1/4

2/4 Fibromyalgia 3/4
Welcome to my compendium website on Fibromyalgia

Introduction

You hurt all over, and you frequently feel exhausted. Even after numerous tests, your doctor can't seem to find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia.

Fibromyalgia is a chronic condition characterized by fatigue, widespread pain in your muscles, ligaments and tendons, and multiple tender points — places on your body where slight pressure causes pain. Fibromyalgia is more common in women than in men. Previously, the condition was known by other names such as fibrositis, chronic muscle pain syndrome, psychogenic rheumatism and tension myalgias.

Although the intensity of your symptoms may vary, they'll probably never disappear completely. It may be reassuring to know, however, that fibromyalgia isn't progressive, crippling or life-threatening. Treatments and self-care steps can improve symptoms and your general health.

Words used to describe problems with Fibromyalgia, fibrositis, chronic muscle pain syndrome, psychogenic rheumatism, tension myalgias, Symptoms, Fatique, Sleep Problems, Diagnosis, Syndrome, Treatment, Ailment, Doctor, Insurance, Medical, Complications, Alternative, Ailment,




You can find this site again  by typing in the  Google search engine  the unique word " 1aiglaymorbiF "  which is  OR " Fibromyalgia1 " backwards.

 

4/4

If after you scan to the bottom of this  website and still can't find the information you are looking for try another Google search here.
Contact information for this Website:
 Brian Nelson, Webpage Marketing Consultant 
 31 Gessner Rd. Houston, TX  01/10/2007 06:55 AM -0600
713-467-3025  Fax 713-467-3192  Click: E-mail me

You are at: http://www.NewMedicalDirectories.com/Fibromyalgia/Information.html    ud 01/10/2007 06:55 AM -0600  Bookmark this page now!

Misspelled words used to find this page 1 of 3.fibroyalgia, fiblomyalgai, fibromalgia, fibromyargia, fibromylgia, fibromyargai, fibromyagia, fiblomyargia, fibromyalia, fiblomyargai, fibromyalga, fbromyalgia, firomyalgia, fibromyalgia, fibomyalgia, fibromyalgai, fibrmyalgia, fiblomyalgia, fiblomyargea, fibromyalgea, fibromyargea, fiblomyalgea, fbronya1g1a, phbronya1g1a, f1bronya1g1a, f1bronyalg1a, fibronyalgia, fibromyaliga, fibromyaglia, fibromylagia, fibromaylgia, fibroymalgia, fibrmoyalgia, fibormyalgia, firbomyalgia, fbiromyalgia, ifbromyalgia, fibromyalgi, ibromyalgia, fibrositis, fiblositis, fibrocitus, fibrosits, fibloucitis, fibrousitee, fiblocitus, fibrocitis, fibroucitee, fiblousitee, fibroesitis, fiblocitis, fbrositis, fibroucitus, fibrousitus, fibloesitis, fibrositee, firositis, fiblousitus, fibroesitee, fiblositee, fibositis, fibroecitis, fibloesitee, fibrocitee, fibrsitis, fibloecitis, fibroesitus, fiblocitee, fibroitis, fibroecitee, fibloesitus, fibrositus, fibrostis, fibroecitus, fibrousitis, fiblositus, fibrosiis, fibroucitis, fiblousitis, fbros1t1s, phbros1t1s, f1bros1t1s, fibrositsi, fibrosiits, fibrostiis, fibroistis, fibrsoitis, fiborsitis, firbositis, fbirositis, ifbrositis, fibrositi, ibrositis, chronic, chrik, chroik, chrnik, chric, chrnic, cronic, chonic, chronc, chronik, chromic, cromic, chomic, chrmic, chroic, chromc, chromik, chrni, croic, chroi, croik, clonic, cronik, clonik, cric, crik, chroni, crnic, chri, crnik, chron1c, chronci, chroinc, chrnoic, chornic, crhonic, hcronic, hronic, muscle, muscul, mussel, muscel, muscre, muscl, muscr, nusc1e, nuscle, muslce, mucsle, msucle, umscle, musce, musle, mucle, mscle, uscle,pain, paeign, paiegn, paen, paan, pian, paign, pane, peon, peen, piin, pyin, pien, pyen, pean, pein, pyan, pani, peni, pa1n, paim, apin, psychoganik, pschogenic, psychogenic, psichogenik, psyhogenic, psichoganik, psycogenic, sychogenik, psychgenic, sychoganik, psychoenic, sychogenic, sichogenik, psychognic, sychoganic, sichoganik, psychogeic, sichogenic, psychogenc, sichoganic, psychogenik, pychogenic, psychoganic, psichogenic, psichoganic, psychogen1c, psychogemic, psychogenci, psychogeinc, psychogneic, psychoegnic, psychgoenic, psycohgenic, psyhcogenic, pscyhogenic, pyschogenic, spychogenic, psychogeni, rheumatism, reumatism, rhematism, rheuatism, rheumtism, rheumaism, rheumatsm, rheumatim, rumaticsim, rheumatiscim, lheumatiscim, rhumatiscim, rumatiscim, rheumaticsim, lheumaticsim, rhumaticsim, rhumatism, rumatism, lheumatism, rheunat1sm, rheunatism, rheumatims, rheumatsim, rheumaitsm, rheumtaism, rheuamtism, rhemuatism, rhuematism, rehumatism, hreumatism, rheumatis, heumatism, tension, tnsion, tesion,
What is Fibromyalgia?

Fibromyalgia (FM) is a chronic pain illness characterized by widespread musculoskeletal aches, pain, and stiffness, soft tissue tenderness, general fatigue, and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle, and hands, but any body part can be affected. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.

Who is affected?

It is estimated that approximately 5-7% of the U.S. population has FM. Although a higher percentage of women of all ages and races are affected, it does strike men and children. Because of its debilitating nature, fibromyalgia has a serious impact on patients' families, friends and employers, as well as society at large.

What are the symptoms?

FM is characterized by the presence of multiple tender points and a constellation of symptoms.

Pain:

The pain of FM is profound, widespread and chronic. It knows no boundaries, migrating to all parts of the body and varying in intensity. FM pain has been described as deep muscular aching, throbbing, twitching, stabbing and shooting pain. Neurological complaints such as numbness, tingling and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors that affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.

Fatigue:

In today's world many people complain of fatigue; however, the fatigue of FM is much more than being tired. It is an all-encompassing exhaustion that interferes with even the simplest daily activities. It feels like every drop of energy has been drained from the body, which at times can leave the patient with a limited ability to function both mentally and physically.  

Sleep Problems:

Many fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep. Medical researchers have documented specific and distinctive abnormalities in the stage 4 deep sleep of FM patients. During sleep, individuals with FM are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep.

Other Symptoms:

Additional symptoms may include: irritable bowel and bladder, headaches and migraines, restless legs syndrome (periodic limb movement disorder), impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, Raynaud's Syndrome, neurological symptoms, and impaired coordination.  

How is it diagnosed?

Currently there are no laboratory tests available for diagnosing fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination. This exam is based on the standardized ACR criteria. Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.  

It is estimated that it takes an average of five years for a FM patient to get an accurate diagnosis. Many doctors are still not adequately informed or educated about FM. Laboratory tests often prove negative and many FM symptoms overlap with those of other conditions, thus leading to extensive investigative costs and frustration for both the doctor and patient. Another essential point that must be considered is that the presence of other diseases, such as rheumatoid arthritis or lupus, does not rule out a FM diagnosis. Fibromyalgia is not a diagnosis of exclusion and must be diagnosed by its own characteristic features.

To receive a diagnosis of FM, the patient must meet the following diagnostic criteria:

  • Widespread pain in all four quadrants of the body for a minimum duration of three months
  • Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see figure above)

What causes FM?

While the underlying cause or causes of FM still remain a mystery, new research findings continue to bring us closer to understanding the basic mechanisms of fibromyalgia. Most researchers agree that FM is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation. The FM patient experiences pain amplification due to abnormal sensory processing in the central nervous system. An increasing number of scientific studies now show multiple physiological abnormalities in the FM patient, including: increased levels of substance P in the spinal cord, low levels of blood flow to the thalamus region of the brain, HPA axis hypofunction, low levels of serotonin and tryptophan and abnormalities in cytokine function.

Recent studies show that genetic factors may predispose individuals to a genetic susceptibility to FM. For some, the onset of FM is slow; however, in a large percentage of patients the onset is triggered by an illness or injury that causes trauma to the body. These events may act to incite an undetected physiological problem already present.

Exciting new research has also begun in the areas of brain imaging and neurosurgery. Ongoing research will test the hypothesis that FM is caused by an interpretative defect in the central nervous system that brings about abnormal pain perception. Medical researchers have just begun to untangle the truths about this life-altering disease.

How is FM treated?

One of the most important factors in improving the symptoms of FM is for the patient to recognize the need for lifestyle adaptation. Most people are resistant to change because it implies adjustment, discomfort and effort. However, in the case of FM, change can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement.

An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and who will listen to and work with the patient is an important component of treatment. It may be a family practitioner, an internist, or a specialist (rheumatologist or neurologist, for example). Conventional medical intervention may be only part of a potential treatment program. Alternative treatments, nutrition, relaxation techniques and exercise play an important role in FM treatment as well. Each patient should, with the input of a healthcare practitioner, establish a multifaceted and individualized approach that works for them.

Pain Management:

Over-the-counter pain medications, such as acetaminophen or ibuprofen, may be helpful in relieving pain. The physician may decide to prescribe one of the newer non-narcotic pain relievers (e.g. tramadol) or low doses of antidepressants (e.g. tricyclic antidepressants, serotonin reuptake inhibitors) or benzodiazepines. Patients must remember that antidepressants are "serotonin builders" and can be prescribed at low levels to help improve sleep and relieve pain. If the patient is experiencing depression, higher levels of these or other medications may need to be prescribed. Lidocaine injections into the patient's tender points also work well on localized areas of pain.  

An important aspect of pain management is a regular program of gentle exercise and stretching, which helps maintain muscle tone and reduces pain and stiffness.

Sleep Management:

Improved sleep can be obtained by implementing a healthy sleep regimen. This includes going to bed and getting up at the same time every day; making sure that the sleeping environment is conducive to sleep (i.e. quiet, free from distractions, a comfortable room temperature, a supportive bed); avoiding caffeine, sugar and alcohol before bed; doing some type of light exercise during the day; avoiding eating immediately before bedtime and practicing relaxation exercises as you fall to sleep. When necessary, there are new sleep medications that can be prescribed, some of which can be especially helpful if the patient's sleep is disturbed by restless legs or periodic limb movement disorder.

Psychological Support:

Learning to live with a chronic illness often challenges an individual emotionally. The FM patient needs to develop a program that provides emotional support and increases communication with family and friends. Many communities throughout the United States and abroad have organized fibromyalgia support groups. These groups often provide important information and have guest speakers who discuss subjects of particular interest to the FM patient. Counseling sessions with a trained professional may help improve communication and understanding about the illness and help to build healthier relationships within the patient's family.

Other Treatments:

Complementary therapies can be very beneficial. These include: physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation.

What is the prognosis?

Better than ever before! The efforts of individuals, support groups, organizations and medical professionals to help improve the quality of life for people with FM are starting to pay off. Better ways to diagnose and treat FM are on the horizon. The symptoms of FM can vary in severity and often wax and wane, but most patients do tend to improve over time. By actively seeking new information, talking to others who have FM, re-evaluating daily priorities, making lifestyle changes, and working hard to keep a hopeful attitude, the FM sufferer can become the FM survivor!

 
An Overview of Fibromyalgia for Newly Diagnosed Patients

Robert Bennett MD

Fibromyalgia (fi-bro-my-AL-ja) syndrome (FMS) is a very common condition of widespread muscular pain and fatigue. Seven to ten million Americans suffer from FMS. It affects women much more than men in an approximate ratio of 20:1. It is seen in all age groups from young children through old age, although in most patients the problem begins during their 20s or 30s. Recent studies have shown that fibromyalgia syndrome occurs world wide and has no specific ethnic predisposition.

 

 The Symptoms of Fibromyalgia Syndrome  

Fibromyalgia syndrome patients have widespread body pain which often seems to arise in the muscles. Some FMS patients feel their pain originates in their joints. Pain that emanates from the joints is called arthritis; extensive studies have shown FMS patients do not have arthritis. Although many fibromyalgia syndrome patients are aware of pain when they are resting, it is most noticeable when they use their muscles, particularly with repetitive activities. Their discomfort can be so severe it may significantly limit their ability to lead a full life. Patients can find themselves unable to work in their chosen professions and may have difficulty performing everyday tasks. As a consequence of muscle pain, many FMS patients severely limit their activities including exercise routines. This results in their becoming physically unfit - which eventually makes their fibromyalgia syndrome symptoms worse.

In addition to widespread pain, other common symptoms include a decreased sense of energy, disturbances of sleep, and varying degrees of anxiety and depression related to patients' changed physical status. Furthermore, certain other medical conditions are commonly associated with fibromyalgia, such as: tension headaches, migraine, irritable bowel syndrome, irritable bladder syndrome, premenstrual tension syndrome, cold intolerance and restless leg syndrome. Patients with estalished rheumatoid arthritis, lupus (SLE) and Sjogren's often develop during the course of their disease. The combination of pain and multiple other symptoms often leads doctors to pursue an extensive course of investigations - which are nearly always normal.

 

 Diagnosing Fibromyalgia Syndrome

 

There are no blood tests or x-rays which show abnormalities diagnostic of FMS. This initially led many doctors to consider the problems suffered by FMS patients were all "in their heads" or that fibromyalgia syndrome patients had a form of masked depression or hypochondriasis. Extensive psychological tests have shown these impressions were unfounded. A physician's diagnosis of FMS is based on taking a careful history and the finding of tender areas in specific areas of muscle. These locations are called "tender points" or "trigger points". They are tender to palpation and often feel somewhat hardened if the muscle is stroked. Frequently, pressure over one of these areas will cause pain in a more peripheral distribution, hence the term trigger point.

