WHAT IS FIBROMYALGIA?
Fibromyalgia is a chronic pain syndrome. It has been recognized throughout this century by various names including firbrositis, fibromyositis and myofascial pain syndrome. It is not a disease discovered after the Gulf War. Fibromyalgia is estimated to effect approximately two to five percent of the population. Women between the ages of 20 and 50 are at an increased risk; however, the disease is found in both sexes and has been diagnosed in adolescents.
The American College of Rheumatology in 1990 developed specific clinical criteria for diagnosis. These criteria specify that a patient must have a history of widespread pain of at least three months duration and there must be pain in multiple sites. In addition, a patient must complain of pain when the examiner digitally applies 10 pounds. of pressure on at least 11 of 18 designated sites. These sites include the back of the neck, shoulder, rib, elbow, hip and knee areas.
Although pain is the primary symptom, patients usually complain of sleep disturbances, fatigue, and morning stiffness. Anxiety, depression, and the gastrointestinal complaints of diarrhea, excessive gas, and bloating are also common. These additional symptoms make the diagnosis of Fibromyalgia often difficult to distinguish from Chronic Lyme Disease, Chronic Fatigue Syndrome and Multiple Chemical Sensitivity Syndrome.
Fibromyalgia is a chronic disease. Symptoms over time may disappear, but more commonly patients have recurrent episodes of pain that wax and wane in intensity and duration.
The cause of Fibromyalgia is unknown. There may be a link between Fibromyalgia and a sleep disturbance, since most patients have disruptive sleep patterns. Other factors that may contribute to the development of Fibromyalgia or sustain symptoms are psychological stress, immune or endocrine abnormalities, or biochemical abnormalities in the central nervous system, such as altered serotonin levels. Many patients have developed the symptoms of FMS following a physical injury.
Fibromyalgia is common, affecting approximately two percent of the population.
It occurs seven times more frequently in women than in men.
It occurs most frequently in women of childbearing age.
Diagnosis is based on the patientís description of chronic widespread pain and the finding of tender points at specific locations by a physician. There are no blood or x-ray tests that are abnormal in Fibromyalgia. Until recently women who presented with the symptoms of FMS were dismissed as having a 'psychosomatic' illness or they were diagnosed as depressed. The recognition of FMS as a specific disorder is fairly new and there still exists a school of thought that FMS is "all in their heads".
There is no known cure for Fibromyalgia. Patients may be reassured that the condition, while painful, does not damage tissues and that it can be managed successfully in many cases.
Physical modalities are often beneficial, including heat treatments, occasionally cold application, massage, and regular stretching and range-of-motion exercises. Supervised aerobic conditioning exercises are valuable. Occupational therapy, such as adaptive activities, can improve functional performance.
Certain medications have an important role. Various medications to improve sleep and relax muscles are widely used. Even though hypnotic agents, anxiolytic drugs and anti-depressant medications may be appropriate for some and are widely used, there is no proof that these types of medications actually improve the symptoms of FMS. Local anesthetic or corticosteroid injections may be appropriate for painful local tender points.
Attention to mental health, including psychological consultation, is also important, since depression may precede or accompany Fibromyalgia but it is important to remember that it is not a CAUSE of FMS.