Fibromyalgia
Fibromyalgia is a syndrome, or
collection of signs (findings on exam) and symptoms
(complaints), with no known underlying disease process.
It may well be that the fibromyalgia syndrome (FMS) can
actually result from many different underlying causes.
Some scientists have suggested that it is related to
abnormalities in a non-dream part of the sleep cycle or
to low levels of serotonin, a brain chemical that
regulates sleep and pain perception. Other theories have
linked fibromyalgia to low levels of somatomedin C, a
chemical related to muscle strength and muscle repair,
or to high levels of Substance P, a chemical involved in
pain perception. Some scientists have also cited trauma,
blood flow abnormalities in the muscles, nonspecific
viral infections or Lyme disease as possible causes of
fibromyalgia.
Fibromyalgia strikes about 3.4%
of women and 0.5% of men in the United States, affecting
3 to 6 million Americans. Although this disorder
occasionally occurs in children and young adults, it
most commonly affects women of childbearing age or
older. In fact, some statistics indicate that more than
7% of women in their 70s suffer from fibromyalgia.
Although many patients with
fibromyalgia also suffer from psychiatric problems such
as depression, anxiety or eating disorders, no definite
relationship has been proven.
Fibromyalgia can cause pain and
stiffness almost anywhere in the body, including the
trunk, neck, shoulders, back, hips and joints. Pain may
be either a general soreness or a gnawing ache, and
stiffness is often worst in the morning. Typically,
patients also complain of feeling abnormally tired,
especially of waking up tired, although they may not
recall having specific sleep disturbances. Patients with
fibromyalgia also have discrete painful body areas
called tender points. The American College of
Rheumatology (ACR), in its list of criteria for
diagnosing fibromyalgia, lists 18 typical tender points.
What
Your Doctor Looks For
After asking about your
symptoms, your doctor will check for swelling, redness
and impaired movement in those portions of your body
where you are having pain. Your doctor will also check
for tenderness in the 18 specific tender points
designated by the ACR.
To confirm the diagnosis of
fibromyalgia, a patient must have suffered at least
three months of widespread pain, and must have
tenderness at 11 or more of the 18 specific ACR tender
points. To evaluate the tender points, your doctor may
use either simple hand pressure, or a spring-loaded
pressure instrument called a dolorimeter.
By definition, the widespread
pain of fibromyalgia must last for at least three
months, although many patients experience pain for much
longer periods. In 10% to 25% of cases affecting adult
workers, symptoms are so persistent and so severe that
patients can no longer perform their normal jobs.
There is currently no way to
prevent fibromyalgia, since its definite cause remains
unknown.
To relieve the pain of
fibromyalgia, your doctor will generally prescribe
either aspirin or non-steroidal anti-inflammatory drugs
(NSAIDs), such as indomethacin or naproxen. Your doctor
may also suggest that you try one or more of the
following therapies: acupuncture, massage therapy, warm
compresses, biofeedback, hypnosis, group therapy, or
stress-management therapy. To improve sleep, your doctor
may prescribe an antidepressant medication to be taken
before bedtime. To improve exercise tolerance and
general well-being, your doctor may also suggest a
program of low-impact aerobic exercise, usually 20 to 30
minutes daily for three or four days a week. If you have
symptoms of depression or anxiety, these may improve
with psychotherapy and/or antidepressant or anti-anxiety
medication.
Note:
Every FMS patient is different, so an individual patient
may have a significantly different treatment plan than
the usual measures outlined above.
Call your doctor whenever
chronic pain or extreme tiredness interferes with your
ability to work, sleep, perform normal household chores
or enjoy recreational activities.
Current studies do not agree
about the prognosis of people with fibromyalgia. For
example, results from some specialized treatment centers
show a poor prognosis, while community-based treatment
programs show remissions in 24% of patients and symptom
improvements in 47%.
Last updated April 20, 1999(Intelihealth-John's
Hopkins Health Information)
For additional information
about fibromyalgia, you can contact:
Fibromyalgia Network
P.O. Box 31750
Tucson, AZ 85751
Phone: (800) 853-2929
www.fmnetnews.com
The Arthritis Foundation
1330 West Peachtree Street
Atlanta, Georgia 30309
404-872-7100
www.arthritis.org
National Institute of
Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484
www.nih.gov/niams
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