 

The Long Term Outcome for Fibromyalgia Syndrome

 

Musculoskeletal pain and fatigue experienced by fibromyalgia syndrome patients is a chronic problem which tends to have a waxing and waning intensity. There is currently no generally accepted cure for this condition. According to recent research, most patients can expect to have this problem lifelong. However, worthwhile improvement may be obtained with appropriate treatment, as will be discussed later in this brochure. There is often concern on the part of patients, and sometimes physicians, that FMS is the early phase of some more severe disease, such as multiple sclerosis, systemic lupus erythematosus, etc. Long term follow up of fibromyalgia patients has shown that it is very unusual for them to develop another rheumatic disease or neurological condition. However, it is quite common for patients with "well established" rheumatic diseases, such as rheumatoid arthritis, systemic lupus and Sjogren's syndrome to also have fibromyalgia. It is important for their doctor to realize they have such a combination of problems, as specific therapy for rheumatoid arthritis and lupus, etc. does not have any effect on FMS symptoms. Patients with fibromyalgia syndrome do not become crippled with the condition, nor is there any evidence it effects the duration of their expected life span. Nevertheless, due to varying levels of pain and fatigue, there is an inevitable contraction of social, vocational and avocational activities which leads to a reduced quality of life. As with many chronic diseases, the extent to which patients succumb to the various effects of pain and fatigue are dependent upon numerous factors, in particular their psycho-social support, financial status, childhood experiences, sense of humor and determination to push on.

 

 The Treatment of Fibromyalgia Syndrome

 

The treatment of FMS is frustrating for both patients and their physicians. In general, drugs used to treat musculoskeletal pain, such as aspirin, non-steroidals (e.g. ibuprofen) and cortisone are not particularly helpful in this situation. As in any chronic pain condition, education is an essential component that helps patients understand what can or can't be done as well as teaching them to help themselves.

It is important for a patient's physician to discover whether there is a cause for sleep disturbances. Such sleep problems include sleep apnea, restless leg syndrome and teeth grinding. If the cause for a patient's sleep disturbance cannot be determined, low doses of an anti-depressive group of drugs, called tricyclic anti-depressants or short acting sleeping medications such as zolpidem (Ambien), may be beneficial. Patients need to understand these medications are not addictive when used in low dosages (eg., Amitriptyline 10 mg at night) and have very few side effects. In general, routine use of sleeping pills such as Halcion, Restoril, Valium, etc. should be avoided as they impair the quality of deep sleep. Ambien (zolpidem), is claimed to avoid this problem.

There is increasing evidence that a regular exercise routine is essential for all fibromyalgia syndrome patients. This is easier said than done because increased pain and fatigue caused by repetitive exertion makes regular exercise quite difficult. However, those patients who do get into an exercise regimen experience worthwhile improvement and are reluctant to give up. In general, FMS patients must avoid impact loading exertion such as jogging, basketball, aerobics, etc. Regular walking, the use of a stationary exercycle and pool therapy utilizing an Aqua Jogger (a floatation device which allows the user to walk or run in the swimming pool while remaining upright) seem to be the most suitable activities for FMS patients to pursue. Supervision by a physical therapist or exercise physiologist is of benefit wherever possible. In general, 20 minutes of physical activity, 3 times a week at 70% of maximum heart rate (220 minus your age) is sufficient to maintain a reasonable level of aerobic fitness.

Drugs such as aspirin and Advil are not particularly effective and seldom do more than take the edge off FMS pain.  Opioid analgesics ( propoxyphene, codeine, morphine,oxycodone, methadone) may provide a worthwhile  relief of pain in a subgroup of severely afflicted patients, but fibromyalgia patients seem especially sensitive to opioid side effects (nausea, constipation, itching and mental blurring) and often decide against the long term use of these drugs. The use of opioid analgesics (narcotics) in the management of non-malignant pain has been a controversial issue for many doctors - the usually cited reasons for concern being addiction, oversight by state medical boards and criminal diversion of drugs.  However recent research has shown that addiction seldom occurs when these medications are use in chronic pain states. It is important to understand the difference between addiction and dependence (which occurs with all these drugs in the majority of patients (see Addiction/Dependence). Two particularly useful weak opioids in the management of FM pain are tramadol (Ultram) and the combination of tramadol with acetaminophen (Ultracet). Neither of these 2 medications is a FDA scheduled drug (i.e. they have minimal addiction potential)

Particularly painful areas often may be helped for a short time (2-3 months) by trigger point injections. This involves injecting a trigger point with a local anesthetic (usually 1% Procaine) and then stretching the involved muscle with a technique called spray and stretch. It should be noted the injection of a tender point is quite painful (indeed, if it is not painful the injection is seldom successful). After the injection, there is typically a 2-4 day lag before any beneficial effects are noted. Other techniques which directly help the tender areas on a transient basis are heat, massage, gentle stretching and acupuncture.

About 20% of FMS patients have a co-existing depression or anxiety state which needs to be appropriately treated with therapeutic doses of anti-depressants or anti-anxiety drugs often in conjunction with the help of a clinical psychologist or psychiatrist. Basically, patients who have a concomitant psychiatric problem have a double burden to bear. They will find it easier to cope with their FMS, if the psychiatric condition is appropriately treated. It is important to understand fibromyalgia syndrome itself is not a psychogenic pain problem and that treatment of any underlying psychological problems does not cure the fibromyalgia.

Most FMS patients quickly learn there are certain things they do on a daily basis that seem to make their pain problem worse. These actions usually involve the repetitive use of muscles or prolonged tensing of a muscle, such as the muscles of the upper back while looking at a computer screen. Careful detective work is required by the patient to note these associations and where possible to modify or eliminate them. Pacing of activities is important; we have recommended patients use a stop watch that beeps every 20 minutes. Whatever they are doing at that time should be stopped and a minute should be taken to do something else. For instance, if they are sitting down, they should get up and walk around or vice versa.

Patients who are involved in fairly vigorous manual occupations often need to have their work environment modified and may need to be retrained in a completely different job. Certain people are so severely affected, that consideration must be given to some form of monetary disability assistance. This decision requires careful consideration, as disability usually causes adverse financial consequences as well as a loss of self esteem. In general, doctors are reluctant to declare fibromyalgia patients disabled and most FMS applicants are initially turned down by the Social Security Administration at the first review. However, each patient needs to be evaluated on an individual basis before any recommendations for or against disability are made.
Newsweek Article on Fibromyalgia, May 19, 2003

 Fibromyalgia:  Not All in Your Head
Thanks to brain-scan technology, this ‘imaginary’ ailment of 6 million people is proving to be very real

 By Anne Underwood

 For years, Lynne Matallana couldn’t wear jewelry.  The pressure of a necklace or watch against her skin burned “like a blowtorch.”  Lying in bed under cotton sheets was agonizing.  Friendly handshakes sent pain shooting up her arm.  Matallana, 48, of Orange Calif., went to 37 doctors over the course of one year before she received a diagnosis of fibromyalgia — a condition involving pain throughout the body, heightened sensitivity to touch, and fatigue.  And she thinks of herself as one of the lucky ones.  “Patients used to go for decades without diagnosis or treatment,” says Matallana, who went on to found the National Fibromyalgia Association in 1997.

 Until recently, doctors didn’t believe fibromyalgia pain was real.  They thought it was “all in the heads” of sufferers, who happened to be mainly women.  When Dr. Muhammad Yumus of the University of Illinois began studying it in 1977, colleagues warned him, “You’ll ruin your career.  These women are just crazy.”  But the fact that doctors couldn’t find a cause or cure for some 6 million sufferers didn’t mean that the pain wasn’t there.  In the past few years scientists have used powerful brain scans to prove that it is.  Researchers have now pinpointed genetic variations that may play a role, and companies are racing to provide effective drugs.  “It’s a new day in fibromyalgia,” says Dr. Andrew Holmann, a Seattle rheumatologist who’s testing promising new pills.  “We’re starting to win the battle.”

 Fibromyalgia was thought to be imaginary largely because there’s no obvious source of pain – no injuries, worn joints or pinched nerves.  Instead it’s one of a number of poorly understood disorders, such as chronic fatigue and gulf-war syndromes, that are caused by “central sensitization” – or imbalances of chemicals and hormones in the nervous system.  In fibromyalgia, sensory messages to the brain are intensified, making even a warm bubble bath feel like torture.  Countervailing messages from the brain are too weak to shut off the pain response.  The combined effect is to “turn up the volume on pain,” says Dr. Daniel Clauw, a rheumatologist and professor of medicine at the University of Michigan.

 Clauw used functional MRI scans to provide the first objective proof that fibromyalgia pain is real.  In a study published last year, he took 16 sufferers and 16 unafflicted volunteers and applied a small amount of pressure to their left thumbs.  In the fibromyalgia patients, blood rushed to areas of the brain involved in pain perception.  The healthy volunteers might just as well have been getting a manicure.  Clauw had to double the pressure on them to elicit the same response that he saw in the afflicted group.

 The challenge now is to explain why.  Recent tests suggest that people who develop the syndrome start with a genetic predisposition.  The disease runs in families, and researchers have identified at least one gene that appears to be involved.  But life-style and temperament also play a part.  Often patients are workaholics who push themselves to the limit, despite years of escalating pain.  Then a trigger — a car accident, a viral infection—pushes them over the edge and knocks their nervous system out of whack.  Researchers have consistently found that patients have three times more of a pain-transmitting chemical called substance P in their spinal fluid and too little of the pain-reducing chemicals serotonin and norepinephrine.

 Understanding the syndrome will ultimately lead to better treatments.  (Therapy now centers on such low-tech approaches as improving sleep quality and doing low-impact aerobic exercise, both of which help rebalance the nervous system.)  But Pfizer is developing a new fibromyalgia drug that works, in part, by reducing substance P.  Cypress Bioscience is testing another that boosts pain-suppressing norepinephrine and serotonin.  For Matallana, a life once full of pain now holds a great deal of hope.

 byCatharine L. Shaner, MD, FAAP

Seven Steps to Finding a Doctor Who is Right For You For Fibromyalgia.

“There is nothing more I can do for you. You have to learn to live with it.” Translation: it is time to find a new doctor. For many patients, the next step is to open the phone book to an eye-catching ad and call for an appointment. Hold the phone! We tour neighborhoods with the best schools to shop for a house, we test drive cars to check out the features we want, and we read Consumer Reports before we buy the latest electronic gadget. Why, oh why, do we pick our doctor from a phone book? There is a better way. Consider this systematic approach to finding your “Dr. Right.”

 step 1

Define your specific requirements.

Each of you has unique needs and circumstances that are important factors in your decision-making process. Ask yourself these questions:  

1| Do I need a specialist?

Generalists, such as family doctors, are trained to know about a very broad range of topics. Your family doctor treats all of your problems, not just fibromyalgia (FM). If you need more in-depth treatment for your FM, she can be helpful in coordinating care with a specialty doctor. Specialists have extra training in their field of expertise and may be needed to diagnose a condition or provide advanced treatment. Traditionally, the rheumatologist is the specialist who most often diagnoses and treats fibromyalgia.
2| How far can I travel?

Most patients with chronic or complex conditions would travel any distance to see a good doctor if they could. Realistically, driving is very hard on some and impossible for others. Think about what you can consistently manage.  

3| Does my insurance restrict who I can see or where?
It is easier to work within your insurance guidelines than outside of the network, but consider all possible doctors at this point, regardless of insurance.

 step 2

Make a list of potential doctors.

Compile an interview list with the names and phone numbers of doctors who interest you. Leave several spaces between each name to jot notes and record appointment dates and times. The phone book is one way to start your list. Most yellow pages list physicians by specialty and location, two of the criteria from step one. Additional sources for locating doctors include:

 State and county medical societies
• Hospital referral services
• Other doctors or nurses
• Word of mouth (relatives, neighbors, co-workers)
• Local chapter of the Arthritis Foundation
• Web sites (See “Finding a Doctor on the Web”)
• Support groups – If there is a support group for fibromyalgia in your area, you have the inside scoop! There sits a group of people with your condition, people who are satisfied or dissatisfied with doctors of all kinds. Don’t be shy about asking for names. Keep in mind, however, that everyone’s needs are different regarding physicians. Hear complaints? Ask specifically what others dislike. For example, an excellent doctor might be worth a long waiting-room time.

 step 3

Make phone calls.
Interview list in hand, your first phone call should be to the office manager for each doctor or medical group. Leave a message that you are a potential patient and you would like to speak with her about the doctors and the office. The office manager knows the doctors’ training and experience. She can answer many of your routine questions, leaving you valuable time when you interview the doctor. Questions to ask the office manager:

1| Is the office accepting new patients?
2| What are the office hours and locations?
3| What is the accessibility of the office and facilities?
4| How long is the wait for a new patient appointment? A routine appointment? A sick visit?
5| In case of emergency or hospitalization, who will see me?
6| Does your office participate with my insurance? Is the office planning to drop that insurance in the next year? If I need to go on medical assistance, can I continue to see you?
7| What is your policy for working out a payment plan if I fall on hard times?
8| Is there a fee for an interview with a doctor?
9| Do any of the doctors treat patients with fibromyalgia? How many patients with fibromyalgia do they treat?
10| Which doctor do you think will suit my needs best? Explain briefly the style of practice you are looking for. Be specific. State, for example, “I want a doctor who is direct and to the point.” The office manager can certainly identify the doctor with the sense of humor, but she can’t really judge which doctors listen well or respect their patients. Some questions are better asked of other patients.
11| Is there anything else I should know about your practice?

Finish this step by asking to make an appointment to interview a doctor in the group. Make it clear to the scheduler that you want a no-cost interview with the doctor, not an exam. On your interview list, jot down the appointment date and time as well as a few notes from your talk with the office manager.

After interviewing the managers of all the offices on your list, choose the doctors you want to interview. Be sure to call back and cancel the appointments for the other offices.

 step 4

Interview the doctors.

This is the trying-on time. Trust your gut feeling. Your main goal is to interact with each doctor, checking for a comfortable fit and the ability to work together as a team. This is not the time, however, to ask about specific problems, such as why your knee is swollen today. That would require an examination.

