Fibromyalgia

Fibromyalgia is a common and disabling disorder affecting 2-4% of the population, or approximately five million people. Women are six times more likely to be diagnosed than men, especially since men may be less inclined to complain about general aches and pains. In most cases, individuals will experience some of the following signs and symptoms for up to ten years before being diagnosed with the disorder. Fibromyalgia can be a primary condition or may appear secondary to another medical problem.

Signs and Symptoms: generalized aches and pains muscle and joint stiffness sleep disturbances chronic fatigue dizziness anxiety irritable bowel syndrome fluid retention headache

DIAGNOSIS
Although there are no diagnostic lab tests or X-rays, the American College of Rheumatology diagnostic criteria identifies fibromyalgia as a widespread aching, without identifiable cause, which lasts at least three months. Fibromyalgia characteristics include a diffuse, chronic, and persistent pain in the deep muscles. This pain has been described as soreness, stiffness, burning, or throbbing. Some patients may experience an unusual “crawling” sensation, numbness and/or tingling in the arms and legs. The diagnosis is confirmed upon examination, if a physician finds muscle tenderness in at least 11 of 18 specific points. Fibromyalgia is also closely related to chronic fatigue and irritable bowel syndrome, and it has been suggested that they are all facets of the same underlying disorder. Identifiable causes of these symptoms should first be excluded by appropriate physical examination and laboratory tests and/or X-rays. Depression does not cause fibromyalgia, but people with fibromyalgia can be depressed.

THEORIES
Research has not identified a specific cause of fibromyalgia. It has been suggested that it is a psychosomatic illness with abnormal responses of the central nervous system, yet there is no evidence to support this theory. Consequently, for fibromyalgia suffers, loud is louder, hot is hotter, cold is colder and pain is more painful. Fibromyalgia sufferers are no more likely to be depressed or anxious than individuals with other debilitating conditions. Within the general population, individuals with greater sensitivity to pain may be more likely to develop fibromyalgia if their coping mechanisms break down. There is speculation that fibromyalgia is a disorder of pain modulation. Evidence has been noted of decreased regional cerebral blood flow possibly affecting regulation of central pain pathways. Still other research suggests that fibromyalgia may be due to a disruption in deep sleep patterns, as some patients exhibit abnormal brain-waves during deep sleep. Even normal volunteers often develop fibromyalgia-like symptoms when deprived of deep sleep for several days.

TREATMENT

• Develop a regular sleep routine with adequate amounts of sleep.
• Ask your doctor about medication to improve sleep quality and to decrease pain and stiffness. Adequate stage IV deep restorative/reparative sleep is critical.
• Perform daily or regular low-impact aerobic exercise (walking, deep-water exercise, etc.) and stretching. Start with only a few minutes and gradually increase to tolerance. Fibromyalgia patients note that water exercise is more beneficial in warm water than in cold water.
• Reduce your physical and emotional stress.
• Try massage, hot baths, or relaxation techniques.
• Enlist the support of your family and friends.
• Educate yourself. Learn more about fibromyalgia and seek out support groups that emphasize maintaining function, rather than defining symptoms. The Arthritis Foundation is an excellent resource.
• Stick to a daily routine.
• Seek evaluation and treatment of an associated mood disorder, if present.
• Getting adequate rest and having good time management skills.

Most fibromyalgia sufferers can get to the point where they feel good most of the time. However, even with successful treatment, brief relapses are common and can be caused by staying up one hour later than normal, skipping exercise, exercising too vigorously, increasing stress and changing weather conditions, or for no obvious reason. When this happens it's best to get extra rest, take aspirin, ibuprofen or naproxen, and relax in a warm bath. Try not to stop exercising, although you may want to limit the amount and intensity. Also, return to your daily routine as soon as possible. You may also want to refer to McKinley’s patient education handout on Exercising with Fibromyalgia.

Check local listings for additional support groups in your area.

References
Cecil’s Textbook of Medicine. 21st ed. (2000), page 1859
Arthritis Foundation Web site, search for fibromyalgia
Goldenberg, D., L. (2005). Patient information
Jones, K., Ross, R., Adams, D., & Bennett, R. (2006). Fibromyalgia: Rational Management in Primary Care.
Clinician Reviews 16 (5). Pages 41-49.

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