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BASIC INFORMATION:
Fibromyalgia (fi-bro-my-AL-ja) is a chronic and debilitating syndrome causing musculosketal pain and fatigue for 3-6 million Americans. The pain associated with FMS is mostly widespread througout the patients body. The cause of FMS is unknown and treatments are usually symptomatic. FMS patients many times will feel terrible for a period of time and then better. It is a chronic condition that shares similarities with Chronic Fatigue Syndrome. Patients have been diagnosed with both Fibromyalgia Syndrome AND Chronic Fatigue Syndrome. However, each illness is probably independent of each other. Governmental research is being done at NIAMS, National Institutes of Arthritis and Musculoskeletal Diseases Centers.
The American College of Rheumalotogy published the diagnostic criteria for FMS in 1990.
DIAGNOSIS CRITERIA:
For the most part, routine laboratory testing reveals nothing. However, upon physical examination, the patient will be sensitive to pressure in certain areas of the body. Fibromyalgia causes pain that is referred to as Tender Points. To obtain a diagnosis of FMS there has to be a minimum of 11 out of 18 specific Tender Points. Many people who have less than the 11 of the required Tender Points may still be diagnosed with FMS as long as they have widespread pain and many of the usual symptoms associated with FMS. Commonly associated symptoms include: Fatigue, Sleep Disorder (or sleep that is unrefreshing), Jaw Pain, Post-Exertion Malaise and Muscle Pain, Numbness and Tingling, Skin Sensitivities, Morning Stiffness, Irritable Bowel, Chronic Headaches (Tension type or Migraines), Cognitive or Memory Impairment, Menstrual cramping and PMS, Dizziness or Impaired Coordination. The symptoms of Fibromyalgia are very similar to Myofascial Pain Syndrome. Roughly 75% of Chronic Fatigue Syndrome diagnosed patients will meet the FMS criteria.
SYMPTOMS EXPLAINED:
PAIN - The pain of FMS has no boundaries. It has been described as deep muscular aching, burning, throbbing, shooting, and stabbing.
FATIGUE - The severity of the fatigue can be from mild to severe. Patients have described feeling totally drained of energy.
SLEEP DISORDERS - Most FMS patients have an associated sleep disorder. Deep level sleep is constantly interrupted by bursts of awake-like brain activity.
IRRITABLE BOWEL SYNDROME - Constipation, diarrhea, frequent abdominal pain, abdominal gas and nausea represent symptoms frequently found in FMS patients.
CHRONIC HEADACHES - Recurrent migraine or tension-type headaches are seen in about half of FMS patients.
Temporomandibular Joint (TMJ) Syndrome, Cognitive or Memory Impairment, and Skin Sensitivities are other major symptoms of Fibromyalgia.
TREATMENT OPTIONS:
The treatment of FMS is frustrating to both physician and patient. Reducing pain and improving the quality of sleep are two major factors in combatting FMS. Medicines that boost your body's level of serotonin and norepinephrine, which are neurotransmitters that modulate sleep, pain, and immune system function, are commonly prescribed. Examples of these drugs might include Elavil, Flexeril, Sinequan, Paxil, Xanax, and Klonopin. Nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen may also be beneficial. Other options include trigger point injections, physical therapy, massage, acupuncture, acupressure, relaxation techniques, osteopathic manipulation and gentle exercise if tolerated. The bottom line is that the symptom is still the major focus rather than the underlying illness.
PAIN IN 11 OF 18 TENDER POINT SITES MUST BE PRESENT:
Occiput (2) - at the suboccipital muscle insertions.
Low cervical (2) - at the anterior aspects of the intertranverse spaces at C5-C7.
Trapezius (2) - at the midpoint of the upper border.
Supraspinatus (2) - at origins, above the scapula spine near the medial border.
Second rib (2) - upper lateral to the second costochondral junction.
Lateral epicondyle (2) - 2 cm distal to the epicondyles.
Gluteal (2) - in upper and outer quadrats of buttocks in anterior fold of muscle.
Greater trochanter (2) - posterior to the trochanteric prominence.
Knee (2) - at the medial fat pad proximal to the joint line.
CONDITIONS AND PERCENTAGES OF FMS SYMPTOMS
Muscular pain = 100%, Fatigue = 96%, Insomnia = 86%, Joint Pains = 72%, Headaches = 60%, Restless Legs = 56%, Numbness & Tingling = 52%, Impaired Memory = 46%, Leg Cramps = 42%, Impaired Concentration = 41%, Nervousness = 32%, Depression = 20%.
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