 Plan to arrive early and listen to the conversations in the waiting room. Are the patients complaining? Can you overhear conversations from the front desk? Observe the facilities for cleanliness, privacy and accessibility. In the interview room, can you overhear nurses talking, or worse, arguing? Is the staff pleasant and happy to be there?  

When you greet the doctor, give her two lists. 1. A list of your current medications. 2. A short list of your medical problems or symptoms. Be brief. You just want to know if the doctor treats the disorders that you have. For example, state “gall bladder removed 1996,” not every belch that led up to the surgery.  

Also prepare a list of specific questions you want to ask the doctor. Remember, this is a 10 to 15 minute interview. You want to address your biggest concerns, so list your most important questions first. Then be sure to take your list with you! Examples of questions to ask the doctor:  

• Are you comfortable with diagnosing and treating fibromyalgia?
• How many FM patients have you treated?
• Are you familiar with my other conditions?
• What medications do you usually prescribe for fibromyalgia? Do you have a problem with prescribing the medications that I am taking? What is your policy on refills? (Be specific, especially with narcotics.)
• What do you feel is adequate pain control?
• Can you treat depression or must I see a specialist?
• Are you familiar with alternative therapies? How do you feel about _______? Fill in any alternative therapies you currently use or are interested in trying, such as herbal supplements, massage therapy, acupuncture, etc.
• One of the problems I had with my last doctor was feeling that she didn’t really listen to me. How can you and I communicate best?
• Do you do any teaching?
• I have disability papers to be filled out every month. How would that be handled?
• Sometimes I find articles on fibromyalgia that are helpful. Would you be willing to review them?
   Lastly, ask any questions the office manager couldn’t answer.

Be honest with yourself about what did not work with your last doc- tor. Whether experienced in treating fibromyalgia or not, you want a physician who is willing to take the time to learn from you and with you. A doctor who teaches keeps up-to-date. At the very minimum, you need a doctor who believes that fibromyalgia is a real disorder!  

Reflect upon the visit and jot down your impressions. Did the doctor’s sense of humor hit you just right or seem offensive? Pay attention to body language. Did you get good eye contact and a smile that crinkled the eyes? Did she believe in fibromyalgia? Were your questions answered? Did she listen with patience? Importantly, do you and she agree on the topics that concern you the most?

step 5

Check credentials.
This is an important, but often overlooked, step. Anyone can put an ad in the phone book or hang a sign on the office door. Here’s where you can check a doctor’s credentials:

• State or county medical society
• American Board of Medical Specialties (www.abms.org)
• Specialty licensing boards (www.abms.org/member.asp)

A lawsuit does not necessarily mean a doctor is incompetent. Some physicians are willing to take on especially challenging cases and may be sued more often, even if no wrongdoing occurred. You should expect, however, that your doctor has not had serious disciplinary actions, such as sexual misconduct or narcotics offenses.  

step 6

Talk with your insurance company.

Policy limits and approved providers vary widely and change frequently, so call your insurance company to be sure you have the most up-to-date information. Questions for the insurance company:  

• Are these doctors on my plan?
• Do I need a referral to see any of them?
• If they are not on the plan, what is the policy for seeing a doctor out-of-network?

 Seeing a doctor who is not on your plan may be allowed, but usually requires a higher co-payment or deductible. Do not cross the doctor off your list just yet. If this is the best physician for you, then perhaps it is money well spent.  

step 7

Choose the doctor you would like to try and schedule an appointment for a complete evaluation as a new patient.

Be sure to tell the scheduler you are a new patient with multiple problems and will need 1 - 1 1/2 hours. Request a copy of your medical records from your previous doctor. If your medical chart is complex, allow the new doctor a few weeks to review it. Deliver it in person and ask for a receipt. Remember to bring your referral slip and insurance card on the day of your first visit. Also, bring three papers for the doctor, preferably typed:  

1| A summary of your complete medical history. Be as concise as possible.
2| A complete medication list that includes: current prescription medications, herbal supplements, vitamins, over-the-counter and topical medications; allergies and previous adverse reactions, prior medications and why they didn’t work at that time.
3| A page listing today’s concerns, changes since your last visit to a doctor, medications for which you need refills today and forms you need filled out.
Keep your medical history and medication list in the computer. Update and print them for each doctor visit.  

During your exam, be clear about your expectations. Statements such as, “I need a diagnosis,” or “I need better pain control,” or “I need help deciding whether to cut back at work,” will tell the physician exactly what you require. At this visit, you can focus more closely on the cleanliness, privacy and confidentiality of the office. Also note the doctor’s listening skills, attention to detail and respect for you. Did she handle your whole case, not just focus on depression as the cause of all your ills? Did she offer ideas and suggestions? Did she exit before all your questions were answered? If you are not pleased with the results of this visit, keep interviewing other doctors until you are satisfied.  

Well, you made it. And it was well worth your effort. You found a gem of a doctor. Like new shoes, the fit may not be perfect at first. Adjustments are necessary for you and your doctor to become a team. Do not give up too easily. Remember, you are the one who needs to be in control of your health care so, when you run into problems, do not feel intimidated. Instead, address concerns frankly with the doctor and work out a solution together. Before long, you will be recommending your doctor to other patients.
Dear Friends: 

Fibromyalgia Awareness Day is right around the corner and this year’s theme “But You Don’t Look Sick! The Invisible Pain of Fibromyalgia” is something that everyone in the fibromyalgia community can relate to!

We hope that you will join us in our ongoing efforts to bring awareness to the issues surrounding fibromyalgia and to personally add your voice to this year’s campaign so that we can make sure that the future will be brighter for everyone living with and affected by fibromyalgia! 

The National Fibromyalgia Association has created a variety of programs that you can implement in your own local community. Each local effort will help assure that this year’s Awareness Day will be the biggest and most successful ever! Everyone who gets involved will make a difference and together we can rest assured that fibromyalgia will not be invisible any more!
Best wishes to all~

Lynne Matallana
 

National Fibromyalgia Association and Citrucel® Launch Awareness Day 2006 Campaign

“But You Don’t Look Sick! The Invisible Pain of Fibromyalgia”

 If you have fibromyalgia, chances are you’ve been told that “you don’t look sick!”

 The medical community has not yet discovered a marker for diagnosing this chronic pain condition, which afflicts over 10 million Americans. Patients’ outward physical appearance remains relatively unaffected: no bruises, no discoloration, no physical indication of the pain they are suffering. 

“This issue of ‘invisibility’ often adds to the challenge of gaining credibility and support for this illness from friends, family, co-workers, the media, and even some in the medical community,” says Lynne Matallana, president and founder of the National Fibromyalgia Association (NFA). “Many of us are still being told that fibromyalgia is ‘all in our heads.’”

To raise awareness of fibromyalgia as a real illness and to bring attention to its hidden symptoms, including sleep disorders, migraine headaches, depression, fatigue and IBS (Irritable Bowel Syndrome), the NFA and Citrucel® today launched this year’s National Fibromyalgia Awareness Day (commemorated on May 12, 2006) with the theme: “But You Don’t Look Sick! The Invisible Pain of Fibromyalgia.”

The NFA’s Awareness Day 2006 poster (click here to order) features the candid Polaroid photos of four people with fibromyalgia who don’t look sick, along with captions detailing the year they were diagnosed.

Introduction

You hurt all over, and you frequently feel exhausted. Even after numerous tests, your doctor can't seem to find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia.

Fibromyalgia is a chronic condition characterized by fatigue, widespread pain in your muscles, ligaments and tendons, and multiple tender points — places on your body where slight pressure causes pain. Fibromyalgia is more common in women than in men. Previously, the condition was known by other names such as fibrositis, chronic muscle pain syndrome, psychogenic rheumatism and tension myalgias.

Although the intensity of your symptoms may vary, they'll probably never disappear completely. It may be reassuring to know, however, that fibromyalgia isn't progressive, crippling or life-threatening. Treatments and self-care steps can improve symptoms and your general health.
 Signs and symptoms

Signs and symptoms of fibromyalgia can vary, depending on the weather, stress, physical activity or even the time of day. Common signs and symptoms include:

  • Widespread pain. Fibromyalgia is characterized by pain in specific areas of your body when pressure is applied, including the back of your head, upper back and neck, upper chest, elbows, hips and knees. The pain generally persists for months at a time and is often accompanied by stiffness.
  • Fatigue and sleep disturbances. People with fibromyalgia often wake up tired and unrefreshed even though they seem to get plenty of sleep. Some studies suggest that this sleep problem is the result of a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. So people with fibromyalgia miss the deep restorative stage of sleep. Nighttime muscle spasms in your legs and restless legs syndrome also may be associated with fibromyalgia.
  • Irritable bowel syndrome (IBS). The constipation, diarrhea, abdominal pain and bloating associated with IBS are common in people with fibromyalgia.
  • Headaches and facial pain. Many people who have fibromyalgia also have headaches and facial pain that may be related to tenderness or stiffness in their neck and shoulders. Temporomandibular joint (TMJ) dysfunction, which affects the jaw joints and surrounding muscles, is also common in people with fibromyalgia.
  • Heightened sensitivity. It's common for people with fibromyalgia to report being sensitive to odors, noises, bright lights and touch.

Other common signs and symptoms include:

  • Depression
  • Numbness or tingling sensations in the hands and feet (paresthesia)
  • Difficulty concentrating
  • Mood changes
  • Chest pain
  • Irritable bladder
  • Dry eyes, skin and mouth
  • Painful menstrual periods
  • Dizziness
  • Anxiety
Misspelled words used to find this page 2 of 3.tenion, tenson, tensin, tensiom, tenshun, tention, tens1on, temsion, tensino, tensoin, tenison, tesnion, tnesion, etnsion, tensio, ension, myalgia, myalgea, myargea, malgia, mylgia, myagia, myalia, myalga, myalgai, myargia, myargai, myalias, myalgas, myalgis, myalgias, myalgais, myargias, myargais, malgias, mylgias, myagias, nya1g1as, nyalg1as, nyalgias, myalgisa, myaligas, myaglias, mylagias, maylgias, ymalgias, yalgias, symptom, symppedom, symppedum, simppedom, smptom, simppedum, syptom, symtom, sympom, symptm, symptum, simptum, simptom, simptoms, symptoms, sympoms, symptms, symptos, symppedoms, simppedoms, smptoms, syptoms, symtoms, synptoms, symptosm, symptmos, sympotms, symtpoms, sypmtoms, smyptoms, ysmptoms, ymptoms, fatigue, ftigue, faigue, fatgue, fatiue, fatige, ft1gue, pht1gue, fat1gue, fatigeu, fatiuge, fatgiue, faitgue, ftaigue, aftigue, fatigu, atigue, sleep, selp, selap, selep, sleap, slep, sreep, sreap, srep, s13p, s1ep, slepe, lseep, problem, poblem, prblem, prolem, probem, problm, porblem, porbelm, probelm, porbrem, probrem, ploblem, plobelm, plobrem, perblem, perbelm, perbrem, probelms, porbrems, probrems, ploblems, plobelms, plobrems, perblems, perbelms, perbrems, porblems, porbelms, problems, poblems, prblems, prolems, probems, problms, probles, prob1ens, problens, problesm, problmes, prolbems, prbolems, rpoblems, roblems, diagnosis, daignosis, dyagnosis, diagnosys, daignosys, dyagnosys, dyagnocys, diagosis, diagnousys, diagnoecys, diagnousus, diagnoesus, diagnocus, diagnosus, diagnsis, dyagnousys, dyagnoecys, dyagnousus, dyagnoesus, daignocus, daignosus, diagnois, daignousys, daignoecys, daignousus, daignoesus, dyagnocus, dyagnosus, diagnoss, diagnoucys, diagnoecis, diagnousis, diagnoesis, diagnosee, diagnocis, dyagnoucys, dyagnoecis, dyagnousis, dyagnoesis, daignosee, daignocis, daignoucys, daignoecis, daignousis, daignoesis, dyagnosee, dyagnocis, dagnosis, diagnoesys, diagnoucis, diagnousee, diagnoesee, diagnocee, diagnocys, dignosis, dyagnoesys, dyagnoucis, dyagnousee, dyagnoesee, daignocee, daignocys, dianosis, daignoesys, daignoucis, daignousee, daignoesee, dyagnocee, d1agnos1s, diagmosis, diagnossi, diagnoiss, diagnsois, diagonsis, diangosis, diganosis, idagnosis, diagnosi, iagnosis, syndrome, syndroe, synderome, sinderome, sndrome, sydrome, synrome, syndome, syndrme, sindrome, syndlome, sindlome, symdrome, syndroem, syndrmoe, syndorme, synrdome, sydnrome, snydrome, ysndrome, syndrom, yndrome, treatment, treatent, treatmnt, treatmet, teatment, treament, tleetmiegnt, tratmiegnt, trheatmeignt, tleaitmant, tleaitmiegnt, tretmiegnt, trheaitmeignt, tlheatment, tlheatmiegnt, treetmiegnt, tleatmeignt, tlheatmant, treaitment, treaitmiegnt, tlatmeignt, tlheaitment, treaitmant, trheatmiegnt, tletmeignt, treatmeignt, trheatment, trheaitmiegnt, tleetmeignt, tratmeignt, trheatmant, tleatmiegnt, tleaitmeignt, tretmeignt, trheaitment, tlatmiegnt, tlheatmeignt, treetmeignt, trheaitmant, tletmiegnt, treatmiegnt, treaitmeignt, tleaitment, tratmant, triatmiegnt, tretmant, tratment, tliatmiegnt, treetmant, tretment, tleatmant, treetment, triatment, tlatmant, tleatment, triatmant, tletmant, tlatment, tliatment, tleetmant, tletment, tliatmant, tleetment,

Causes

The specific cause of fibromyalgia is unknown. However, doctors believe a number of factors may contribute. These factors may include:

  • Chemical changes in the brain. Some people with fibromyalgia appear to have alterations in the regulation of certain brain chemicals called neurotransmitters. This may be particularly true of serotonin — which is linked to depression, migraines and gastrointestinal distress — and substance P, a brain chemical associated with pain, stress and anxiety, as well as depression.
  • Sleep disturbances. Some researchers theorize that disturbed sleep patterns may be a cause rather than just a symptom of fibromyalgia.
  • Injury. An injury or trauma, particularly in the upper spinal region, may trigger the development of fibromyalgia in some people. An injury may affect your central nervous system, which may trigger fibromyalgia.
  • Infection. Some researchers believe that a viral or bacterial infection may trigger fibromyalgia.
  • Abnormalities of the autonomic (sympathetic) nervous system. Your autonomic nervous system is divided into the sympathetic and parasympathetic systems. Your sympathetic nervous system releases norepinephrine and influences the release of epinephrine from the adrenal gland. The sympathetic nervous system also controls bodily functions that you don't consciously control, such as heart rate, blood vessel contraction, sweating, salivary flow and intestinal movements.
  • Changes in muscle metabolism. For example, deconditioning and decreased blood flow may contribute to decreased strength and fatigue. Differences in metabolism and abnormalities in the hormonal substance that influences the activity of nerves (neuroendocrine) may play a role

 
Risk factors for fibromyalgia include:
  • Sex. Fibromyalgia occurs more often in women than in men.
  • Age. Fibromyalgia tends to develop during early and middle adulthood. But it can also occur in children and elderly adults.
  • Disturbed sleep patterns. It's unclear whether sleeping difficulties are a cause or a result of fibromyalgia — people with sleep disorders, such as nighttime muscle spasms in the legs, restless legs syndrome or sleep apnea, can also develop fibromyalgia.
  • Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.
  • Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis, lupus or ankylosing spondylitis, you may be more likely to have fibromyalgia.

