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FIBROMYALGIA

Fibromyalgia (FM, also known as fibromyalgia syndrome or FMS) is a condition of widespread body pain that occurs by itself (primary FM) and with other illnesses (secondary FM) like lupus and rheumatoid arthritis. Its severity varies from day-to-day and from person-to-person. It can range from mild discomfort to intense, disabling whole-body pain. It is not crippling or fatal. More women than men have the syndrome, and it occurs in adults and children.

The similarities in symptoms and research findings between CFS and FM have led many researchers and clinicians to link the two syndromes, although others believe them to be quite distinct. Often, whether a patient is diagnosed with FM or CFIDS, or sometimes both, is as much a function of the doctor's knowledge as the patient's individual symptoms.

Diagnosing FM
The American College of Rheumatology (ACR) developed criteria for the classification of FM in 1990. The diagnostic criteria require that the following two findings be made:

  • Pain on both sides of the body and above and below the waist  
  • Pain in at least 11 of 18 defined "tender points" on the body upon applying a force equal to 4 kg. Using the thumb to press into a tender point, 4 kg. of force is about the amount required to make the thumbnail blanch. See figure 1 for the location of tender points.

Other symptoms common in FM include:

  • Fatigue (96% of patients)
  • Morning stiffness (95%)
  • Headache (90%)
  • Insomnia (86%Irritable bowel symptoms (80%)
  • Joint pain (72%)
  • Impaired memory (46%)
  • Leg cramps (42%)
  • Impaired concentration (41%)
  • Nervousness (32%)

Treating FM
Validating the patient's experience by making a positive diagnosis and educating them about the condition is a helpful first step toward treatment. Several symptomatic treatments are commonly used to improve sleep and relieve pain, such as tricyclic antidepressants (Elavil (amitryptilene) and Pamelor (noritriptylene)), analgesics (pain-killers), non-steroidal anti-inflammatory drugs (NSAIDs like Advil (ibuprofen) and Aleve (naproxen sodium)), and muscle relaxants (like Flexeril (cyclobenzaprine)). Serotonin-reuptake inhibitors (e.g., Prozac (fluoxetine) and Zoloft (sertraline)) are also used often. As with CFIDS, many patients experience unusual sensitivity to medications and it is important to start with low doses and increase gradually until the desired effect (without undue side effects) is achieved. Altering lifestyle, gentle exercise and physical therapy and massage can also benefit function and quality of life.

Research on FM
The cause of FM is not known, although FM often follows physical injury or emotional trauma, a viral or bacterial infection, childbirth, or medical operations. Research suggests that FM patients have abnormal transmission of pain through the body, causing even minor stimuli to be unusually painful. Some research findings are similar to those in CFS: decreased number and function of the body's "natural killer" cells of the immune system, abnormal levels of chemical messengers called neurotransmitters, and lower than normal levels of the hormone cortisol, which affects the body's response to unpleasant stimuli. Unlike CFS patients, primary FM patients have higher than normal levels of a protein called Substance P that produces pain and have not been found to have a unique antiviral protein, 37 kda RNase L. Several research groups follow both CFS and FM patients in hopes of answering questions about the inter-relatedness of these two conditions.

Learning More about FM
Fibromyalgia is very common - much more common than CFS - in the general population; it is believed to affect about 3 to 10 million people. The numbers of people with FM are higher mostly because other possible causes of pain and fatigue do not have to be excluded and FM can exist with other common diseases like arthritis and Parkinson's Disease. Although there is considerable overlap in the symptoms of FM and CFS, more research is needed to determine whether these conditions represent different points along a continuum of pain and fatigue producing illness, distinct clinical entities, or two names for the same pathophysiologic process. Rheumatologists may have the most experience in managing FM, although primary care providers may also be comfortable handling basic diagnosis and treatment.

You can learn more about FM from the following organizations:

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