Fibromyalgia : Fibromyalgia: A syndrome characterized by stress reduction, exercise, and medication. Also known as fibrositis.
The NIH on fibromyalgia: The following information is verbatim from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), one of the National Institutes of
Health (NIH):
Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. "Tender points" refers to tenderness that occurs in precise, localized
areas, particularly in the neck, spine, shoulders, and hips. People with this syndrome may also experience irritable bowel syndrome , anxiety, and other symptoms.
affected. be also can men and elderly, the children, but age, childbearing of women in occurs primarily It Americans. million 6 to 3 affects fibromyalgia Rheumatology, College American
According>Although the cause of fibromyalgia is unknown, researchers have several theories about causes or triggers of the disorder. Some scientists believe that the syndrome may be caused by an injury
or trauma. This injury may affect the central nervous system. Fibromyalgia may be associated with changes in muscle metabolism, such as decreased blood flow, causing fatigue and decreased strength.
Others believe the syndrome may be triggered by an infectious agent such as a virus in susceptible people, but no such agent has been identified.
Fibromyalgia is difficult to diagnose because many of the symptoms mimic those of other disorders. The physician reviews the patient's medical history and makes a diagnosis of fibromyalgia based on
a history of chronic widespread pain that persists for more than 3 months. The American College of Rheumatology (ACR) has developed criteria for fibromyalgia that physicians can use in diagnosing the
disorder. According to ACR criteria, a person is considered to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of 18 specific tender point sites.
Treatment of fibromyalgia requires a comprehensive approach. The physician, physical therapist, and patient may all play an active role in the management of fibromyalgia. Studies have shown that
aerobic exercise, such as swimming and walking, improves muscle fitness and reduces muscle pain and tenderness. Heat and massage may also give short-term relief. Antidepressant medications may help
elevate mood, improve quality of sleep, and relax muscles. Patients with fibromyalgia may benefit from a combination of exercise, medication, physical therapy, and relaxation.
Based on University of Miami School of Medicine [Medical_Dictionary]:
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Fibromyalgia : What_is_fibromyalgia?">Medical Author: William C. Shiel, Jr., MD, FACP, FACR
What is fibromyalgia?
Fibromyalgia is a chronic condition causing pain, stiffness, and tenderness of the muscles, tendons, and joints. Fibromyalgia is also characterized by
restless depression , and disturbances in bowel function. Fibromyalgia was formerly known as fibrositis.
While fibromyalgia is one of the most common diseases affecting the muscles, its cause is currently unknown. The painful tissues involved are not accompanied by tissue inflammation. Therefore,
despite potentially disabling body pain, patients with fibromyalgia do not develop body damage or deformity. Fibromyalgia also does not cause damage to internal body organs. Therefore, fibromyalgia is
different from many other rheumatic conditions (such as What causes fibromyalgia?
The cause of fibromyalgia is not known. Patients experience pain in response to stimuli that are
normally not perceived as painful. Researchers have found elevated levels of a nerve chemical signal, called substance P, and nerve growth factor in the spinal fluid of fibromyalgia patients. The brain
nerve chemical serotonin is also relatively low in these patients. Studies of pain in fibromyalgia have suggested that the central nervous system (brain) may be somehow supersensitive. Also, patients
with fibromyalgia have impaired non-Rapid-Eye-Movement, or non-REM, sleep phase (which likely explains the common feature of waking up fatigued and unrefreshed in these patients). The onset of
fibromyalgia has been associated with psychological distress, trauma, and infection.
Who does fibromyalgia affect?
Fibromyalgia affects predominantly women (over 80 percent) between the ages of 35 and 55. Rarely, fibromyalgia can also affect men, children, and
the elderly. It can occur independently, or can be associated with another disease, such as systemic lupus or rheumatoid arthritis. The prevalence of fibromyalgia varies in different countries. In
Sweden and Britain, 1 percent of the population is affected by fibromyalgia. In the United States, approximately 2 percent of the population have fibromyalgia.
What are symptoms of fibromyalgia?
The universal symptom of fibromyalgia is pain. As mentioned earlier, the pain in fibromyalgia is not caused by tissue inflammation. Instead,
these patients seem to have an increased sensitivity to many different sensory stimuli, and an unusually low pain threshold. Minor sensory stimuli that ordinarily would not cause pain in individuals
can cause disabling pain in patients with fibromyalgia. The body pain of fibromyalgia can be aggravated by noise, weather change, and emotional stress.