When to seek medical advice

See your doctor if you experience general aching or widespread pain that lasts several months and is accompanied by fatigue. Many of the symptoms of fibromyalgia mimic those of other diseases, such as low thyroid hormone production (hypothyroidism), polymyalgia rheumatica, neuropathies, lupus, multiple sclerosis and rheumatoid arthritis. Your doctor can help determine if one of these other conditions may be causing your symptoms.

Screening and diagnosis

Diagnosing fibromyalgia is difficult because there isn't a single, specific diagnostic laboratory test. In fact, before receiving a diagnosis of fibromyalgia, you may go through several medical tests, such as blood tests and X-rays, only to have the results come back normal. Although these tests may rule out other conditions, such as rheumatoid arthritis, lupus and multiple sclerosis, they can't confirm fibromyalgia.

The American College of Rheumatology has established general classification guidelines for fibromyalgia, to help in the assessment and study of the condition. According to these guidelines, to be diagnosed with fibromyalgia you must have experienced widespread aching pain for at least three months and have a minimum of 11 locations on your body that are abnormally tender under relatively mild, firm pressure. In addition to taking your medical history, a doctor checking for fibromyalgia will press firmly on specific points on your head, upper body and certain joints so that you can confirm which cause pain.

Not all doctors agree with these guidelines. Some believe that the criteria are too rigid and that you can have fibromyalgia even if you don't meet the required number of tender points. Others question how reliable and valid tender points are as a diagnostic tool.

Complications

Fibromyalgia isn't progressive and generally doesn't lead to other conditions or diseases. It can, however, cause pain, depression and lack of sleep. These problems can then interfere with your ability to work at home or on the job, or maintain close family or personal relationships. The frustration of dealing with an often-misunderstood condition also can be a complication of the condition.

Treatment

In general, treatment for fibromyalgia is with a combination of medication and self-care. The emphasis is on minimizing symptoms and improving general health.

Medications
Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

  • Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Anaprox, Aleve) — in conjunction with other medications, but NSAIDs haven't proven to be effective in managing the pain in fibromyalgia when taken by themselves.
  • Antidepressants. Your doctor may prescribe antidepressant medications, such as amitriptyline (Elavil), nortriptyline (Aventyl, Pamelor) or doxepin (Sinequan) to help promote sleep. Fluoxetine (Prozac) in combination with amitriptyline has also been found effective. Sertraline (Zoloft) and paroxetine (Paxil) can help if you're experiencing depression.
  • Muscle relaxants. Taking the medication cyclobenzaprine (Flexeril) at bedtime may help treat muscle pain and spasms. Muscle relaxants are generally limited to short-term use.

Prescription sleeping pills, such as zolpidem (Ambien), may provide short-term benefits for some people with fibromyalgia, but doctors usually advise against long-term use of these drugs. These medications tend to work for only a short time, after which your body becomes resistant to their effects. Ultimately, using sleeping pills tends to create even more sleeping problems in many people.

Benzodiazepines may help relax muscles and promote sleep, but doctors often avoid these drugs in treating fibromyalgia. Benzodiazepines can become habit-forming, and they haven't been shown to provide long-term benefits.

Doctors don't usually recommend narcotics for treating fibromyalgia because of the potential for dependence and addiction. Corticosteroids, such as prednisone, haven't been shown to be effective in treating fibromyalgia.

Cognitive-behavioral therapy
Cognitive-behavioral therapy seeks to increase your belief in your own abilities and teaches you methods for dealing with stressful situations. Therapy can be provided via individual counseling, audiotapes or classes, and may help you manage your fibromyalgia.

Treatment programs
Interdisciplinary treatment programs may be effective in improving your symptoms, including relieving pain. These programs can combine a variety of treatments, such as relaxation techniques, biofeedback and receiving information about chronic pain. There isn't one combination that works best for everybody. Your doctor can create a program based on what works best for you.
Self-care is critical in the management of fibromyalgia.
  • Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
  • Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
  • Exercise regularly. At first, exercise may increase your pain. But doing it regularly often decreases symptoms. Appropriate exercises often include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
  • Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days.
  • Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.

Coping skills

Besides dealing with the pain and fatigue of fibromyalgia, you may also have to deal with the frustration of having a condition that's often misunderstood. In addition to educating yourself about fibromyalgia, you may find it helpful to provide your family, friends and co-workers with information.

It's also helpful to know that you're not alone. Organizations such as the Arthritis Foundation and the American Chronic Pain Association provide educational classes and support groups. These groups can often provide a level of help and advice that you might not find anywhere else. They can also help put you in touch with others who have had similar experiences and can understand what you're going through.

Complementary and alternative medicine

Complementary and alternative therapies for pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia.

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven't been adequately studied. Some of the more common complementary and alternative treatments promoted for pain management include:

  • Chiropractic care. This treatment is based on the philosophy that restricted movement in the spine may lead to pain and reduced function. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn't need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm. Because manipulation has risks, always go to properly trained and licensed practitioners.
  • Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. The therapy aims to improve circulation in the muscle, increasing the flow of nutrients and eliminating waste products. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety. Although massage is almost always safe, avoid it if you have open sores, acute inflammation or circulatory problems.
  • Osteopathy. Doctors of osteopathy go through rigorous and lengthy training in academic and clinical settings, equivalent to medical doctors. They're licensed to perform many of the same therapies and procedures as conventional doctors. One area where osteopathy differs from conventional medicine — but is similar to chiropractic medicine — is in the use of manipulation to address joint and spinal problems.
  • Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. In a 2006 Mayo Clinic study, acupuncture significantly improved symptoms of fibromyalgia. Research on the benefits of acupressure — a similar practice that uses finger pressure on the skin rather than needles — is inconclusive.
 Fibromyalgia

Fibromyalgia (FM or FMS) is a chronic syndrome (constellation of signs and symptoms) characterized by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. It is not contagious, and recent studies suggest that people with fibromyalgia may be genetically predisposed[1]. It affects more females than males, with a ratio of 9:1 by ACR (American College of Rheumatology) criteria[2]. Fibromyalgia is seen in 3% to 6% of the general population, and is most commonly diagnosed in individuals between the ages of 20 and 50. The nature of fibromyalgia is not well understood, with many frustrated physicians driven to accusing their patients of feigning illness. There are few, if any, treatments available. Although there is no cure, the disease itself is neither life-threatening nor progressive, though the degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission.

History

Fibromyalgia has been studied since the early 1800s and referred to by a variety of former names, including muscular rheumatism and fibrositis[3]. The term fibromyalgia was coined in 1976 to more accurately describe the symptoms, from the Latin word fibra, meaning fiber, myo, meaning muscle, and the Greek word algos, meaning pain.

Fibromyalgia was first recognized by the American Medical Association as a "true" illness and the cause of disability in 1987. In an article the same year, in the Journal of the American Medical Association, a physician named Goldenberg called the syndrome Fibromyalgia.

Symptoms

The primary symptom of fibromyalgia is widespread, diffuse pain, often including heightened sensitivity of the skin (Allodynia), tingling of the skin (often needlelike), achiness in the muscle tissues, prolonged muscle spasms, weakness in the limbs, and nerve pain. Chronic sleep disturbances are also characteristic of fibromyalgia, and some studies suggest that these sleep disturbances are the result of a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. REM sleep is seldom reached.

Many patients experience "brain fog", also known as "fibrofog", exhibiting abnormally slow brain waves and cognitive deficits[4]. Many experts suspect that "brain fog" is directly related to the sleep disturbances experienced by sufferers of fibromyalgia. It is not unusual for patients to experience extended periods (two hours or more) of 'sleep inertia'.

Other symptoms often attributed to fibromyalgia (possibly due to another comorbid disorder) are chronic paresthesia, physical fatigue, irritable bowel syndrome, genitourinary symptoms such as those associated with the chronic bladder condition interstitial cystitis, dermatological disorders, headaches, myoclonic twitches, and symptomatic hypoglycemia. Although it is common in people with fibromyalgia for pain to be widespread, it may also be localized in areas such as the shoulders, neck, back, hips, or other areas. Many sufferers also experience varying degrees of temporomandibular joint disorder. Not all patients have all symptoms.

Fibromyalgia can start as a result of some trauma (such as a traffic accident) or major surgery (usually hysterectomy[citation needed]), but there is currently no known strong correlation between any specific type of trigger and the subsequent initiation of fibromyalgia. Symptoms can have a slow onset, and many patients have mild symptoms beginning in childhood, such as growing pains. Symptoms are often aggravated by unrelated illness or changes in the weather. They can become more tolerable or less tolerable throughout daily or yearly cycles; however, many people with fibromyalgia find that, at least some of the time, the condition prevents them from performing normal activities such as driving a car or walking up stairs. The syndrome does not cause inflammation as is presented in arthritis, but anti-inflammatory treatments, such as Ibuprofen and Iontophoresis, are known to temporarily reduce pain symptoms in some people.

 Variability of Symptoms

The following factors are said to temporarily increase the suffering of patients:

  • Cold weather, especially when damp
  • Changes in atmospheric pressure (such as with the onset of a cold front)
  • Malnutrition, hunger, or starvation
  • Physical activity
  • Lack of deep (REM) sleep
  • Increase of stress

 Diagnosis

When making a diagnosis of fibromyalgia, a practitioner would take into consideration the patient's case history and the exclusion of other conditions such as endocrine disorders, arthritis, and polymyalgia rheumatica. There are also two criteria established by The American College of Rheumatology for diagnosis:

  • A history of widespread pain lasting more than three months — widespread as in all four quadrants of the body, i.e., both sides, and above and below the waist.
  • Tender points — there are 18 designated possible tender points (although a person with the syndrome may feel pain in other areas as well). During diagnosis, four kilograms-force (40 newtons) of force[3] is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered. Four kilograms of force is about the amount of pressure required to turn fingernails white or to feel pain sensations on the forehead. This technique was developed by the American College of Rheumatology as a means of confirming the diagnosis for clinical studies. It is also used in the United Kingdom. Pressure on nearby areas rarely elicits any reaction. Fibromyalgia patients also have elevated levels of Substance P in the body, which increases the levels of pain and intensity.

However, it should be remembered that this diagnostic criteria was originally established as an inclusion criteria for a research study and was not then intended for general diagnosis. The number of tender points that invoke a response can vary as the condition flares and eases. Patients have also been known to start off having Fibromyalgic symptoms in only one half of their body. The tender point test also depends on a good medical practitioner and good communication between doctor and patient: if the doctor misses the tender point site, then a false negative reponse could be noted; the doctor might not apply the right level of pressure to the tender point; if the patient has some tender points that hurt less than other points they might not mention them even if they do hurt; and some doctors do the test without telling the patient to say when it hurts, so if the patient conceals when some points hurts then a false negative response could be noted.

 Differentials

A number of other disorders can produce essentially the same symptoms as fibromyalgia. Other disorders known to produce similar symptoms are:

Treatment

As with many other soft tissue and rheumatolgical organic disorders, there is no cure for fibromyalgia. However, there is increasing interest and research which has led to improvements in treatment. Treatment ranges from symptomatic prescription medication to alternative and complementary medicine.

One experimental treatment is the use of the Guaifenesin Protocol, developed by Dr. R. Paul St. Amand. Because of the large number of patients improving on Guaifenesin, there are now several doctors throughout the U.S. who are using the Guaifenesin protocol in their practices[5]. Guaifenesin is an ingredient in some decongestants. However, the Guai protocol has not been proved in proper research studies.

Another treatment being researched is the use of dextromethorphan, which is sold over the counter as a cough suppresant.[6]

Another treatment protocol developed by Dr. John Brimhall, a chiropractor from Mesa, Arizona, focuses on treating all different aspects of the body together. Nutrition, particularly for the adrenal glands, and healing nutrients for the digestive and hormonal systems are used in conjunction with emotional balancing techniques and detox therapies. [7]

Low doses of antidepressants like amitriptyline and trazodone may be used to reduce the sleep disturbances sometimes associated with fibromyalgia and are believed by some practitioners to help correct sleep problems that may exacerbate the symptoms of the condition. Because depression often accompanies chronic illness, these antidepressants have additional psychological benefits for patients suffering from depression. Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain. Some doctors advise against using narcotic sleep aids ("hypnotics"), since these can actually disrupt deep sleep in some patients.

Normal doses of newer anti-depressants (SSRI's) like Celexa are being used. Anti-seizure drugs are sometimes also used.

