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Fibromyalgia: When It Hurts All Over

From: Fibromyalgia: When It Hurts All Over

Barbara Loera Health Correspondent

Unlike many illnesses, fibromyalgia syndrome (FMS) is defined as much by what it isn't as by what it is. Doctors know that FMS is a chronic musculoskeletal condition causing fatigue, widespread pain and muscle stiffness throughout the body, but there is no specific laboratory test or X-ray that can diagnose it. And the syndrome's symptoms mimic at least 46 other conditions. With its wide variety of symptoms and its undeserved reputation as "catch-all" diagnosis, fibromyalgia is a frustrating condition to manage, but treatment is possible. Fibromyalgia is a real illness and it should be taken seriously.

What FMS Is ... and Isn't

Doctors classify FMS as a form of nonarticular rheumatism, meaning that the pain associated with the syndrome does not affect joints. Instead, patients report pain in the muscles and tissues throughout the body, usually with no triggering mechanism, such as an injury or illness. The pain is not a result of inflammation, so traditional approaches involving rest, ice and anti-inflammatory medication are of little help.

FMS symptoms are many and varied, but the classic signs are widespread muscle pain, muscle stiffness, fatigue and nonrestorative sleep. Physicians may use laboratory tests to rule out other possible diseases, such as other rheumatic diseases or hypothyroidism, but the most effective test for pinpointing FMS is the "tender point test." FMS sufferers will test positive for at least 11 of 18 specified tender points on the body; these tender points will hurt when pressed, but the pressure will not cause pain in any other part of the body.

FMS is often compared to chronic fatigue syndrome and myofascial pain syndrome, but there are significant differences. Individuals with chronic fatigue syndrome generally list fatigue as their greatest complaint, while FMS patients rank pain as their predominant symptom. Myofascial pain syndrome causes pain, but generally in only one region of the body, such as the neck or lower back, and MPS trigger points (similar to FMS tender points) produce pain that radiates into other parts of the body.

Related Conditions

Some of the conditions commonly linked to FMS include headaches, depression or anxiety; "subjective swelling" (a feeling that an area is swollen even though there is no physical change in the site); dizziness or vertigo; and cognitive problems (difficulty concentrating or remembering) or a general feeling that one's brain just isn't working right. Because such symptoms can't be quantified or measured, doctors long classified FMS as a form of psychogenic rheumatism, and "fibrositis" became a wastebasket diagnosis that was applied to anyone who had vague symptoms that couldn't be attributed to a classified disease.

In recent years, however, doctors have made great strides in identifying specific criteria for FMS diagnosis, and the emergence of two objective, measurable symptoms (the 18 localized tender points and EEG evidence of nonrestorative sleep in FMS patients) has further legitimized the syndrome. The notion that FMS is all in the patient's head has become as outmoded as the flat earth theory. In fact, FMS symptoms have been induced in otherwise healthy individuals by subjecting them to the disruptive sleep patterns common among FMS patients.


The first step in treatment is, as always, a correct diagnosis. Doctors specializing in rheumatology and physical medicine are the most knowledgeable about FMS, but many general practitioners and internists are becoming more familiar with it as well. Diagnosis generally includes a tender point exam and lab tests to rule out other conditions.

There is no cure for FMS, so the goal of treatment is symptom management. Several medications have proven useful in treatment, including tricyclic medications such as amitriptyline (Elavil), nortriptyline (Pamelor) and cyclobenzaprine (Flexeril), and the newer SSRI (selective serotonin reuptake inhibitor) antidepressants such as fluoxetine (Prozac) and sertraline (Zoloft). These drugs raise the brain's level of the neurotransmitter serotonin; low levels of serotonin are linked to pain sensitivity, sleep difficulties and depression. Anti-inflammatory drugs such as aspirin and ibuprofen tend to have limited results because FMS pain is not caused by inflammation. Tranquilizers, narcotic drugs and prescription sleeping pills should be avoided except in rare, limited circumstances.

Beyond Medication

Nondrug treatments tend to play an even bigger role in FMS management. Anything that reduces a patient's level of pain and improves the quality of sleep can be of significant help. FMS patients benefit from a wide range of mind-body treatments, including therapeutic massage; biofeedback and other relaxation techniques; stress reduction; meditation; acupuncture or acupressure; and behavior modification. Comfort measures such as warm baths or showers, ice packs for painful areas, and a comfortable bed play a role in the everyday management of symptoms.

Two of the most critical areas for FMS patients to focus on, however, are diet and exercise. A healthful diet that includes plenty of fresh fruits and vegetables, water, and whole grains ensures that the body gets an array of needed vitamins and minerals while also controlling symptoms of irritable bowel syndrome. Eliminating or reducing intake of caffeine and nicotine can improve oxygen flow in the blood and contribute to more restful sleep. And although initial pain levels may make exercise seem impossible, a careful, regular program of stretching and aerobic exercise is essential for rehabilitating muscles, reducing pain and increasing the quality of sleep. Of course, a physician should approve any exercise program before you begin.

Barbara Loera is a freelance writer based in Austin, Texas.

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