The pain of fibromyalgia is generally widespread, involving both sides of the body. Pain usually affects the neck, buttocks, shoulders, arms, the upper back, and the chest. "Tender points" are
localized tender areas of the body that can bring on widespread pain and muscle spasm when touched. Tender points are commonly found around the elbows, shoulders, knees, hips, back of the head, and the
sides of the breast bone. 
Fatigue occurs in 90 percent of patients. Fatigue may be related to abnormal sleep patterns commonly observed in these patients. Normally, there are several levels of depth of sleep. Getting enough
of the deeper levels of sleep may be more important in refreshing a person than the total number of hours of sleep. Patients with fibromyalgia lack the deep, restorative level of sleep, called
"non-rapid-eye- movement" (non-REM) sleep. Consequently, patients with fibromyalgia often awaken in the morning without feeling fully rested. Some patients awaken with muscle aches or a sensation of
muscle fatigue as if they had been "working out" all night!
Mental and/or emotional disturbances occur in over half of fibromyalgia patients. These symptoms include poor concentration, forgetfulness, mood changes, irritability, depression, and anxiety. Since
a firm diagnosis of fibromyalgia is difficult, and no confirmatory laboratory tests are available, patients with fibromyalgia are often misdiagnosed as having depression as their primary underlying
problem.
Other symptoms of fibromyalgia include migraine and tension headaches, numbness or tingling of different parts of the body, abdominal pain related to irritable bowel syndrome ("spastic colon"), and
irritable bladder, causing painful and frequent urination. Like fibromyalgia, irritable bowel syndrome can cause chronic Irritable Bowel Syndrome article.
Each patient with fibromyalgia is
unique. Any of the above symptoms can occur intermittently and in different combinations.
How is fibromyalgia diagnosed?
There is no blood or x-ray test to help the doctor determine whether someone has fibromyalgia. Therefore, the diagnosis of fibromyalgia is made
purely on clinical grounds based on the doctor's history and physical examination. In patients with widespread body pain, the diagnosis of fibromyalgia can be made by identifying point tenderness areas
(typically, patients will have at least 11 of the 18 classic tender points), by finding no accompanying tissue swelling or inflammation, and by excluding other medical conditions that can mimic
fibromyalgia. Many medical conditions can cause pain in different areas of the body, mimicking fibromyalgia. These conditions include: - low thyroid hormone level (hypothyroidism)
- parathyroid disease (causing elevated blood calcium level)
- muscle diseases causing muscle pain (such as polymyositis)
- bone diseases causing bone pain (such as cancer
Even though there is no blood test for fibromyalgia, blood tests are important to exclude other medical conditions. Therefore, thyroid hormone and calcium blood levels are obtained to exclude
hypercalcemia, hyperparathyroidism and hypothyroidism . The blood alkaline phosphatase (a bone enzyme) level is often raised in patients with Paget's disease of the bone. The CPK (a muscle enzyme)
level is often elevated in patients with polymyositis, a disease with diffuse muscle inflammation. Therefore, obtaining alkaline phosphatase and CPK blood levels can help the doctor decide whether
Paget's disease and polymyositis are the causes of bone and muscle pains. A complete blood count (CBC), and liver tests help in the diagnosis of hepatitis and other infections.
Fibromyalgia can occur alone, or in association with other systemic rheumatic conditions. Systemic rheumatic conditions refer to diseases that can cause inflammation and damage to numerous different
tissues and organs in the body. Systemic rheumatic conditions associated with fibromyalgia include systemic lupus, rheumatoid arthritis, polymyositis, and rheumatoid factor (RF). In patients with
fibromyalgia without associated systemic illnesses, the ESR, SPEP, ANA, and RF blood tests are usually normal.
What is the treatment for fibromyalgia?
Since the symptoms of fibromyalgia are diverse and vary among patients, treatment programs must be individualized for each patient.
Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Recent studies have verified that the best outcome for each patient
results from a combination of approaches that involves the patient in customization of the treatment plan.
Patient Education
Patient education is an important first step in helping patients understand and cope with the diverse symptoms. Unfortunately, not all physicians are intimately
acquainted with the vagaries of this illness. Therefore, community hospital support groups and the local chapters of the Arthritis Foundation have become important educational resources for patients
and their doctors. Arthritis Foundation is a national voluntary health organization that provides community education through their many local chapters. Community hospital support groups also provide
an arena for patients to share their experiences and treatment successes and failures.
