Fibromyalgia Health Article

Definition

Fibromyalgia is a syndrome of chronic fatigue and diffuse muscle pain and sleep problems. There is not yet a proven cause, but there is some evidence to suggest that it may be created by a certain central nervous system abnormality that heightens a person's sensitivity to pain.

Alternative Names

Fibrositis, fibromyositis, fibrositides.

Causes, incidence, and risk factors

People with fibromyalgia have pain in many muscle groups and feel tired much of the time, yet their doctors tell them they can't find anything wrong with them because there is no definitive lab test from which the diagnosis can be made. In most case, the doctor cannot find an anatomical or laboratory abnormality. Fibromyalgia is not a disease but a condition, thought to be a response to stress such as an injury or infection (e.g. Epstein-Barr virus) or stressful emotional event. It is more common in women than in men - nine out of ten fibromyalgia patients are women. Certain people who are more susceptible to stress than others may also be more susceptible to fibromyalgia.

It is estimated that six million Americans suffer with fibromyalgia. As many as 20% of the patients seeking treatment from rheumatologists may have fibromyalgia. The syndrome usually occurs in people ages 20 to 65 years old, peaking at age 35 years. Chronic fatigue syndrome is a common comorbidity, as are myofascial pain syndrome and depression. It is possible that there is a common genetic predisposition to fibromyalgia and depression.

Symptoms

The hallmark of fibromyalgia is tender points of the body. This is different than myofascial pain syndromewhich is characterized by trigger points. These tender points are:

• Just below the hairline on either side of the neck
• Above the collar bone on either side of the neck
• Below the collar bone on either side of the chest
• On the upper back, right or left, where the neck and shoulder join
• Between the shoulder blades on either side of the upper back
• On the inside of either arm, where it bends at the elbow
• On either side of the lower back, just below the waist
• On either side of the buttocks just under the hip bones
• On either knee cap
• On the bottom of the feet

The pain of fibromyalgia is widespread aching that persistsfor at least three months. To be diagnosed with fibromyalgia, pain must appear on both sides of the body, above and below the waist, and along the length of the spine.

Some experts believe that if a patient presents with eight of the above tender point and three of the symptoms below the diagnosis is likely to be fibromyalgia:

• Fatigue
• Morning stiffness
• Sleep disturbance
• Numbness and tingling in the hands and feet
• Headache

Other common symptoms reported by fibromyalgia patients include:

• Intolerance to pain
• Lightheadedness
• Dizziness
• Depressed mood
• Anxiety
• Sensitivity to light, sound and odors

Secondary Fibromyalgia

Secondary fibromyalgia has all of the characteristics of primary fibromyalgia, except that a specific cause can be identified for the condition. Some of the problems that trigger secondary fibromyalgia are:

• Silicone breast implants: Women whose silicone implants ruptured and leaked were almost three times more likely to develop fibromyalgia than were those whose implants remained intact
• Endometriosis: 30% of women with this condition develop fibromyalgia or chronic fatigue syndrome
• HepatitisC
• Lymedisease
• Surgery
• Traumatic injury
• Repetitive stress injury

Signs and tests

There is no specific diagnostic study or test to confirm fibromyalgia. If you have suffered from generalized aching or pain that has lasted several months, and your primary care doctor has been unable to determine a diagnosis, you may wish to discuss a referral to a rheumatologist.

The American College of Rheumatology has developed specific criteria for diagnosis of this condition, outlined above in Symptoms. All fibromyalgia patients suffer muscle pain and most suffer fatigue and insomnia. Some also suffer joint pain, headaches, restless legs, numbness and tingling, impaired memory, leg cramps, impaired concentration, nervousness and depression.

It is likely that diagnostic studies will be performed to rule out (that is, to make sure that you do not have) one or more of the following: lupus erythematosus, rheumatoid arthritis, multiple sclerosis, Lyme disease, arthritis, AIDS, Kawasaki's disease, erythema nodosum and polymyalgia rheumatica. This is the rationale for referral to a rheumatologist.

There are many conditions that commonly occur with fibromyalgia, and which may be referred to as comorbidities. Some of these may be:

• chronic fatigue syndrome
• irritable bowel syndrome (IBS)
• temporomandibular joint disorder (TMJ)

The bottom line is that fibromyalgia is often unrecognized, untreated and under-diagnosed. if you have a constellation of symptoms that fits this pattern, talk to your doctor about referring you to the appropriate specialist for consultation and treatment.