Fibromyalgia Health Article

Definition

Fibromyalgia (formerly known as fibrositis) is an inflammation of the fibrous or connective tissue (muscles, joints, ligaments, and tendons) of the body. Widespread pain, fatigue, and multiple tender points characterize this condition. Other symptoms may include sleep disturbance, headache, and bowel disturbances.

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 aged 35 to 55. Fibromyalgia symptoms have often been characterized as psychosomatic in origin. Recent research has proved that belief false, and fibromyalgia is now regarded as a disorder that can be diagnosed and treated effectively with ongoing care and follow-up.

Causes and symptoms

The exact cause of fibromyalgia is not known. There are events that can precipitate the symptoms of fibromyalgia, including sports injuries, car accidents, falls, or other trauma to the body. Sometimes it occurs in several members of a family, suggesting that there may be an inherited tendency for the disorder. People with fibromyalgia are most likely to complain of three primary symptoms: pain in muscles, joints, and ligaments; stiffness; and excessive fatigue. Widespread, ongoing pain is characteristic of fibromyalgia. A careful history and physical examination may uncover additional areas of pain when the chief complaint lies in only one area of the body. The most significant area of pain may shift over time, and the pain can be intermittent.

Pain is the major symptom of fibromyalgia, with aches, tenderness, and stiffness of multiple muscles, joints, and soft tissues. The pain may also tend 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 is variable and dependent on individual patient perception.

Symptoms of sleeplessness and overall fatigue may result from the individual's chronic pain, coupled with anxiety about the problem and how to find relief. The body's inflammatory response also produces chemicals in the brain that are known to contribute to fatigue. Other common symptoms are tension headaches, difficulty swallowing, recurrent abdominal pain, diarrhea (irritable bowel syndrome), and numbness or tingling of the extremities. Stress, anxiety, depression, lack of dietary control, or lack of sleep can increase symptoms. Intensity of symptoms varies. Some patients gradually improve, while others have recurrent episodes of their symptoms.

Diagnosis

Diagnosis is difficult, and the disease may be overlooked because symptoms of fibromyalgia are vague and general. In addition, fibromyalgia may mimic symptoms of other diseases and conditions. Support staff should question the patient regarding sleep and exercise patterns, diet, and emotional conditions. 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 final diagnosis is frequently made after a period of time in which the physician observes the patient and rules out other medical conditions with similar symptoms.

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 psychosomatic condition. Recognition of the underlying inflammatory process involved in fibromyalgia has helped promote the validity of this disease. Nurses, nurse practitioners or physician's assistants should inquire into the emotional state of the patient, and be prepared to note it in the chart. Mental health consultation may be necessary due to depression or anxiety, and emphasis on the importance of a support group for fibromyalgia patients should be given.

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 for at least three months in at least 11 of the 18 sites known as trigger points. Trigger point sites include the neck, spine, hip, elbow, knee, and shoulder.