New drugs showing significant efficacy on fibromyalgia pain and other symptoms include milnacipran, gabapentin, meloxicam and pregabalin. Milnacipran belongs to a new series of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs), and is currently available in parts of Europe where it has been safely prescribed for other disorders. As of August 2005, Milnacipran is the subject of a Phase III study, and, if ultimately approved by the FDA, will be distributed in the United States.

Studies have found gentle exercise, such as warm-water pool therapy, improves fitness and sleep and may reduce pain and fatigue in people with fibromyalgia. Stretching is recommended to allay muscle stiffness and fatigue, as is mild aerobic exercise. Because strenuous activity can exacerbate the muscle pain and fatigue already present, patients are advised to begin slowly and build their activity level gradually to avoid inducing additional pain. Exercise may be poorly tolerated in more severe cases with abnormal post-exertional fatigue.

Cognitive behavioral therapy has been shown to improve quality of life and coping in fibromyalgia patients and other sufferers of chronic pain.

EEG Biofeedback has also shown to provide temporary and long term relief, and as it gains more widespread coverage.

Many patients find temporary relief by applying heat to painful areas. Those with access to physical therapy and/or massage may find them beneficial. Chiropractic care can also help relieve pain due to fibromyalgia.

A holistic approach, including managing diet, sleep, stress, activity and pain is used by many patients. Dietary supplements, massage, chiropactic care, managing blood sugar levels, and avoiding known triggers when possible means living as well as it is in the patient's power to do.

Treatment for the "brain fog" has not yet been developed, however biofeedback and self-management techniques such as pacing and stress management may be helpful for some patients. The use of anti-depressants, which improves sleep, helps some patients.

A number of practitioners are attracted to the treatment of fibromyalgia, especially because its cause has yet to be identified, and due to its permanent nature, ongoing treatments can be very profitable. While this interest may promote legitimate medical research, patients should be wary: treatments of dubious validity exist in the meantime.

Living with fibromyalgia

Fibromyalgia can affect every aspect of a person's life. While neither degenerative nor fatal, the chronic pain associated with fibromyalgia is pervasive and persistent. FMS can severely curtail social activity and recreation, and as many as 30% of those diagnosed with fibromyalgia are unable to maintain full-time employment. Like others with disabilities, individuals with FMS often need accommodations to fully participate in their education or remain active in their careers.

In the United States, those who are unable to maintain a full-time job due to the condition may apply for Social Security Disability benefits. Although fibromyalgia has been recognized as a condition, along with chronic fatigue syndrome, by the government, applicants are often denied benefits. However, most are awarded benefits at the state judicial level; the entire process often takes two to four years.

In the United Kingdom, the Department for Work and Pensions recognizes fibromyalgia as a condition for the purpose of claiming benefits and assistance[8].

In India, the position with reference to this condition is unclear. However, where the person is rendered incapable of maintaining a regular life due to any disability, he/she can claim disability benefits. Indian laws guarantee that discrimination against people with disabilities is a violation of their individual rights.

Fibromyalgia is often referred to as an "invisible" illness or disability due to the fact that generally there are no outward indications of the illness or its resulting disabilities. The invisible nature of the illness, as well as its relative rarity and the lack of understanding about its pathology, often has psychosocial complications for those that have the syndrome. Individuals suffering from invisible illnesses in general often face disbelief or accusations of malingering or laziness from others that are unfamiliar with the syndrome.

There are a variety of support groups on the Web that cater to fibromyalgia sufferers. Some are offered at the bottom of this article.

Theories on the cause of fibromyalgia

The cause of fibromyalgia is currently unknown. Over the past few decades, many theories have been presented, and the understanding of the disorder has changed dramatically. Most current theories explain only a few symptoms of the disorder and are thus incomplete.

Dopamine abnormality

Dopamine is a neurotransmitter that is now known to play a role in Parkinson's disease and likely plays a role in fibromyalgia, as well as restless leg syndrome. Pramipexole, a drug that stimulates dopamine receptors and is used to treat Parkinson's disease, has been shown to have a positive effect on fibromyalgia and restless legs syndrome. Because dopamine is very difficult to measure, it could explain why sufferers of fibromyalgia do not show a pattern of abnormal results in other medical tests that do not measure dopamine. Even in Parkinson's disease, dopamine is not measured, but the link is now accepted. ]

 Serotonin deficiency

Serotonin is a neurotransmitter that is known to play a role in regulating sleep patterns, mood, feelings of well-being, concentration, digestion. One theory of fibromyalgia causation is a serotonin deficiency contributing to poor sleep, headaches, migraines, irritable bowel syndrome, tinnitus, PMS, poor concentration, depression, constipation. Some patients treated with SSRI's (especially Celexa) have shown improvement in these areas.

Sleep disturbance

The sleep disturbance theory postulates that fibromyalgia is related to sleep quality. Electroencephalography (EEG) studies have shown that people with fibromyalgia lose deep sleep[10]. Circumstances that interfere with "stage 4" deep sleep (such as drug use, pain, depression, serotonin deficiency, or anxiety) appear to be able to cause or worsen the condition.

According to the sleep disturbance theory, an event such as a trauma or illness causes sleep disturbance and, possibly, some sort of initial chronic pain. These initiate the disorder. The theory supposes that "stage 4" sleep is critical to the function of the nervous system, as it is during that stage that certain neurochemical processes in the body reset. In particular, pain causes the release of the neuropeptide substance P in the spinal cord, and substance P has the effect of amplifying pain and causing nerves near the initiating ones to become more sensitive to pain. Under normal circumstances, this just causes the area around a wound to become more sensitive to pain, but, if pain becomes chronic and body-wide, then this process can run out of control. The sleep disturbance theory holds that deep sleep is critical in order to reset the substance P mechanism and prevent this out-of-control effect.

An interesting aspect of the sleep disturbance/substance P theory is that it explains "tender points" that are characteristic of fibromyalgia but which are otherwise enigmatic, since their positions don't correspond to any particular set of nerve junctions or other obvious body structures. The theory posits that these locations are more sensitive because the sensory nerves that serve them are positioned in the spinal cord to be most strongly affected by substance P. The theory also explains some of more general neurological features of fibromyalgia, since substance P is active in many other areas of the nervous system.

Critics of the theory argue that it does not explain slow-onset fibromyalgia, fibromyalgia present without tender points, or patients without heightened pain symptoms, and a number of the non-pain symptoms present in the disorder.

Also of interest is a possible connection between this theory and the theory that chronic fatigue syndrome and post-polio syndrome are due, at least in part, to damage to the ascending reticular activating system of the reticular formation. This area of the brain, in addition to apparently controlling the sensation of fatigue, is known to control sleep behaviors and is also believed to produce some neuropeptides, and thus injury or imbalance in this area could cause both CFS and sleep-related fibromyalgia, explaining why the two disorders so often occur together.

Deposition disease

Another theory involves phosphate and calcium accumulation in cells that eventually reaches a level to impede the ATP process, possibly caused by a kidney defect or missing enzyme that prevents the removal of excess phosphates from the blood stream. This theory posits that fibromyalgia is an inherited disorder, and that phosphate buildup in cells is gradual (but can be accelerated by trauma or illness). Calcium is required for the excess phosphate to enter the cells. The additional phosphate slows down the ATP process; however the excess calcium prods the cell to continue producing ATP[11].

Diagnosis is made with a specialized technique called mapping, a gentle palpitation of the muscles to detect lumps and areas of spasm that are thought to be caused by an excess of calcium in the cytosol of the cells. This mapping approach is specific to deposition theory, and is not related to the trigger points of myofascial pain syndrome.

While this theory does not identify the causative mechanism in the kidneys, it proposes a treatment known as guaifenesin therapy. This treatment involves administering the drug guaifenesin to a patient's individual dosage, avoiding salicylic acid in medications or on the skin, and, if the patient is also hypoglycemic, a diet designed to keep insulin levels low.

The phosphate build-up theory explains many of the symptoms present in fibromyalgia and proposes an underlying cause. The guaifenesin treatment, based on this theory, has received mixed reviews, with some practitioners claiming many near-universal success and others reporting no success. Only one controlled clinical trial has been conducted to date, and it showed no evidence of the efficacy of this treatment protocol. This study was criticized for not limiting the salicylic acid exposure in patients, and for studying the effectiveness of only guaifenesin, not the entire treatment method. As of 2005, further studies to test the protocol's effectiveness are in the planning stages, with funding for independent studies largely collected from groups which advocate the theory.

Fibromyalgia as severe TMS

Another theory is that fibromyalgia is a severe form of Tension myositis syndrome (TMS) which is a mindbody disorder popularized in the books on healing back, neck, and other limb pain by Dr. John E. Sarno of the Howard A. Rusk Institute of Rehabilitation Medicine. Briefly the theory is that in many cases chronic pain is the result of physical changes (primarily mild oxygen deprivation) caused by the brain through the autonomic nervous system as a strategy for distracting you from painful or dangerous unconscious emotions such as repressed anger. Treatment is through a program of education and attitude change which stops the brain from using that chronic pain strategy. Psychotherapy is suggested in the minority of cases where education alone is not sufficient.

 

[edit] Other theories

Other theories relate to various toxins from the patient's environment, viral causes such as the Epstein-Barr Virus, growth hormone deficiencies possibly related to an underlying (maybe autoimmune) disease affecting the hypothalamus gland, an aberrant immune response to intestinal bacteria,[15][16] neurotransmitter disruptions in the central nervous system, and erosion of the protective chemical coating around sensory nerves. Due to the multi-systemic nature of illnesses such as fibromyalgia and chronic fatigue syndrome (CFS/ME), an emerging branch of medical science called psychoneuroimmunology (PNI) is looking into how the various theories fit together.

Comorbid diseases

Cutting across several of the above theories is a theory that proposes that fibromyalgia is almost always a comorbid disorder, occurring in combination with some other disorder that likely served to "trigger" the fibromyalgia in the first place. This concept fits especially well with the sleep disturbance theory.

By this theory, some other disorder (or trauma) occurs first, and fibromyalgia follows as a result. In some cases, the original disorder abates on its own or is separately treated and cured, but the fibromyalgia remains. This is especially apparent when fibromyalgia seems triggered by major surgery. In other cases the two disorders coexist. This theory would explain why such a wide variety of symptoms are often ascribed to fibromyalgia, since there are potentially a wide variety of comorbid disorders. It also helps explain why fibromyalgia is so hard to treat, since the fibromyalgia is unlikely to abate while the comorbid condition is untreated.

Skepticism

Some physicians believe that fibromyalgia is not an actual symptom complex. They claim that the symptoms of fibromyalgia are manifestations of depression, along with symptoms of diseases such as chronic fatigue syndrome, Epstein-Barr syndrome, interstitial cystitis, irritable bowel syndrome, bacterial infection, and others. Fibromyalgia has also been called a "wastebasket" diagnosis, usually meaning that the doctor doesn't acknowledge real pathology or consistent disease.

Few medical authorities still believe that depression and psychological factors are the root cause of the syndrome, similar to hypochondria

"This isn't a disease, it's merely a description of symptoms... We've taken stress, psychosocial distress and pain and the ordinary life experiences some people have and turned them into something they're not -- a physical illness"
-- Dr. Fred Wolfe, a skeptical Rheumatologist who helped define the disease earlier in his career[17].

However, new research has provided a blood test for the syndrome, and some pathological abnormalities have been discovered.

"Recent genetic findings suggest that specific gene mutations may predispose individuals to develop Fibromyalgia.

In addition, neurobiological studies indicate that Fibromyalgia patients have abnormalities within central brain structures that normally encode pain sensations in healthy pain-free controls."'' [6]

The underlying premises of the fibromyalgia hypothesis fail under critical scrutiny, some practicing physicians believe. In fact, the very existence of the fibromyalgia concept testifies to the degree that physiologic data has been confounded and reprocessed by a fanciful and untestable theory. The concrete physical examination data of patients with “chronic widespread pain” typically reveal a very rational array of musculotendinous pain disorders.

Frequent features include trapezio-cervical and rhomboid muscle strain ailments, humeral epicondylitis, greater trochanteric pain disorder, iliac crest syndrome and other peri-pelvic resiliency problems. Any one or combination of such persistent variable pain sources can, in the right socio-medical setting, be misinterpreted by all involved as a seemingly spontaneous or innate mystery disorder of comfort.

In a subset of individuals, spurious fibromyalgia concepts become a dysfunctional interface with family, employment, compensation sources, and the legal system. Instead, one may simply identify the array of muscle-tendon pain disorders as an expression of the common heritage of the human anatomy which is vulnerable to resiliency failures at numerous points along the kinetic chains which mechanically operate the body. The specific diagnosis of each pain pattern allows plausible explanation and management with standard techniques, permitting physician and patient to work together without the curious frustration common to the “fibromyalgia” hypothesis.

In this critique of fibromyalgia, there is no justification for aligning musculotendinous pain with irritable bowel syndrome, bladder and cerebral symptoms, chronic fatigue, or other poorly defined symptom patterns. Resiliency disorders of muscle-tendon units are endemic, easily-understood, and in a sense anatomically necessary. When interpreted as such, the “mystery” disappears, the term fibromyalgia is discarded, and the ailments causing this form of pain take their place among those medical problems subject to rational management
Fibromyalgia What Is It?

Fibromyalgia (fye-bro-my-AL-gee-ah) is an arthritis-related condition that is characterized by  generalized muscular pain and fatigue. The term "fibromyalgia" means pain in the muscles, ligaments and tendons. This condition is referred to as a "syndrome" because it's a set of signs and symptoms that occur together.

Fibromyalgia is especially confusing and often misunderstood condition. Because its symptoms are quite common and laboratory  tests are generally normal, people with fibromyalgia were once told that their condition was "all in their head." However, medical studies have proven that fibromyalgia does indeed exist, and it is estimated to affect about 2 percent of the U.S. population today.

In 1990, the American College of Rheumatology, the official body of doctors who treat arthritis and related conditions, finally legitimized fibromyalgia in the medical community by presenting its criteria for diagnosing it. It is diagnosed when the you display the following symptoms:

  • A history of widespread pain (pain on both sides of the body and above and below the waist) that is present for at least three months
     
  • Pain in at least 11 of 18 tender-point sites.