Stress Reduction
It is extremely difficult to measure stress levels in different patients. For some people, spilling milk on the table can represent a significant tragedy. For
others, a tank rolling into the living room might represent "just another day!" Therefore, stress reduction in the treatment of fibromyalgia must be individualized. Stress reduction might include
simple stress modification at home or work, biofeedback, relaxation tapes, psychological counseling, and/or support among family members, friends, and doctors. Sometimes, changes in environmental
factors (such as noise, temperature, and weather exposure) can exacerbate the symptoms of fibromyalgia, and these factors need to be modified.
Exercise
Low-impact aerobic exercises, such as swimming, cycling, walking and stationary cross-country ski machines can be effective treatments for fibromyalgia. Exercise regimens
are most beneficial when performed on an every-other-day basis, in the morning. How exercise benefits fibromyalgia is unknown. Exercise may exert its beneficial effect by promoting a deep level of
sleep (non-REM sleep). Similarly, avoiding alcohol and caffeine before bedtime can also help promote a more restful sleep.
Medications
The most effective medications in the treatment of fibromyalgia are the tricyclic antidepressants, medications traditionally used in treating depression. In treating
fibromyalgia, tricyclic antidepressants are taken at bedtime in doses that are a fraction of those used for treating depression. Tricyclic antidepressants appear to reduce fatigue, relieve muscle pain
and spasm, and promote deep restorative sleep in patients with fibromyalgia. Scientists believe that tricyclics work by interfering with a nerve transmitter chemical in the brain called "serotonin."
Examples of tricyclic antidepressants commonly used in treating fibromyalgia include doxepin (Sinequan).
A recent study suggests that adding fluoxetine (Prozac) to low dose amitriptyline (Elavil) further reduces muscle pain, anxiety, and depression in patients with fibromyalgia. The combination is
also more effective in promoting restful sleep, and improving an overall sense of well-being. These two medications also tend to cancel out certain side effects each can have. Tricyclic medications can
cause tiredness and fatigue while fluoxetine can make patients more cheerful and awake. Even more recently, study of patients with resistant fibromyalgia found that lorazepam (Ativan) was helpful in
relieving symptoms. Fluoxetine (Prozac) has also been shown to be effective when used alone for some patients with fibromyalgia.
Other Treatments
Local injections of analgesics and/or cortisone medication into the trigger point areas can also be helpful in relieving painful soft tissues, while breaking cycles
of pain and muscle spasm. Some studies indicate that the pain-reliever cyclobenzaprine (Flexeril) has been helpful for reducing pain symptoms and improving sleep.
The nonsteroidal antiinflammatory drugs (NSAIDs), while very helpful in treating other rheumatic conditions, have only a limited value in treating fibromyalgia pain. Narcotic pain relievers and
cortisone medications have not been shown to be beneficial in this condition. Narcotics and cortisone medications are avoided because they have not been shown to be beneficial and they have potential
adverse side effects, including dependency, when used long-term.
Both biofeedback and electroacupuncture have been used for relief of symptoms with some success. Standard acupuncture was recently reported to be effective in treating some patients with
fibromyalgia.
What is in the future for fibromyalgia therapy?
The key to unlocking the mystery of fibromyalgia has yet to be found. Research scientists have been studying numerous viruses as
potential causes for fibromyalgia. Identification of an infectious agent or toxin which causes the disease may one day lead to a laboratory test which can help doctors diagnose fibromyalgia. Until
further research uncovers the exact cause of the disease, specific treatment aimed at a cure remains unattainable.
New drugs may be developed that block substance P or nerve growth factor to relieve pain of fibromyalgia. Many fibromyalgia patients can be helped by improved patient education, proper exercise, and
medications. With ongoing research, the future will certainly improve for those affected by fibromyalgia. - Fibromyalgia causes pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation.
- Fibromyalgia does not cause body damage or deformity.
- Fatigue occurs in 90% of patients with
fibromyalgia.
- Irritable bowel syndrome can occur with fibromyalgia.
- Sleep disorder is common in patients with fibromyalgia.
- There is no test for the diagnosis of
fibromyalgia.
- Fibromyalgia can be associated with other rheumatic conditions.
- Treatment of fibromyalgia is most effective with combinations of education, stress reduction, exercise,
and medications.
For further information about fibromyalgia, contact:
Arthritis Foundation
(http://www.arthritis.org/)
P.O Box 19000
Atlanta, Georgia 30326
Based on University of Miami School of Medicine [Medical_Dictionary]:
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