LEARNING ACCOMMODATIONS CENTER Tel: 978-556-3654 Northern Essex Community College Fax: 978-556-3168 100 Elliott Street, Haverhill MA 01830 TTY: 978-556-3655 WHAT IS FIBROMYALGIA?
Fibromyalgia syndrome is a common form of generalized muscular pain and fatigue that is believed to
affect approximately 2 percent of the U.S. population, or 5 million people. The name fibromyalgia means pain in the muscles and the fibrous connective tissues (the ligaments and tendons). This condition is known as a syndrome because it’s a set of signs and symptoms that occur together. (A sign is what the physician finds on examination; a symptom is what a person reports to the doctor.) Fibromyalgia is especially confusing and often misunderstood because some of its symptoms may be found in other conditions.
The term fibrositis was once used to describe this condition. The itis means inflammation – a process
that can result in pain, swelling, warmth, redness and stiffness. Investigators have now found that inflammation is not a significant part of this condition. The name fibromyalgia is more accurate, and has largely replaced the older term.
Fibromyalgia mainly affects muscles and their attachments to bones. Although it may feel like a joint
disease, it is not a true from of arthritis and does not cause deformities of the joints. Fibromyalgia is, instead a form of soft tissue or muscular rheumatism. The word rheumatism refers to pain and stiffness associated with arthritis and related disorders of the joints, muscles and bones.
Unfortunately, because certain syndromes lack physical and laboratory findings, but depend mostly on a
person’s report of complaints and feelings, these syndromes are often viewed as imaginary or unimportant. In the past, fibromyalgia was affected by this type of negative thinking.
During the past 10 years, however, fibromyalgia has been better defined through studies that have
established guides for its diagnosis. These studies have shown that certain symptoms, such as generalized muscular pain and specific tender points, are present in people with fibromyalgia and not common in healthy people or people with other rheumatic conditions. These features separate fibromyalgia from other types of conditions that have chronic muscle and bone pain. SYMPTOMS AND SIGNS Pain
Pain is the most prominent symptom of fibromyalgia. It generally occurs throughout the body, although
it may start in one region, such as the neck and shoulders, and spread over a period of time. Fibromyalgia pain has been described in a variety of ways including burning, gnawing, sore, stiff and aching. It often varies according to time of the day, activity level, weather, sleep patterns and stress. Most people with fibromyalgia say that some degree of pain is always present. They feel the pain mainly in their muscles, and often note that fibromyalgia feels like a persistent flu. For some people with fibromyalgia, the pain may be quite severe.
Although the general physical examination is usually normal, and individuals may look healthy, a
careful examination of their muscles reveals tender areas at specific locations (see diagram). The presence and pattern of these characteristic tender points with symptoms of pain separate fibromyalgia from other conditions. Not all physicians are familiar with this syndrome. However, most rheumatologists (specialists in arthritis and rheumatic diseases) do know when and how to perform a tender point evaluation to aid in diagnosis. K:\Documents\learning_accomodations\Fibromyalgia.doc
The dots in this figure indicate the various locations of tender points. People who have fibromyalgia experience undue tenderness when pressure is applied over many of these locations.
The tender areas in fibromyalgia are similar in location to tender areas in other common disorders of muscle and bone pain such as tennis elbow and trochanteric bursitis (tenderness of the outer side of the hip). Tender points are almost always present on both sides of the body. Although the tender points illustrated have been used for diagnosis, many other muscles and soft tissue points can be excessively tender. People often are not aware of the exact location or even the presence of many of these tender points until they are specifically examined by a doctor. Fatigue and Sleep Disturbances About 90 percent of people with fibromyalgia experience moderate or severe fatigue with lack of energy, decreased exercise endurance, or the kind of exhaustion felt with the flu or lack of sleep. Often the fatigue is more of a problem than the pain. Generally, people with fibromyalgia have fatigue that is similar to another condition called chronic fatigue syndrome (CFS). Some people with fibromyalgia have symptoms of CFS,
and vice versa. For example, many people with CFS have the tender points and symptoms considered to be characteristic of fibromyalgia. Because there is an overlap in these tow common syndromes, it may not be possible to separate these tow conditions, and one doctor may give a diagnosis of fibromyalgia whereas another may call the same condition chronic fatigue syndrome.
