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FIBROMYALGIA

Fibromyalgia is a common condition of muscles and tendons, which causes diffuse pain, fatigue and poor sleep, among other symptoms. The pain is generalized, but specific areas of tenderness called tender points are characteristic.

The pain can fluctuate. It is often aggravated by physical, environmental, emotional, and hormonal factors. It can be seen as a result of unusual positioning, poor posture, inclement weather, physical or psychological trauma, or may flare up out of the blue. It may be related to abnormal thyroid or other hormone levels, specific abnormalities on an EEG, or poor local blood/oxygen flow.

It is NOT, however, a tumor or a crippling neurologic disorder. Fibromyalgia is a pain syndrome, but it is not a death sentence.

Fibromyalgia is diagnosed by history and physical examination. There are no blood tests or x-rays that diagnose fibromyalgia.

The main symptoms of fibromyalgia are:

• Diffuse muscle pain.
• Pain in areas where tendons or ligaments attach to bone.
• A non-restorative sleep pattern (that is not waking up refreshed and ready to go).
• Fatigue.
• Stiffness in the morning, that gets better as the day goes on.
• Numbness and tingling.
• Headaches.
• A sense of swelling, but without true swelling noted on examination.
• A sense of weakness.

On physical examination the main findings are tender points. There are 18 specific tender points, and at least 11 need to be identified on an exam. Other characteristic findings include a hypersensitivity to scratching the skin such that a red mark forms (this is called dermatographia), forwardly protruded shoulder and chin posturing, limited range of motion secondary to pain. Sometimes a dynamometer (which is a like a fancy gauge) can be used to determine how sensitive to palpation soft tissues may be.

Effective treatment is based upon maintaining a regular exercise program. Low impact aerobic activity (such as swimming, walking, biking, jogging, and aerobics) helps maintain oxygen flow to the tiny blood vessels that supply muscles, tendons and joints. Developing good sleep hygiene is essential. This can be established through a specific nightly routine or even low doses of specific sleep medications. Physical therapy for flexibility and posture exercises can also be helpful. Cessation of smoking is also helpful, as nicotine can decrease blood flow to tiny vessels.

Fibromyalgia is a condition that can be controlled. It is a chronic condition that can flare up or be quiet over time. The overall condition, however, does not disappear. The patient, who is an active participant in a treatment program, has the best chance to control the fibromyalgia so that the effects from any possible flare ups can be minimized and the patient can maintain a productive lifestyle despite the condition. The goal of treatment in fibromyalgia is to enable patients to live and thrive successfully.

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