as well as society at large.

What are the symptoms?

FM is characterized by the presence of multiple tender points and a constellation of symptoms.
The pain of FM is profound, widespread and chronic. It knows no boundaries, migrating to all parts of the body and varying in intensity. FM pain has been described as deep muscular aching, throbbing, twitching, stabbing and shooting pain that defines the very existence of the Fibromyalgia patient. Neurological complaints such as numbness, tingling and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors which affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.
In today's world many people complain of fatigue; however, the fatigue of FM is much more than being tired. It is an all-encompassing exhaustion that interferes with even the simplest daily activities. It feels like every drop of energy has been drained from the body, which at times can leave the patient with a limited ability to function both mentally and physically.
Sleep Problems Many Fibromyalgia patients have an associated sleep disorder which prevents them from getting deep, restful, restorative sleep. Medical researchers have documented specific and distinctive abnormalities in the stage 4 deep sleep of FM patients. During sleep, individuals with FM are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep.
Other symptoms Additional symptoms may include: irritable bowel and bladder, headaches and migraines, restless legs syndrome (periodic limb movement disorder), impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, raynaud's syndrome, neurological symptoms and impaired coordination.

How is it diagnosed?

Fibromyalgia is difficult to diagnose because many of the symptoms mimic those of other disorders.
The symptoms can be similar to other muscle, joint, and gland diseases.The physician reviews the patient's medical history and makes a diagnosis of fibromyalgia based on a history of chronic widespread pain that persists for more than 3 months. The American College of Rheumatology (ACR) has developed criteria for fibromyalgia that physicians can use in diagnosing the disorder. According to ACR criteria, a person is considered to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of 18 specific tender point sites (also known as trigger points).
Many doctors are still not adequately informed or educated about FM. Laboratory tests often prove negative and many FM symptoms overlap with the symptoms of other conditions, thus leading to extensive investigative costs and frustration for both the doctor and patient. Another essential point that must be considered is that the presence of other diseases, such as rheumatoid arthritis or lupus, does not rule out a FM diagnosis. Fibromyalgia is not a diagnosis of exclusion and must be diagnosed by its own characteristic features.

What causes Fibromyalgia?

While not known, doctors believe there may be several causes. Fibromyalgia may be caused by chemical changes in the brain. The cause of FMS remains elusive, but there are many triggering events thought to precipitate its onset. A few examples would be an infection (viral or bacterial), an automobile accident or the development of another disorder, such as rheumatoid arthritis, lupus, or hypothyroidism. These triggering events probably don't cause FMS, but rather they may awaken an underlying physiological abnormality that is already present.

Theories pertaining to alterations in pain-related chemical transmitters (particularly substance P, nerve growth factor, serotonin, and norepinephrine), immune system function (e.g. abnormally elevated levels of cytokines that form the communications link between your immunologic and neurologic systems), sleep physiology, and hormonal irregularities are under investigation. In addition, modern brain imaging techniques are being used to explore various aspects of brain function. The body's response to exercise, stress, and alterations in the operation of your autonomic nervous system (the one that operates in your peripheral tissues) are also being evaluated. Substance P and nerve growth factor are increased threefold and fourfold (respectively) in the spinal fluid of people with FMS, but researchers are working to figure out why these elevations exist.

Some researchers believe abnormal sleep is a cause of fibromyalgia rather than a just a symptom.
Patients with fibromyalgia seem to lack a phase of sleep known as non-REM, or non-rapid-eye-movement sleep, which is very important in restoring energy.

How is FM treated?

As of now there is no cure for fibromyalgia. One of the most important factors in improving the symptoms of FM is for the patient to recognize the need for lifestyle adaptation. However, in the case of FM, change can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement.
An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and who will listen to and work with the patient is an important component of treatment. Conventional medical intervention may be only part of a potential treatment program. Alternative treatments, nutrition, relaxation techniques and exercise play an important role in FM treatment as well. Each patient should, along with the healthcare practitioner, establish a multifaceted and individualized approach that works for them.
Pain Management Over-the-counter pain medications, such as acetaminophen or ibuprofen, may be helpful in relieving pain. The physician may decide to prescribe one of the newer non-narcotic pain relievers (e.g. tramadol) or low doses of antidepressants (e.g. tricyclic antidepressants, serotonin reuptake inhibitors) or benzodiazepines. Patients must remember that antidepressants are "serotonin builders" and can be prescribed at low levels to help improve sleep and relieve pain. If the patient is experiencing depression, higher levels of these or other medications may need to be prescribed. Another beneficial pain therapy, which works well on localized areas of pain, is lidocaine injections into the patient's tender points. An important aspect of pain management is a regular program of gentle exercise and stretching, which helps maintain muscle tone and reduces pain and stiffness.
Sleep Management Improved sleep can be obtained by implementing a healthy sleep regimen, which includes going to bed and getting up at the same time every day, making sure that the sleeping environment is conducive to sleep (i.e. quiet, free from distractions, a comfortable room temperature, a supportive bed), avoiding caffeine, sugar and alcohol before bed, doing some type of light exercise during the day, avoiding eating immediately before bedtime and practicing relaxation exercises as you fall to sleep. When necessary, there are new sleep medications that can be prescribed, some of which can be especially helpful if the patient's sleep is disturbed by restless legs or periodic limb movement disorder.
Most patients will do better if they give up caffeine and other stimulants entirely. Alcohol should be avoided because of its tendency to suppress deep sleep.Certain symptoms such as migraine or depression can also be treated directly if treatment of the underlying disorder does not control them adequately.
Other Treatments Complementary therapies can be very beneficial. These include: physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation.

What is the prognosis?

Fibromyalgia is a common condition that causes pain and fatigue in the muscles, joints, ligaments and tendons.

There is no cure for fibromyalgia. Treatment consists of managing the symptoms with medication and improving general health through self-care. Complementary Medicine may also be helpful for some patients.

Since fibromyalgia has no visable symptoms, it is often misunderstood. Helping patients and their friends understand the condition makes coping easier.

Stress management techniques, exercises, and medications help fibromyalgia patients cope with pain and get their lives back. FMS is a common, chronic, and if untreated, often disabling disorder of unknown etiology associated with neuroendocrine and immunologic changes and disordered deep sleep. Most patients can be helped with a combination of medication, exercise, and maintenance of a regular sleep schedule. Think of this condition in any patient with a complaint of aching and tiredness and look for associated symptoms and tender points to confirm the diagnosis. The common misconceptions that FMS is a psychosomatic or somatoform disorder, that is untreatable, that it is a diagnosis of exclusion or a "wastebasket" diagnosis, and that most FMS patients are hypochondriacs or whiners are unfounded and insupportable. (2)

(1) Devin S. Starlanyl & Mary Ellen copeland 1995-1998 "Fibromyalgia & Chronic Myofascial Pain Syndrome"

(2) Dr. David Nye, MD, University of Missouri