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Definition

Fibromyalgia is described as inflammation of the fibrous or connective tissue of the body. Widespread muscle pain, fatigue, and multiple tender points characterize these conditions. Fibrositis, fibromyalgia, and fibromyositis are names given to a set of symptoms believed to be caused by the same general problem.

Description

Fibromyalgia is more common than previously thought, with as many as 3-6% of the population affected by the disorder. Fibromyalgia is more prevalent in adults than children, with more women affected than men, particularly women of childbearing age.

Causes and symptoms

The exact cause of fibromyalgia is not known. Sometimes it occurs in several members of a family, suggesting that it may be an inherited disorder. People with fibromyalgia are most likely to complain of three primary symptoms: muscle and joint pain, stiffness, and fatigue.

Pain is the major symptom with aches, tenderness, and stiffness of multiple muscles, joints, and soft tissues. The pain also tends to move from one part of the body to another. It is most common in the neck, shoulders, chest, arms, legs, hips, and back. Although the pain is present most of the time and may last for years, the severity of the pain changes and is dependent on individual patient perception.

Symptoms of fatigue may result from the individual's chronic pain coupled with anxiety about the problem and how to find relief. The inflammatory process also produces chemicals that are known to cause fatigue. Other common symptoms are tension headaches, difficulty swallowing, recurrent abdominal pain, diarrhea, and numbness or tingling of the extremities. Stress, anxiety, depression, or lack of sleep can increase symptoms. Intensity of symptoms is variable ranging from gradual improvement to episodes of recurrent symptoms.

Diagnosis

Diagnosis is difficult and frequently missed because symptoms of fibromyalgia are vague and generalized. Coexisting nerve and muscle disorders such as rheumatoid arthritis, spinal arthritis, or Lyme disease may further complicate the diagnostic process. Presently, there are no tests available to specifically diagnose fibromyalgia. The diagnosis is usually made after ruling out other medical conditions with similar symptoms and using criteria physicians and researchers have defined.

Because of the emotional distress experienced by people with this condition and the influence of stress on the symptoms themselves, fibromyalgia has often been labeled a psychological problem. Recognition of the underlying inflammatory process involved in fibromyalgia has helped promote the validity of this disease.

In 1990, the America College of Rheumatology developed standards for fibromyalgia that health care practitioners can use to diagnose this condition. According to these standards, a person is thought to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of the 18 sites known as trigger points. Trigger point sites include the base of the neck, along the backbone, in front of the hip and elbow, and at the rear of the knee and shoulder.

Treatment

There is no known cure for fibromyalgia. Therefore, the goal of treatment is successful symptom management. Treatment usually requires a combination of therapies, exercise, proper rest, and diet. A patient's clear understanding of his or her role in the recovery process is imperative for successful management of this condition. In 2004, a study demonstrated that a drug called paroxeteine HCI (Paxil CR) in controlled release tablet form significantly reduced symptoms in fibromyalgia patients. As of spring 2004, there were no FDA-approved treatments for fibromyalgia.

Treatments found to be helpful include heat and occasionally cold applications. A regular stretching program is often useful. Aerobic activities focusing on increasing the heart rate are the preferred forms of exercise over most other forms of exertion. Exercise programs need to include good warm-up and cool-down sessions, with special attention given to avoiding exercises causing joint pain. The diet should include a large variety of fruits and vegetables which provide the body with trace elements and minerals that are necessary for healthy muscles.

Adequate rest is essential in the treatment of fibromyalgia. Avoidance of stimulating foods or drinks (such as coffee) and medications like decongestants prior to bedtime is advised. If diet, exercise, and adequate rest do not relieve the symptoms of fibromyalgia, medications may be prescribed. Medications prescribed and found to have some benefit include antidepressant drugs, muscle relaxants, and anti-inflammatory drugs.

People with fibromyalgia often need a rheumatology consultation (a meeting with a doctor who specializes in disorders of the joints, muscles, and soft tissue) to decide the cause of various rheumatic symptoms, to be educated about fibromyalgia and its treatment, and to exclude other rheumatic diseases. A treatment program must be individualized to meet the patient's needs. The rheumatologist, as the team leader, enlists and coordinates the expertise of other health professionals in the care of the patient.

Alternative treatment

Massage therapy can be helpful, especially when a family member is instructed on specific massage techniques to manage episodes of increased symptoms. Specific attention to mental health, including psychological consultation, may also be important, since depression may precede or accompany fibromyalgia. Other alternative therapies, including hellerwork, rolfing, homeopathic medicine, Chinese traditional medicine (both acupuncture and herbs), polarity therapy, and Western botanical medicine, can assist the person with fibromyalgia to function day to day and can contribute to healing.

Prognosis

Fibromyalgia is a chronic problem. The symptoms sometimes improve and at other times worsen, but they often continue for months to years.

Prevention

There is no known or specific way to prevent fibromyalgia. However, similar to many other medical conditions, remaining as healthy as possible with a good diet, safe exercise, and adequate rest is the best prevention.

Key Terms

Connective tissue

Tissue that supports and binds other body tissue and parts.

Lyme disease

An acute recurrent inflammatory disease involving one or a few joints, believed to be transmitted by a tickborne virus. The condition was originally described in the community of Lyme, Connecticut, but has also been reported in other parts of the United States and other countries. Knees, other large joints are most commonly involved with local inflammation and swelling.

Rheumatology

The study of disorders characterized by inflammation, degeneration of connective tissue, and related structures of the body. These disorders are sometimes collectively referred to as rheumatism.

For Your Information

Resources

Periodicals

• "Study: Paroxetine Seems to Reduce Fibromyalgia Symptoms." Obesity, Fitness & Wellness Week June 5, 2004: 803.

• The American College of Rheumatology. 1800 Century Place, Suite 250, Atlanta, GA 30345. (404) 633-3777.
• Arthritis Foundation.1300 W. Peachtree St., Atlanta, GA 30309. (800) 283-7800.

This article was updated on 08-14-2006