Most people with fibromyalgia experience an associated sleep disorder in which they wake up feeling
unrefreshed or tired. Although they may be able to fall asleep without major difficulty, the deep level sleep in interrupted. They may sleep lightly and wake up during the night. Other sleep disturbances, including sleep apnea, sleep myoclonus and restless leg syndrome, are also common. Research has shown that a disruption of deep sleep alters many crucial body functions and pain perceptions. Therefore, people with fibromyalgia may be treated with medications to improve sleep and reduce pain perception. Nervous System Symptoms
Changes in mood and thinking are common in fibromyalgia. Many individuals feel “blue” or “down”,
although only about 25 percent are truly depressed. Some people also feel very anxious. Some researchers feel there may be a link between fibromyalgia and some forms of depression and chronic anxiety. It’s important to remember that people with many chronic illnesses, not only fibromyalgia, may feel depressed by their difficult symptoms.
People with fibromyalgia may report difficulty concentrating or performing simple mental tasks. There
is no evidence that these problems become more serious over time. Similar problems have been noted in many people with mood changes, other sleep disturbances or other chronic illnesses.
Some people with fibromyalgia may feel numbness and tingling in their hands, arms, feet, legs or face.
These feelings can suggest other disorders such as carpal tunnel syndrome, neuritis or even multiple sclerosis.
Therefore, people with fibromyalgia often undergo numerous tests for such conditions, only to find that the test results are normal. Other Problems
Headaches, especially muscular (tension headaches) and migraine headaches, are common in
fibromyalgia. Abdominal pain, bloating and alternating constipation and diarrhea (irritable bowel syndrome or “spastic colon”) are also common. Similar bladder spasms and irritability may cause urinary urgency or frequency. The skin and circulation are often sensitive to temperature changes, resulting in temporary changes in skin color. How is FMS treated?
Traditional treatments are geared towards improving the quality of sleep, as well as reducing pain.
Because deep level (stage 4) sleep is so crucial for many body functions, such as tissue repair, antibody production, and perhaps even the regulation of various neurotransmitters, hormones and immune system chemicals, the sleep disorders that frequently occur in FMS patients are thought to be a major contributing factor to the symptoms of this condition. Medicines that boost your body’s level of serotonin – a neurotransmitter that modulates sleep, pain and immune system function – are commonly prescribed. Examples of drugs in this category would include Elavil, Flexeril, Sinequan, Prozac, Xanax and Klonopin. A low dose of one of the medications may be of help. In addition, nonsteroidal, anti-inflammatory drugs (NSAIDS) like ibuprofen may also be beneficial. Most patients, however, will probably need to use other treatment methods as well, such as tender or trigger point injections with lidocaine, physical therapy, acupuncture, acupressure, relaxation techniques, osteopathic manipulation or a gentle exercise program. What is the prognosis?
Long term follow-up studies on FMS have shown that it is chronic, but the symptoms may wax and
wane. The impact that FMS can have on daily living activities, including the ability to work a full-time job, differs among patients. Overall, studies have shown that FMS can be equally as disabling as rheumatoid arthritis. Self-help strategies
Lifestyle modifications may help you conserve your energy and minimize your pain. Learn what factors
aggravate your symptoms and avoid them if possible.
Excerpts from the Arthritis Foundation and the Arthritis and Rheumatism Journal
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CURRICULUM VITAE – RAK, Janusz Assistant Professor, Department of Medicine, Division of Oncology, McMaster University, Hamilton, Canada. Faculty of Health Sciences , Graduate Faculty of Hemostasis, Thrombembolism and Atherosclerosis. McMaster University. Associated Graduate Faculty at the Department of Biomedical Sciences, University of Guelph. Address. Henderson Research Centre. De