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Fibromyalgia is a common condition associated with muscular pain and fatigue. It occurs more commonly in women than in men especially in women of childbearing age.
Fibromyalgia is not a form of arthritis nor is it associated with inflammation. Instead, fibromyalgia is a form of soft-tissue rheumatism, a broad term including a group of disorders that cause pain and stiffness around the joints and in muscles and bones.
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Symptoms and Signs
Widespread musculoskeletal pain is the most prominent symptom of fibromyalgia. Most individuals complain of aching and stiffness in areas around the neck, shoulders, upper back, lower back and hip areas. It generally occurs throughout the body, although it may start in one region, such as the neck and shoulders, and may spread over a period of time.
Fibromyalgia pain has been described in a variety of ways, such as burning, gnawing, aching, or as stiffness or soreness. It often varies according to time of the day, activity level, the weather, sleep patterns and stress. Most people with fibromyalgia say that some degree of pain always is present. They feel the pain mainly in their muscles. For some people, the pain may be quite severe. Although the results of a general physical examination usually are normal and individuals may look healthy, a specific examination of the muscles of people with fibromyalgia reveals tender areas at locations known as tender points. Tender points are areas of the body that are painful when pressed. The presence and pattern of these characteristic tender points separate fibromyalgia from other conditions. People often are not aware of the exact location or even the presence of many of these tender points until a doctor performs a tender point evaluation.
Fatigue and Sleep Disturbances
Most people with fibromyalgia have fatigue, decreased endurance, or the kind of exhaustion felt with the flu or lack of sleep. Sometimes the fatigue is severe and a much greater problem than the pain. Most people with fibromyalgia experience sleeping problems. Although they may be able to fall asleep without major difficulty, they sleep lightly and wake up frequently during the night. They often wake up feeling tired, even after sleeping through the night. The tiredness can range from listlessness and decreased endurance to exhaustion, and can vary from one day to the next.
Nervous System Symptoms
Changes in mood are a common symptom of fibromyalgia. Feelings of sadness or being down are common and some people with fibromyalgia have depression. People with fibromyalgia also may feel anxious. Some researchers think there is a link between fibromyalgia and certain forms of depression and chronic anxiety. However, any person with a chronic illness – not just fibromyalgia – may feel depressed at times while struggling with their pain and fatigue. People with fibromyalgia may have difficulty concentrating or performing simple mental tasks. These problems tend to come and go and are often most prominent at times of extreme fatigue or anxiety. Similar problems have been noted in many people with mood changes, sleep disturbances or other chronic illnesses.
Headaches, especially tension headaches and migraine headaches, are common in people with fibromyalgia. Abdominal pain, bloating and alternating constipation and diarrhea (called irritable bowel syndrome or spastic colon) also are common. Bladder spasms and irritability may cause urinary urgency or frequency. Additional problems that may be associated with fibromyalgia include cramps, dizziness, pain in the temporomandibular joint (TMJ), hands, arms, feet, legs or face.
How Is Fibromyalgia Diagnosed?
Fibromyalgia cannot be diagnosed with laboratory tests. The results of X-rays, blood tests, and muscle biopsies look normal. Therefore, the diagnosis is based on a careful history and physical examination. According to the American College of Rheumatology (ACR) criteria, a person has fibromyalgia if he or she has a history of widespread pain of at least three months’ duration, and pain in at least 11 or more of 18 specific tender point sites. Common conditions that may mimic fibromyalgia include hypothyroidism, lupus, rheumatoid arthritis, and infections. These can usually be excluded by examination and laboratory tests. Because the complaints of fibromyalgia are so general and often bring to mind other medical disorders, many people undergo complicated and often repeated evaluations before they are diagnosed with fibromyalgia. It is important to see a physician or rheumatologist who knows how to diagnose and treat the condition.
What Causes Fibromyalgia?
The cause of fibromyalgia is unknown. There are many different factors, alone or in combination, that may cause fibromyalgia. For example, factors such as an infectious illness, physical trauma, emotional trauma or hormonal changes, may contribute to the generalized pain, fatigue and sleep disturbances that characterize the condition. Studies have suggested that people with fibromyalgia have abnormal levels of several of the different chemicals that help transmit and amplify pain signals to and from the brain. Whether these abnormalities are a cause or a result of fibromyalgia is unknown.
Fibromyalgia Treatment and Care
There is no known cure for fibromyalgia. Patients may be reassured that the condition, while painful, does not damage tissues and that it can be managed successfully in many cases.
Treatment options for fibromyalgia include:
- Medications to diminish pain and improve
- Exercise programs that stretch muscles and improve cardiovascularly
- Relaxation techniques to ease muscle tension and
- Educational programs to help you understand and manage fibromyalgia.
Your doctor can create a treatment plan specifically for you. Some people with fibromyalgia have mild symptoms and need very little treatment once they understand what fibromyalgia is and how to avoid what worsens their condition. Other people, however, require a comprehensive care program, involving medication, exercise, and pain coping skills training.
Frequently, people with fibromyalgia have undergone many tests and have seen several specialists in their search for answers. They often are told that because they look well and their tests are normal, there is nothing wrong with them. Their family and friends, as well as physicians, may doubt the reality of their complaints, increasing their feelings of isolation, guilt, and anger. You and your family should understand that fibromyalgia causes chronic pain and fatigue. You must take an active role in managing your fibromyalgia by exercising regularly, educating yourself about your condition, and learning how to implement relaxation techniques and stress management strategies.