A disorder characterized by muscle pain, stiffness and easy fatigability. The cause is unknown and an estimated 3 million are affected in the USA. Fibromyalgia (and its sister myofascial pain syndrome) is characterized by several things:
• muscle pain
• impairment of daily activities
• interrupted sleep pattern
• fatigue
In many cases, fibromyalgia evolves into muscle pain that is unrelenting and a devastating life experience. The existence of fibromyalgia (and probably myofascial pain syndrome) has been debated for many years, but its existence cannot be denied. The fibromyalgia sufferer has several challenges: to improve their quality of life, to better understand why they hurt, and to help loved ones (and, yes, even their physicians) understand their symptoms and suffering. Fibromyalgia often overlaps with other diseases.
For the most part, routine laboratory testing reveals nothing about Fibromyalgia. However, upon physical examination, the fibromyalgia patient will be sensitive to pressure in certain areas of the body called tender points.
To meet the diagnostic criteria, patients must have:
• Widespread pain in all four quadrants of their body for a minimum of three months
• At least 11 of the 18 specified tender points (see diagram)
These 18 sites used for diagnosis cluster around the neck, shoulder, chest, hip, knee and elbow regions. Over 75 other tender points have been found to exist, but are not used for diagnostic purposes.
While many chronic pain syndromes display symptoms that overlap with fibromyalgia, the 1990 ACR multi-center criteria study (published in the February 1990 issue of Arthritis and Rheumatism) evaluated a total of 558 patients, of which 265 were classified as controls. These control individuals weren't your typical healthy "normals". They were age and sex matched patients with neck pain syndrome, low back pain, local tendinitis, trauma-related pain syndromes, rheumatoid arthritis, lupus, osteoarthritis of the knee or hand, and other painful disorders. These patients all had some symptoms that mimic FM, but the trained examiners were not foiled--they hand-picked the FM patients out of the "chronically ill" melting pot with an accuracy of 88%. FM is not a wastebasket diagnosis!
Although the above criteria focuses on tender point count, a consensus of 35 FM experts published a report in 1996 saying that a person does not need to have the required 11 tender points to be diagnosed and treated for FM. This criteria was created for research purposes and many people may still have FM with less than 11 of the required tender points as long as they have widespread pain and many of the common
symptoms associated with FM. Commonly associated symptoms include:
• fatigue
• irritable bowel (e.g., diarrhea, constipation, etc.)
• sleep disorder (or sleep that is unrefreshing)
• chronic headaches (tension-type or migraines)
• jaw pain (including TMJ dysfunction)
• cognitive or memory impairment
• post-exertional malaise and muscle pain
• morning stiffness (waking up stiff and achy)
• menstrual cramping
• numbness and tingling sensations
• dizziness or lightheadedness
• skin and chemical sensitivities
Long term follow-up studies on fibromyalgia syndrome have shown that it is chronic, but the symptoms may wax and wane. The impact that FMS can have on daily-living activities, including the ability to work a full-time job, differs among patients. Overall, studies have shown that fibromyalgia can be equally as disabling as rheumatoid arthritis.
Lifestyle modifications may help you conserve your energy and minimize your pain. Learn what factors aggravate your symptoms and avoid them if possible.