Fibromyalgia: What It Is and How to Manage It

What is fibromyalgia?

Fibromyalgia is a condition that causes pain in the muscles, joints, ligaments and tendons. The pain occurs in areas called "tender points." Common tender points are the front of the knees, the elbows, the hip joints and around the neck.

Fibromyalgia affects up to 5% of the population, including children. This disorder might be hereditary (run in families), so you may have family members with similar symptoms.

What are the symptoms of fibromyalgia?

Increased sensitivity to pain is the main symptom of fibromyalgia. Many other symptoms also occur in people with this disorder. Symptoms may come and go.

You may have some degree of constant pain, but the pain may get worse in response to activity, stress, weather changes and other factors. You may have a deep ache or a burning pain. You may have muscle tightening or spasms. Many people have migratory pain (pain that moves around the body).

Most people with fibromyalgia feel tired or fatigued (out of energy). This fatigue may be mild or very severe. You may also have trouble sleeping, which may add to the fatigue.

You may have feelings of numbness or tingling in parts of your body, or a feeling of poor blood flow in some areas. Many people are very sensitive to odors, bright lights, loud noises and even medicines. Headaches and jaw pain are also common.

In addition, you may have dry eyes or difficulty focusing on nearby objects. Problems with dizziness and balance may also occur. Some people have chest pain, a rapid or irregular heartbeat, or shortness of breath.

Digestive symptoms are also common in fibromyalgia and include difficulty swallowing, heartburn, gas, cramping abdominal pain, and alternating diarrhea and constipation.

Some people have urinary complaints, including frequent urination, a strong urge to urinate and pain in the bladder area. Women with fibromyalgia often have pelvic symptoms, including pelvic pain, painful menstrual periods and painful sexual intercourse.

Why do I feel depressed?

Depression or anxiety may occur as a result of your constant pain and fatigue, or the frustration you feel with the condition. It is also possible that the same chemical imbalances in the brain that cause fibromyalgia also cause depression and anxiety.

Does fibromyalgia cause permanent damage?

No. Although fibromyalgia causes symptoms that can be very uncomfortable, your muscles and organs are not being damaged. This condition is not life-threatening, but it is chronic (ongoing). Although there is no cure, you can do many things to help you feel better.

Is there any medicine I can take to help my symptoms?

Several medicines can help relieve symptoms of fibromyalgia. Many of these medicines are taken before bedtime and improve your sleep. They also help the pain and other symptoms.

You will probably begin to notice the benefits of these medicines in about 6 to 8 weeks. When you begin taking these medicines, it is common to feel very groggy the following morning. Other possible side effects include dry eyes and mouth, nightmares, constipation and increased appetite. These side effects are worse when you begin taking the medicine and improve with time.

What else can I do to relieve my symptoms?

One of the best things you can do is low-impact aerobic exercise. Examples of this type of exercise include swimming or water exercise, stationary bicycling and exercising on ski-type machines. You may need to begin at a very low level of exercise (5 minutes every other day is helpful at first). Continue to increase the length and frequency of exercise until you are exercising for at least 30 to 60 minutes at least 4 times a week. Once you reach this point, you can consider switching to high-impact exercises, like walking, jogging and tennis.

Because the symptoms of fibromyalgia are made worse by stress and poor sleep, it is important to cut stress out of your life whenever possible and to get as much sleep as you need. Since alcohol and caffeine cause poor sleep, avoid these substances around bedtime.

Other simple lifestyle changes may be helpful. For example, try keeping your activity level the same each day. Many people with fibromyalgia try to do as much as possible on "good" days, which leads them to have several "bad" days. If you keep your activity level even, you may not have as many "bad" days.

Questions and Answers About Fibromyalgia

Table of Contents

Information Box

What Is Fibromyalgia?

Fibromyalgia syndrome is a common and chronic disorder characterized by widespread muscle pain, fatigue, and multiple tender points. The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Tender points are specific places on the body—on the neck, shoulders, back, hips, and upper and lower extremities—where people with fibromyalgia feel pain in response to slight pressure.

Although fibromyalgia is often considered an arthritis-related condition, it is not truly a form of arthritis (a disease of the joints) because it does not cause inflammation or damage to the joints, muscles, or other tissues. Like arthritis, however, fibromyalgia can cause significant pain and fatigue, and it can interfere with a person's ability to carry on daily activities. Also like arthritis, fibromyalgia is considered a rheumatic condition.

You may wonder what exactly rheumatic means. Even physicians do not always agree on whether a disease is considered rheumatic. If you look up the word in the dictionary, you'll find it comes from the Greek word rheum, which means flux—not an explanation that gives you a better understanding. In medicine, however, the term rheumatic means a medical condition that impairs the joints and/or soft tissues and causes chronic pain.

In addition to pain and fatigue, people who have fibromyalgia may experience

  • sleep disturbances,
  • morning stiffness,
  • headaches,
  • irritable bowel syndrome,
  • painful menstrual periods,
  • numbness or tingling of the extremities,
  • restless legs syndrome,
  • temperature sensitivity,
  • cognitive and memory problems (sometimes referred to as "fibro fog"), or
  • a variety of other symptoms.

Fibromyalgia is a syndrome rather than a disease. Unlike a disease, which is a medical condition with a specific cause or causes and recognizable signs and symptoms, a syndrome is a collection of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause.

Who Gets Fibromyalgia?

According to a paper published by the American College of Rheumatology (ACR), fibromyalgia affects 3 to 6 million - or as many as one in 50 - Americans. For unknown reasons, between 80 and 90 percent of those diagnosed with fibromyalgia are women; however, men and children also can be affected. Most people are diagnosed during middle age, although the symptoms often become present earlier in life.

People with certain rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus (commonly called lupus), or ankylosing spondylitis (spinal arthritis) may be more likely to have fibromyalgia, too.

Several studies indicate that women who have a family member with fibromyalgia are more likely to have fibromyalgia themselves, but the exact reason for this—whether it be hereditary or caused by environmental factors or both—is unknown. One study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is trying to identify if certain genes predispose some people to fibromyalgia. (See What Are Researchers Learning About Fibromyalgia?)

What Causes Fibromyalgia?

The causes of fibromyalgia are unknown, but there are probably a number of factors involved. Many people associate the development of fibromyalgia with a physically or emotionally stressful or traumatic event, such as an automobile accident. Some connect it to repetitive injuries. Others link it to an illness. People with rheumatoid arthritis and other autoimmune diseases, such as lupus, are particularly likely to develop fibromyalgia. For others, fibromyalgia seems to occur spontaneously.

Many researchers are examining other causes, including problems with how the central nervous system (the brain and spinal cord) processes pain.

Some scientists speculate that a person's genes may regulate the way his or her body processes painful stimuli. According to this theory, people with fibromyalgia may have a gene or genes that cause them to react strongly to stimuli that most people would not perceive as painful. However, those genes—if they, in fact, exist—have not been identified.

How Is Fibromyalgia Diagnosed?

Research shows that people with fibromyalgia typically see many doctors before receiving the diagnosis. One reason for this may be that pain and fatigue, the main symptoms of fibromyalgia, overlap with many other conditions. Therefore, doctors often have to rule out other potential causes of these symptoms before making a diagnosis of fibromyalgia. Another reason is that there are currently no diagnostic laboratory tests for fibromyalgia; standard laboratory tests fail to reveal a physiologic reason for pain. Because there is no generally accepted, objective test for fibromyalgia, some doctors unfortunately may conclude a patient's pain is not real, or they may tell the patient there is little they can do.

A doctor familiar with fibromyalgia, however, can make a diagnosis based on two criteria established by the ACR: a history of widespread pain lasting more than 3 months and the presence of tender points. 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 ACR also has designated 18 sites on the body as possible tender points. For a fibromyalgia diagnosis, a person must have 11 or more tender points. (See illustration on page 5.) One of these predesignated sites is considered a true tender point only if the person feels pain 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.

The location of the nine paired tender points that comprise the 1990 American College of Rheumatology criteria for fibromyalgia
The location of the nine paired tender points that
comprise the 1990 American College of Rheumatology
criteria for fibromyalgia.

How Is Fibromyalgia Treated?

Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Many family physicians, general internists, or rheumatologists (doctors who specialize in arthritis and other conditions that affect the joints or soft tissues) can treat fibromyalgia.

Fibromyalgia treatment often requires a team approach, with your doctor, a physical therapist, possibly other health professionals, and most importantly, yourself, all playing an active role. It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these various professionals can help you improve your quality of life.

You may find several members of the treatment team you need at a clinic. There are pain clinics that specialize in pain and rheumatology clinics that specialize in arthritis and other rheumatic diseases, including fibromyalgia.

At present, there are no medications approved by the U.S. Food and Drug Administration (FDA) for treating fibromyalgia, although a few such drugs are in development. Doctors treat fibromyalgia with a variety of medications developed and approved for other purposes.

Following are some of the most commonly used categories of drugs for fibromyalgia:

Analgesics

Analgesics are painkillers. They range from over-the-counter acetaminophen (Tylenol*) to prescription medicines, such as tramadol (Ultram), and even stronger narcotic preparations. For a subset of people with fibromyalgia, narcotic medications are prescribed for severe muscle pain. However, there is no solid evidence showing that narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential that the person taking them will become physically or psychologically dependent on them.

* Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

As their name implies, nonsteroidal anti-inflammatory drugs, including aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Anaprox, Aleve), are used to treat inflammation. Although inflammation is not a symptom of fibromyalgia, NSAIDs also relieve pain. The drugs work by inhibiting substances in the body called prostaglandins, which play a role in pain and inflammation. These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.

Antidepressants

Perhaps the most useful medications for fibromyalgia are several in the antidepressant class. Antidepressants elevate the levels of certain chemicals in the brain, including serotonin and norepinephrine (which was formerly called adrenaline). Low levels of these chemicals are associated not only with depression, but also with pain and fatigue. Increasing the levels of these chemicals can reduce pain in people who have fibromyalgia. Doctors prescribe several types of antidepressants for people with fibromyalgia, described below.

  • Tricyclic antidepressants—When taken at bedtime in dosages lower than those used to treat depression, tricyclic antidepressants can help promote restorative sleep in people with fibromyalgia. They also can relax painful muscles and heighten the effects of the body's natural pain-killing substances called endorphins.

    Tricyclic antidepressants have been around for almost half a century. Some examples of tricyclic medications used to treat fibromyalgia include amitriptyline hydrochloride (Elavil, Endep), cyclobenzaprine (Cycloflex, Flexeril, Flexiban), doxepin (Adapin, Sinequan), and nortriptyline (Aventyl, Pamelor). Both amitriptyline and cyclobenzaprine have been proved useful for the treatment of fibromyalgia.

  • Selective serotonin reuptake inhibitors—If a tricyclic antidepressant fails to bring relief, doctors sometimes prescribe a newer type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). As with tricyclics, doctors usually prescribe these for people with fibromyalgia in lower dosages than are used to treat depression. By promoting the release of serotonin, these drugs may reduce fatigue and some other symptoms associated with fibromyalgia. The group of SSRIs includes fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

    SSRIs may be prescribed along with a tricyclic antidepressant. Doctors rarely prescribe SSRIs alone. Because they make people feel more energetic, they also interfere with sleep, which often is already a problem for people with fibromyalgia. Studies have shown that a combination therapy of the tricyclic amitriptyline and the SSRI fluoxetine resulted in greater improvements in the study participants' fibromyalgia symptoms than either drug alone.

  • Mixed reuptake inhibitors—Some newer antidepressants raise levels of both serotonin and norepinephrine, and are therefore called mixed reuptake inhibitors. Examples of these medications include venlafaxine (Effexor) and nefazadone (Serzone). Researchers are actively studying the efficacy of these newer medications in treating fibromyalgia.

Benzodiazepines

Benzodiazepines help some people with fibromyalgia by relaxing tense, painful muscles and stabilizing the erratic brain waves that can interfere with deep sleep. Benzodiazepines also can relieve the symptoms of restless legs syndrome, which is common among people with fibromyalgia. Restless legs syndrome is characterized by unpleasant sensations in the legs as well as twitching, particularly at night. Because of the potential for addiction, doctors usually prescribe benzodiazepines only for people who have not responded to other therapies. Benzodiazepines include clonazepam (Klonopin) and diazepam (Valium).

Other medications

In addition to the previously described general categories of drugs, doctors may prescribe others, depending on a person's specific symptoms or fibromyalgia-related conditions. For example, in recent years, two medications— tegaserod (Zelnorm) and alosetron (Lotronex) - have been approved by the FDA for the treatment of irritable bowel syndrome. Gabapentin (Neurontin) currently is being studied as a treatment for fibromyalgia. (See What Are Researchers Learning About Fibromyalgia?.) Other symptom-specific medications include sleep medications, muscle relaxants, and headache remedies.

People with fibromyalgia also may benefit from a combination of physical and occupational therapy, from learning pain-management and coping techniques, and from properly balancing rest and activity.

Complementary and alternative therapies

Many people with fibromyalgia also report varying degrees of success with complementary and alternative therapies, including massage, movement therapies (such as Pilates and the Feldenkrais method), chiropractic treatments, acupuncture, and various herbs and dietary supplements for different fibromyalgia symptoms. (For more information on complementary and alternative therapies, contact the National Center for Complementary and Alternative Medicine. See Where Can I Get More Information About Fibromyalgia?.)

Though some of these supplements are being studied for fibromyalgia, there is little, if any, scientific proof yet that they help. The FDA does not regulate the sale of dietary supplements, so information about side effects, the proper 12 dosage, and the amount of a preparation's active ingredient may not be well known. If you are using or would like to try a complementary or alternative therapy, you should first speak with your doctor, who may know more about the therapy's effectiveness, as well as whether it is safe to try in combination with your medications.

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.

What Can I Do To Try To Feel Better?

