Fibromyalgia (FMS) is a common and chronic disorder that causes three primary symptoms.
- widespread muscle pain
- multiple tender points
Fibromyalgia is the most common rheumatological diagnosis after rheumatoid arthritis and osteoarthritis. It affects as many as 1 in 50 Americans. For unknown reasons, about 80-90% of those diagnosed with fibromyalgia are women. However, men and children can also be affected. Most people are diagnosed during middle age, although the symptoms often present earlier in life.
In addition to pain and fatigue, people who have fibromyalgia may experience:
- Sleep disturbances
- Morning stiffness
- Irritable Bowel Syndrome (IBS)
- Painful menstrual periods
- Numbness or tingling of the extremities
- Restless legs syndrome (RLS)
- Temperature sensitivity
- Cognitive and memory problems (sometimes referred to as “fibro fog”)
Symptoms vary widely among individuals and tend to wax and wane over time. An illness, injury, cold weather or emotional stress may trigger a fibromyalgia episode or make ongoing symptoms worse.
The term “syndrome” is used to describe fibromyalgia instead of “disease” because its cause remains unknown. A syndrome is a collection of symptoms (what the patient feels) and signs (abnormalities detected by a physician) that tend to appear together. Of course, no matter what words are used to describe this medical condition, it can severely impact a person’s life.
Diagnosis of Fibromyalgia
It often takes many doctor visits before someone is diagnosed with fibromylagia. The diagnosis of fibromyalgia can take months or even years because the main symptoms, pain and fatigue, overlap with many other medical conditions. Therefore, doctors have to rule out other possible causes of these symptoms before making a diagnosis of fibromyalgia. Another reason that diagnosis may be delayed is that there are currently no laboratory tests for fibromyalgia. Standard tests cannot yet reveal the reason for pain.
A doctor familiar with fibromyalgia, can make a diagnosis based on two criteria:
- A history of widespread pain lasting more than 3 months. Pain is considered to be widespread when it affects all four quadrants of the body; that is, you must have pain in both your right and left sides as well as above and below the waist to be diagnosed with fibromyalgia.
- The presence of tender points. 18 sites on the body have been designated as possible tender points. For a fibromyalgia diagnosis, a person must have 11 or more tender points. One of these predesignated sites is considered a true tender point only if the person feels pain (not just tenderness) upon the application of 4 kilograms of pressure to the site. People who have fibromyalgia certainly may feel pain at other sites, too, but those 18 standard possible sites on the body are the criteria used for classification.
Cause of Fibromyalgia
The cause of fibromyalgia remains unknown.
Identifying a single abnormality as a cause is difficult, in part, because fibromyalgia comprises a range of symptoms, including widespread muscle pain, fatigue and abnormal sleep patterns. These varied symptoms cannot be explained by any single factor.
Another difficulty is that fibromyalgia may not be caused by an external factor but instead may be an underlying abnormality unmasked by any one of a number of triggers. Triggers can include a flu-like illness or a traumatic event, such as divorce, an auto accident or the death of a spouse.
In the past, symptoms of fibromyalgia were labeled as “fibrositis” or “muscular rheumatism”. These diagnostic terms were based on incorrect assumptions about the cause being located within the muscle fiber, or related to arthritis (a disease of the joints). Like arthritis, fibromyalgia can cause significant pain and fatigue, and it can interfere with a person's ability to carry on daily activities. However it does not cause inflammation or damage to the joints, muscles, or other tissues.
Today most research on the cause of fibromyalgia is focused on how the central nervous system (the brain and spinal cord) processes pain.
Treatment of Fibromyalgia
There is presently no cure for fibromyalgia, but there are several treatments available that can help to reduce the pain and fatigue and bring other symptoms under control, leading to a more active life.
In treating fibromyalgia, most physicians combine medications with non-pharmacologic treatments, such as maintaining a healthy sleep and exercise regimen. The importance of getting sufficient sleep and exercise cannot be overlooked.
Your doctor may prescribe a medication to help get fibromyalgia symptoms to reduce pain and improve overal function. Other medications may be prescriberd to treat other symptoms that accompany a person's fibromyalgia, such as headache medications, or sleep medications.
No single therapy stands out as the most effective because comparative studies have not been done. These alternative therapies--whether hypnosis or biofeedback, exercise or acupuncture--require your willingness to incorporate them into daily life. For instance, to truly benefit from fitness training, you must exercise at least three times a week. If you stop exercising after three or six months, you will lose any ground gained.
Because of the commitment required, select a therapy that fits into your schedule, appeals to your understanding of fibromyalgia, is reasonably priced, and takes advantage of community resources such as specialized healthcare providers.
Realize that a new therapy may take time to work; stick with the it. If your symptoms have not improved within a reasonable trial period, even 3-4 months, discuss the problem with the person who is overseeing your therapy. There may be ways they can help you maximize the benefits.
Keep in mind, though, that you are the best judge of "effectiveness." What helps someone else may not help you. Once you have allowed enough time for a treatment to prove itself, think about its impact on you. Be critical of therapies that do not make you feel better, especially if the person recommending the treatment benefits financially from your continued use of it.
People with fibromyalgia also may benefit from a combination of physical therapy (PT) and occupational therapy (OT), from learning pain-management and coping techniques, and from properly balancing rest and activity.
Will Fibromyalgia Get Better With Time?
Fibromyalgia is a chronic condition, meaning it lasts a long time — possibly a lifetime. However, it may comfort you to know that fibromyalgia is not a progressive disease. It is never fatal, and it won't cause damage to your joints, muscles, or internal organs. In many people, the condition does improve over time.
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