Fibromyalgia syndrome (also called "FMS" or "FM" ) is a complex, chronic condition which causes widespread pain and profound fatigue, as well as a variety of other symptoms. Its effects are felt primarily in muscles, tendons, and ligaments throughout the body. Unlike arthritis, however, no inflammation accompanies fibromyalgia, and the joints of the body are not directly affected.
The pain of fibromyalgia syndrome is usually described as aching or burning and is unpredictable in nature. Its severity varies from day to day, and different parts of the body tend to be affected at different times. In some people, FMS pain can be very severe and disabling, while in others it may cause only mild discomfort. Likewise, the fatigue which often accompanies fibromyalgia syndrome ranges from a mild, tired feeling to all-consuming exhaustion.
Fibromyalgia Tender Points
Identified by the American College of Rheumatology in 1990, at digital palpation with an approximate force of 4kg.
1 & 2, Occiput: bilateral, at the suboccipital muscle insertions.
3 & 4, Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7.
5 & 6, Trapezius: bilateral, at the midpoint of the upper border.
7 & 8, Supraspinatus: bilateral, at origins, above the scapula spine near the medial border.
9 & 10, Second Rib: bilateral, at the second costochondral junctions, just lateral to the junctions on upper surfaces.
11 & 12, Lateral epicondyle: bilateral, 2cm distal to the epicondyles.
13 & 14, Gluteal: bilateral, in upper outer quadrant of buttocks in anteriorfold of muscle.
15 & 16, Greater trochanter: bilateral, posterior to the trochanteric prominence.
17 & 18, Knee: bilateral, at the medial fat pad proximal to the joint line.
Symptoms
In addition to pain and fatigue, individuals with FMS usually experience some of the following symptoms:
Stiffness
Body stiffness is a significant problem experienced by most patients.
It can occur upon awakening or remaining in one position for prolonged periods. It can also accompany weather changes.
Increased Headaches or Facial Pain
Headaches are a common complaint for many with FMS.
They may be caused by referred pain from tender neck and shoulder areas, or they may be associated with
pain in the muscles and other soft tissues around the temporomandibular joint, or TMJ, which is located
where the jaw meets the ear. In the latter case, jaw or facial pain is usually present, too.
Abdominal Discomfort
FMS-related symptoms include digestive disturbances, abdominal pain
and bloating, constipation, and diarrhea. As a whole, such symptoms are known as irritable bowel syndrome.
Irritable Bladder
Fibromyalgia patients may notice an increase in urinary frequency or
experience a greater urgency to urinate. Often, no accompanying bladder infection is present.
Numbness or Tingling
Also known as "paresthesia", symptoms usually involve a prickling or
burning sensation, particularly in the extremities.
Chest Pain
Persons with FMS sometimes experience a condition called "costochondralgia"
which involves muscular pain at the spot where the ribs meet the chest bone. Since costochondralgia mimics cardiac symptoms, it
is always a good idea to check with a physician if chest pain occurs.
Cognitive Disorders
Frequent complaints, which vary from day to day, include difficulty
concentrating, "spaciness", memory lapses, word mix-ups when speaking or writing, and clumsiness or dropping things.
Dysequilibrium
FMS patients may also experience dizziness and balance problems. Typically,
there is no classical, spinning vertigo. Rather difficulties in orientation occur when standing, driving, or reading.
Environmental Sensitivity
Allergic-like reactions to a variety of substances are common,
as are sensitivities to light, noise, odors, and weather patterns. Dryness of the skin, eyes, and mouth is also common.
Other Symptoms
Increasingly, additional symptoms and syndromes are being associated with FMS.
These are discussed in more detail in publications and audiotapes produced or sold by the Fibromyalgia
Association of Greater
Washington, Inc. (FMAGW).
Diagnosis
Currently, no diagnostic, laboratory test exists for FMS. For fibromyalgia to be diagnosed, other conditions that mimic its symptoms must first be excluded (i.e., thyroid disease, lupus, lyme disease, rheumatoid arthritis, etc.). Furthermore, according to official, diagnostic criteria established by the American College of Rheumatology, a patient must suffer from widespread pain in all four body quadrants for at least three months. Finally, 11 of 18 possible tender points should be present when specific locations in the neck, shoulders, chest, hip, knee, and elbow regions of the body are examined by a physician (see diagram at right), although patients may not be aware that these tender points exist. Some physicians take the position that less than 11 tender points can be present at any given time for a fibromyalgia diagnosis to be made. Rheumatologyists and physiatrists (specialists in physical medicine and rehabilitation) are often the most knowledgeable when it comes to diagnosing FMS.
Treatment
To date, there is no cure for FMS. Treatment consists of managing symptoms to the greatest extent possible. Because patients vary widely in their responses to available modalities, several approaches may need to be tried before a satisfactory regimen can be established. For this reason, a multi-disciplinary, medical team approach is beneficial. The following treatments, used alone or in combination, generally help patients feel better and improve their quality of life:
Cause
While researchers continue to seek the cause of fibromyalgia syndrome, there is evidence that FMS is triggered in pre-disposed individuals by such precipitants as illness, physical trauma to the body, or acute emotional stress. FMS also seems to run in some families, although no genetic component has yet been identified. Encouraging research is now occurring in the fields of neuroendocrinology, immunology, cardiology, and exercise physiology, among others. Detailed information about ongoing research can be found in medical journals, FMS association newsletters like FMAGW's Fibromyalgia Frontiers, and publications by the National Institutes of Health.
FMAGW
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