Besides taking medicine prescribed by your doctor, there are many things you can do to minimize the impact of fibromyalgia on your life. These include:

  • Getting enough sleep—Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. (See Tips for Good Sleep.) Even so, many people with fibromyalgia have problems such as pain, restless legs syndrome, or brain-wave irregularities that interfere with restful sleep.
  • Exercising—Though pain and fatigue may make exercise and daily activities difficult, it's crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise and build their endurance and intensity slowly. Although research has focused largely on the benefits of aerobic and flexibility exercises, a new NIAMS-supported study is examining the effects of adding strength training to the traditionally prescribed aerobic and flexibility exercises.
  • Making changes at work—Most people with fibromyalgia continue to work, but they may have to make big changes to do so; for example, some people cut down the number of hours they work, switch to a less demanding job, or adapt a current job. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job. An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift.

    If you are unable to work at all due to a medical condition, you may qualify for disability benefits through your employer or the Federal Government.

    Social Security Disability Insurance (SSDI) and Supplemental Security Insurance (SSI) are the largest Federal programs providing financial assistance to people with disabilities. Though the medical requirements for eligibility are the same under the two programs, the way they are funded is different. SSDI is paid by Social Security taxes, and those who qualify for assistance receive benefits based on how much an employee has paid into the system; SSI is funded by general tax revenues, and those who qualify receive payments based on financial need. For information about the SSDI and SSI programs, contact the Social Security Administration. (See Where Can I Get More Information About Fibromyalgia?.)

  • Eating well—Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.
Tips for Good Sleep
  • Keep regular sleep habits. Try to get to bed at the same time and get up at the same time every day—even on weekends and vacations.
  • Avoid caffeine and alcohol in the late afternoon and evening. If consumed too close to bedtime, the caffeine in coffee, soft drinks, chocolate, and some medications can keep you from sleeping or sleeping soundly. Even though it can make you feel sleepy, drinking alcohol around bedtime also can disturb sleep.
  • Time your exercise. Regular daytime exercise can improve nighttime sleep. But avoid exercising within 3 hours of bedtime, which actually can be stimulating, keeping you awake.
  • Avoid daytime naps. Sleeping in the afternoon can interfere with nighttime sleep. If you feel you can't get by without a nap, set an alarm for 1 hour. When it goes off, get up and start moving.
  • Reserve your bed for sleeping. Watching the late news, reading a suspense novel, or working on your laptop in bed can stimulate you, making it hard to sleep.
  • Keep your bedroom dark, quiet, and cool.
  • Avoid liquids and spicy meals before bed. Heartburn and latenight trips to the bathroom are not conducive to good sleep.
  • Wind down before bed. Avoid working right up to bedtime. Do relaxing activities, such as listening to soft music or taking a warm bath, that get you ready to sleep. (An added benefit of the warm bath: It may soothe aching muscles.)

What Are Researchers Learning About Fibromyalgia?

The NIAMS sponsors research that will improve scientists' understanding of the specific problems that cause or accompany fibromyalgia, in turn helping them develop better ways to diagnose, treat, and prevent this syndrome.

The research on fibromyalgia supported by NIAMS covers a broad spectrum, ranging from basic laboratory research to studies of medications and interventions designed to encourage behaviors that reduce pain and change behaviors that worsen or perpetuate pain.

Following are descriptions of some of the promising research now being conducted:

  • Understanding pain—Because research suggests that fibromyalgia is caused by a problem in how the body processes pain—or more precisely, a hypersensitivity to stimuli that normally are not painful—several NIAMS-supported researchers are focusing on ways the body processes pain to better understand why people with fibromyalgia have increased pain sensitivity.

    Previous research has shown that people with fibromyalgia have reduced blood flow to parts of the brain that normally help the body deal with pain. In one new NIAMS-funded study, researchers will be using imaging technology called positron emission tomography (PET) to compare blood flow in the brains of women who have have fibromyalgia with those who do not. In both groups, researchers will study changes in blood flow that occur in response to painful stimuli.

    Researchers speculate that female reproductive hormones may be involved in the increased sensitivity to pain characteristic of fibromyalgia. New research will examine the role of sex hormones in pain sensitivity, in reaction to stress, and in symptom perception at various points in the menstrual cycles of women with fibromyalgia and of women without it. The results from studying these groups of women will be compared with results from studies of the same factors in men without fibromyalgia over an equivalent period of time.

    Another line of NIAMS-funded research involves developing a rodent model of fibromyalgia pain. Rodent models, which use mice or rats that researchers cause to develop symptoms similar to fibromyalgia in humans, could provide the basis for future research into this complex condition.

  • Understanding stress—Medical evidence suggests that a problem or problems in the way the body responds to physical and/or emotional stress may trigger or worsen the symptoms of any illness, including fibromyalgia. Researchers funded by NIAMS are trying to uncover and understand these problems by examining chemical interactions between the nervous system and the endocrine (hormonal) system. Scientists know that people whose bodies make inadequate amounts of the hormone cortisol experience many of the same symptoms as people with fibromyalgia, so they also are exploring if there is a link between the regulation of the adrenal glands, which produce cortisol, and fibromyalgia.

    Another NIAMS-funded study suggests that exercise improves the body's response to stress by enhancing the function of the pituitary and adrenal glands. The hormones produced by these two endocrine glands are essential to regulating sleep and emotions, as well as processing pain.

  • Improving sleep—Researchers supported by NIAMS are investigating ways to improve sleep for people with fibromyalgia whose sleep problems persist despite treatment with medications. One team has observed that fibromyalgia patients with persistent sleep problems share characteristics with people who have insomnia, such as having erratic sleep and wake schedules and spending too much time in bed. This team is testing whether strategies developed to help insomnia patients will also help people with fibromyalgia achieve deep sleep, which eases pain and fatigue. Preliminary results show that sleep education, which teaches good sleep habits, and cognitive behavioral therapy, which includes sleep education and a regimen to correct poor habits and improper sleep schedules, both reduce insomnia.
  • Looking for the family connection—Because fibromyalgia appears to run in families, one group of NIAMS-supported researchers is working to identify whether a gene or genes predispose people to the condition.

    Another team is trying to determine if fibromyalgia is more common in people with other conditions, such as serious mood disorders, that tend to run in families. Specifically, the group is studying the prevalence of psychiatric disorders and arthritis and related disorders in people with fibromyalgia and their first-degree relatives (parents, children, sisters, brothers) as compared to people with rheumatoid arthritis and their relatives. The group is exploring whether clusters of conditions exist in families, which might shed light on shared common risk factors or disease processes.

  • Studying and targeting treatments—NIAMS recently funded its first study of a drug treatment for fibromyalgia. The study will measure the effectiveness of gabapentin, an anticonvulsant medication, in reducing symptoms of fibromyalgia. Gabapentin has been found to relieve chronic pain caused by nervous system disorders, and it was recently approved by the FDA for the treatment of persistent, severe pain that can follow an episode of shingles.

    Scientists recognize that people with fibromyalgia often fall into distinct subgroups that adapt to and cope with their symptoms differently. They also realize that these subgroups may respond to treatments differently. One NIAMS-funded team of researchers has divided people with fibromyalgia into three groups based on how they cope with the condition. Relative to other chronic pain patients, those in the first group have higher levels of pain and report more interference in their life due to pain. They also have higher levels of emotional distress, and feel less control over their lives and are less active. The second group reports receiving less support from others, higher levels of negative responses from significant others, and lower levels of supportive responses from significant others. Those in the third group are considered adaptive copers; they have less pain, report less interference in their lives due to pain, and have less emotional distress. Members of this last group feel more control over their lives and are more active. On the premise that the better you understand the subgroups, the better you can tailor treatments to fit them, the researchers now are trying to design and test different programs for each group, combining physical therapy, interpersonal skills training, and supportive counseling.

Where Can I Get More Information About Fibromyalgia?

  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
    National Institutes of Health
    1 AMS Circle
    Bethesda, MD 20892-3675
    Phone: 877-22-NIAMS (226-4267) (free of charge)
    TTY: 301-565-2966
    Fax: 301-718-6366
    E-mail: NIAMSInfo@mail.nih.gov
    www.niams.nih.gov

     
  • National Center for Complementary and Alternative Medicine
    National Institutes of Health
    P.O. Box 7923
    Gaithersburg, MD 20898-7923
    Phone: 888-644-6226 (free of charge)
    TTY: 866-464-3615 (free of charge)
    Fax: 866-464-3616 (free of charge)
    E-mail: info@nccam.nih.gov
    www.nccam.nih.gov

     
  • Social Security Administration
    Office of Public Inquiries
    Windsor Park Building
    6401 Security Boulevard
    Baltimore, MD 21235
    Phone: 800-772-1213 (free of charge)
    TTY: 800-325-0778 (free of charge)
    www.ssa.gov/disability

     
  • American College of Rheumatology/Association of Rheumatology Health Professionals
    1800 Century Place, Suite 250
    Atlanta, GA 30345-4300
    Phone: 404-633-3777
    Fax: 404-633-1870
    www.rheumatology.org

     
  • Advocates for Fibromyalgia Funding, Treatment, Education, and Research
    P.O. Box 768
    Libertyville, IL 60048-0766
    Phone: 847-362-7807
    Fax: 847-680-3922
    E-mail: info@affter.org
    www.affter.org

     
  • Fibromyalgia Network
    P.O. Box 31750
    Tucson, AZ 85751-1750
    Phone: 800-853-2929 (free of charge)
    www.fmnetnews.com

     
  • National Fibromyalgia Association
    2200 N. Glassell Street, Suite A
    Orange, CA 92865
    Phone: 714-921-0150
    www.fmaware.org
    Tenemos disponible información en español y personal bilingüe.

     
  • National Fibromyalgia Partnership
    P.O. Box 160
    Linden, VA 22642-0160
    Phone: 866-725-4404 (free of charge)
    Fax: 866-666-2727 (free of charge)
    E-mail: mail@fmpartnership.org
    www.fmpartnership.org

     
  • Arthritis Foundation
    1330 West Peachtree Street, Suite 100
    Atlanta, GA 30309
    Phone: 404-872-7100 or
    800-568-4045 (free of charge) or call your local chapter
    (To find your local chapter, check your phone directory or visit the foundation's Web site.)
    www.arthritis.org

Key Words

Adrenal glands—A pair of endocrine glands located on the surface of the kidneys. The adrenal glands produce corticosteroid hormones such as cortisol, aldosterone, and the reproductive hormones.

Arthritis—Literally means joint inflammation, but is often used to indicate a group of more than 100 rheumatic diseases. These diseases affect not only the joints but also other connective tissues of the body, including important supporting structures, such as muscles, tendons, and ligaments, as well as the protective covering of internal organs.

Analgesic—A medication or treatment that relieves pain.

Connective tissue—The supporting framework of the body and its internal organs.

Chronic disease—An illness that lasts for a long time, often a lifetime.

Cortisol—A hormone produced by the adrenal cortex, important for normal carbohydrate metabolism and for a healthy response to stress.

Fibrous capsule—A tough wrapping of tendons and ligaments that surrounds the joint.

Fibromyalgia—A chronic syndrome that causes pain and stiffness throughout the connective tissues that support and move the bones and joints. Pain and localized tender points occur in the muscles, particularly those that support the neck, spine, shoulders, and hip. The disorder includes widespread pain, fatigue, and sleep disturbances.

Inflammation—A characteristic reaction of tissues to injury or disease. It is marked by four signs: swelling, redness, heat, and pain. Inflammation is not a symptom of fibromyalgia.

Joint—A junction where two bones meet. Most joints are composed of cartilage, joint space, fibrous capsule, synovium, and ligaments.

Ligaments—Bands of cordlike tissue that connect bone to bone.

Muscle—A structure composed of bundles of specialized cells that, when stimulated by nerve impulses, contract and produce movement.

Nonsteroidal anti-inflammatory drugs (NSAIDs)—A group of drugs, such as aspirin and aspirin-like drugs, used to reduce inflammation that causes joint pain, stiffness, and swelling.

Pituitary gland—A pea-sized gland attached beneath the hypothalamus at the base of the skull that secretes many hormones essential to bodily functioning. The secretion of pituitary hormones is regulated by chemicals produced in the hypothalamus.

Sleep disorder—A disorder in which a person has difficulty achieving restful, restorative sleep. In addition to other symptoms, people with fibromyalgia usually have a sleep disorder.

Tender points—Specific places on the body where a person with fibromyalgia feels pain in response to slight pressure.

Tendons—Fibrous cords that connect muscle to bone
Misspelled words used to find this page 3 of 3 triatmeignt, treatmant, tliatmeignt, treatnemt, treatmemt, treatmetn, treatmnet, treatemnt, treamtent, tretament, traetment, teratment, rteatment, treatmen, reatment, aiment, ailment, alment, ailmet, ailmnt, ailent, ialment, airment, ailmant, ialmant, airmant, arimiegnt, alimiegnt, arimeignt, aliment, alimeignt, alimet, alimnt, alient, ariment, alimant, arimant, a11nemt, a1lnemt, ailnemt, ailmemt, ailmetn, ailmnet, ailemnt, aimlent, ailmen, ilment, ,doctor, docter, doctur, doctol, doctro, docotr, dotcor, dcotor, odctor, docto, doctr, docor, dotor, dctor, octor, insurance, insulenc, isurance, inurance, insrance, insuance, insurnce, insurace, insurane, insurenc, insulanse, insulense, insurence, insuranse, insurense, insulance, insulence, iegnsurance, iegnsurence, eignsurance, iegnsuranse, eignsurence, iegnsurense, eignsuranse, iegnsurenc, eignsurense, iegnsulance, eignsurenc, iegnsulence, eignsulance, iegnsulanse, eignsulence, eignsulanse, insuanc, insuranc, insurnc, insulanc, insurac, eignsuranc, eignsulanc, iegnsuranc, iegnsulanc, isuranc, inuranc, insranc, 1nsurance, imsurance, insuranec, insuracne, insurnace, insuarnce, insruance, inusrance, isnurance, nisurance, nsurance, medical, meical, medcal, medicl, mdical, medycal, medicar, medycar, metical, meticar, medial, medail, medyal, mediar, medyar, medair, metial, metiar, medear, medeal, medica, medyca, metica, ned1ca1, ned1cal, nedical, medicla, mediacl, medcial, meidcal, mdeical, emdical, edical,complicatin, complication, complicatiom, cmplication, compricatiom, coplication, complicachon, comlication, compricachon, compication, complicachun, complcation, compricachun, compliation, compliction, complicaion, compricasion, complicaton, complicashun, complicashon, comprication, compricaton, compricashun, compricashon, complicasion, complicashons, comprications, compricatons, compricashuns, compricashons, complicasions, compricasions, complicatons, complicashuns, complications, compricatioms, comlications, complicachons, compications, compricachons, complcations, complicachuns, compliations, compricachuns, complictions, complicaions, complicatins, complicatios, cmplications, complicatioms, coplications, conp11cat1oms, conpl1cat1oms, conplicatioms, complicatiosn, complicatinos, complicatoins, complicaitons, complictaions, compliactions, complciations, compilcations, comlpications, copmlications, cmoplications, ocmplications, omplications, alternative, artornative, alternatie, alternatve, alternaive, alterntive, altenative, altrnative, alernative, aternative, altornative, alturnative, arternative, arturnative, altelnative, artelnative, alteative, alterative, altrative, alerative, alteraive, aterative, altorative, artorative, alteratie, alteratve, altertive, alturative, arterative, arturative, altelative, artelative, altelnativ, alterntiv, altornatiff, artelnativ, alternaiv, artornatiff, altornativ, alternatv, alturnatiff, artornativ, arturnatiff, alturnativ, aternativ, arturnativ, alernativ, alternatiff, altrnativ, arternatiff, alternativ, altenativ, altelnatiff, arternativ, alterativ, artelnatiff, a1ternat1ve, alternat1ve, altermative, alternatiev, alternatvie, alternaitve, alterntaive, alterantive, altenrative, altrenative, aletrnative, atlernative, laternative, lternative
You Get a Party Tent or Consulting Discount  or Free Stuff When
You Are Signed Up To Receive My Daily Newsletter.
For Details  Click: NelsonsNews
Letter.com 
404

Brian Nelson's Blue Box
Reference Directory
 31 Gessner Rd. Houston, TX  77024
Tel. 713-467-3025, Fax 713-467-3192
 Click: E-mail me
01/10/2007 07:02 AM -0600

 Click To See All of Brian's Websites
Complete Directory
Or Try Another Google Search Here.

Click Brian's Websites List Directory
Categories Click below to view these 183 interesting and informational websites.
Animals Click Dog - Cat/ Diarrhea & Constipation  Click Fighting Carpenter Ant Backyard Click Koi Pond Fish
Anti-Aging Click Youthful Beauty Treatment Anti-Aging
Automotive Click Car Auto Safety Problem: Killing 43,200 Americans / Year. Click Car Safety. Crash Tests, Comparing Sedans, SUV's, Sport Utility Vehicles, Upscales Cars, Luxury & Passenger Cars,  Click JD Auto Collision Houston .com Body Shop Repair  Click Hybrid Cars
Cancer Click Cancer- Head-Neck- Diagnosis Info  Cancer Chemotherapy Treatment Side Effects  Click Cancer Fighting Foods - Vegetables.
  Click Dogs Detecting Cancer Fact or Fiction?
Click Cancer Healing Foods Photo Directory    Click Rosemary's Cancer Fighting Food Recipies.  Click Prostate Cancer  Click Rare Medical Problems Click Cancer Treatment Click Cancer & Malnutrition
Click Cancer Head-Neck-Treatment Radiation Chemotherapy Info V1 Click V2 NI Cancer-Chemotherapy Drugs-Side-Effects   Click Cancer Feeding Tube Click My Story Parotid Gland Cancer of Jill Bates Father.
Click I Am Fighting Cancer.com Cancer Journal for Brian Nelson .  Click Lung Cancer
Computers Click Computer & Laser Printer and Inkjet Repair .com Click Remove Mirar A Bad Toolbar
Click Computer Keyboard Tips & Tricks Click  Computer Warranties
Consulting Click Brian Nelson Consulting .com Business and Organization Consulting. Click The Business Critic
Click NelsonIdeas.com Creative problem solving Click Creative Inventions by Brave Entrepreneurs. Ideas That Changed the Way We Live Click Entrepreneur Think Tank Click Warranty Vs. Guarantee FAQ
Click Improvement Trainer for Any Business or Organization.   Click Misspelled Words on Brian's  Websites
Click Discontinued Wallpaper Co. A 25 year Pictorial Business StudyClick Computer Warranaties,  Houston, TX
Consumer Issues Click Wal-Mart  Great Outdoors Grill Quality
 Click KItchenAid Defective Can Opener Click Microwave Safety
Directories Click Brian Nelson's Websites Directories
Engineering Click Truss-Systems-History-Of-Trusses Click-Bridge Construction History of Bridges
Click Tunnel Construction History of Tunnels Click Dam Construction History of Dams
Education Click Internationl Educational Directories
Entertainment
And Funny Stuff.

Click Percussion Teacher.com Piano & Percussion Lessons Houston, TX Meredith Nelson, Percussionist,
 Click Wind Chimes Photo & Audio Directory  Click Ted-Drews Compared to Shipley Donuts
Click No. 4.Humor Directory Video Clips, Slide Shows
Click No. 1 Brian's Collections of 80 Funny Pics, Pictures, Photos, Images, Comedic & Interesting Drawings 
Click No. 2 Funny Talking  Dead Deer Mini Movie 5 min Movie . Click No. 3 Dog Fatih, Walks Bi-Pedal 2 legsl like a Human Movie Click Houston Area Free Concerts. Click George Bush Photos and Quotes
 Click Remember When?  Brian Nelson's Senior Citizen Photo Journal of Memories from the Early 1900's
Click Houston Seniors Entertainment.com for Nursing Homes, Retirement  & Alzheimers & Assisted Living Centers

Free Internet Space Click Wanted to Buy Classifieds .com FREE . Click Brians Google Information Websites
Click Make  a difference In The World. Write About Your Thoughts Free. email Brian  
Free Newsletters Click Brian Nelson's  Free Daily Newsletter on Hundreds of  Different Topics
Foreign Language Sites Click Spanish/Espanol  Party Tent Info Letter    Click German/Deutsch Party Tent Info Letter  Click Portuguese Party Tent Info Letter. Click French/Français   Party Tent Info Letter    Click Italian/ItalianoParty Tent  Info Letter
General Sales Click Surplus City Sales. com Houston List you items to buy or sell here. Click Brian's eBay Store 679 Customers
Click Houston-Garage-Sale.com list your Wanted to Buy or Items For Sale here.
Holidays Click History of Christmas Family Holiday Celebration Story & PIctures. Religious  Art. Click History of Valentines Day
Legal Click Houston Immigration and Accident Lawyer Manuel Solis  Abogoado  Inmigracion & Accidentes
Click Medical Malpractice
Medical Information
TN TNA		 Click Asparagus causes stinky urine.  Click Hiccoughs, Hiccups Click Bilateral Facial Pain   Click Upset Stomach Compendium Click Burning Tongue    Click Dreams  Click Alzheimers Disease Early Warning Signals 
 Click Nelson Family Medical History Data Base Click Diabetes Click Constipation   Click Diarrhea  Click Heart Operation ByPass Surgery Click Temporomandibular Joint or Jaw FAQ. TMJ Click Aneurysm Medical  Bill S Testimonial
Click Foreign Accent Syndrome Click Heart Attack Click Poison Ivy Click Sleep DisordersClick Updates on Nail Fungus Cures, Remedy/Treatments For Fungal Nails, Onychomycosis  Click Coughing Cures Cough Treatment
Click Blood Pressure Click Fibromyalgia Click Earache Pain Click Depression Click Sneezing Sneeze
Click Sciatica Nerve Treatment Click Arthritis Pain Treatment
Military Click Big Military Directory Army, Navy, Marines, Air Force, Coast Guard
Money And Finance Click Mortgage Financing Information Tips for low Rates, Mortgage Rate Calculators
Click Adwords Prices  Click I Bonds The Govt. Guarnanted  Investment .
 Click  Reverse Mortgages Click Internet Search Words & Phrases
Money And Finance Click Mortgage Financing Information Tips for low Rates, Mortgage Rate Calculators  Click Adwords Prices
 Click I Bonds The Govt. Guarnanted  Investment . Click  Reverse Mortgages Click Internet Search Words & Phraes
People to Know Click Charles Lang's 80th Birthday Party Click Josephine Visnovske.Click George Bush Photos and Quotes
Click Howard Dean Controversial Democrat Speech.Click Judge Sandra Day O'Connor Supreme Court Retires/ Judge Samuel A. Alito, Jr. Click Brian's Best Digital Photos Click The J. B. Nelson Family Ironwood, MI. Click Pope John Paul II 1920-2005 A Great Man Did you know him?.Click Rosemary Nelson Activities Photo Journal Houston, TX  Click Sharon and Gil Lewsion Family  Click ETM Rosemarys Education Music Party  Click Drew B Party
Photography Click Nelson Family Medical History Data BaseClick Kitchen-Remodeling-31-Gessner/Houston, TX Click Idea Photos
Click Houston Digital Still Photographer  Emergency and Backup Photography for Weddings & Commercial
Public Issues  Click Metro Rail Accident Record  Click End Addiction To Oil
 Click Global Warming It Must be Stopped. Click Immigration Laws Legal Enforcement Click NelsonsNewsletter.com Free daily informative letter.
Real Estate Click Dean Nelson, The Best Realtor in Madison, WI.
Recreation Click Houston-Recumbent-Bike-Club.com Houston, TX  Click Houston BarbQ Cookoff " Outta Control "Cooker Photos Red Tent Click-Adam Buffalo Bayou Click Red-Stairs.com Brians Photos  Dock and Deck on Buffalo Bayou Houston
Religious Click Bible Pronunciation .com  AUDIO Version Pronounce A-M,  Click Bible Pronunciation .com  AUDIO Version Pronounce N-Z,  Click  Bible Pronunciation WRITTEN Version A-M  Click  Bible Pronunciation WRITTEN Version N-Z
Click OLD Testament Brian's Bible Audio Visual Reference Directory. View Bible Images. Listen to Bible while you Surf.
 Click NEW Testament Brian's Bible Audio Visual Reference Directory. View Bible Images. Listen to Bible while you Surf. Click Intelligent Design Creationism-Evolution What is it? Click Study of Proverbs Click MDPC Future Click History of EasterClick God Is The .com  GOD-The Place to Go for the Best Answer to Any Problem. He Is Your Best Friend.  One Liner Bible Quotes.
Technology Click Radford Video Creations Jim Radford, Producer  Receptions,Click  If you have Cable Speed for a 6 minute Radford Video Creations.  Click  Do You Understand Your Cell Phone? The Cell Phone Expert
Click Cell-Phone-Expert.com  Click AdSense and AdWords Marketing Research   
Click U of H Internet Marketing on monetizing SEO via EBay / Ofoto  Click  Remove Mirar  A Bad Toolbar
Click  Biometrics  Security! Fingerprint, Retina, Voice, Click Misspelled Words On Brians Websites Click Pelamis Wave Energy Converter Electricity
Tents, Tarps, Party
Tent Canopies, Awnings Dome Tents		 Click Competitors Tent-Tarp-Awnings-Directory  Click Form Letter Click Generic-Text Only  PTC Info Click Misspelled Party Tent Words Click Party Tent Duradiagrams
Click Party Tent City.com Party Tents, Awnings, Fire& Flame Retardant Tarps Canopies Camping Canopy, Clear Window Tarpaulins, Wedding & Church Revival Tents, Tent Hardware, Dome Shelters,  Garage Tents, Portable Storage, Modular Tents, Backyard Movie Screens, Golf Driving Range Rain & Shade Shelters, Black Mesh Shade Cloth, White,Silver, Tarps, 6x8, 10x10, 10x20,10x20, 20x20, 20x30,20x40, 30x30,30x40,40x40,40x50, 40x60. 50x50. Click Images Photos-Only Party Tents Canopies  Awnings Click Tent Installation Instructions  Click Tarp City .com Fire Retardant, Flame Retardant  White & Silver Heavy Duty Tarps. Red, White and Blue Patriotic tarps. Clear Window Tarps, Black Mesh and Shade Cloth. Custom Tarps. Custom .Click Tent DuraDiagrams 1 Connector Images. Click Diagrams 2
Click ChangingIdeas.com Tent Folder Click IdeaPhotos.com Tents File   Click Dome Tent Photos and Instructions. Click Clear Tarps/ Clear Window Tarp Click Changing Ideas Party Tents Click Party Tent Compressed Version
Tent  Discounts Click Ask about the Party Tent or Consulting discounts you get when you subscribe free to: www.NelsonsNewsLetter.com
Travel Click Cruise to Cozumel, Mexico and Progresso, Yucatan . Click China Travel
Click Josephine Visnovske's Free E-Book on Greece Click World Travel Directories for International FAQ's on Air & Train Travel, Lodging, Touring
Click Google Earth. You won't Believe What you can see on this site. Your House, Free Software Download Required
Click Evergreen Club& Affordable Travel Club Members  Brian & Rosemary Nelson New England Seniors Visited
Click Evergreen Club & Affordable Travel Club  Lyn & David Hargreaves  Animal & Scenic Photo Journal
 Click China Modern Architecture Photos. Modernization in the 21st Century.
Trigeminal Neuralgia
Extreme Facial Pain		 Click Dental Education Trigeminal Neuralgia Extreme Facial Pain Click Trigeminal Neuralgia Patient Painful-Stories
Click My Trigeminal Neuralgia (TN) Story only  Click My Story on TN Brian N   Click Trigeminal Neuralgia Slide Show Story of Pain Click Medical Data Base  Medical Costs More Expensive  Due to Non Use of Technology Click MyTrigeminal Neuralgia Story Directory Click Slide Show Draft for New TN Patients. Click-Trigeminal Neuralgia Assn Page 1  Click-Trigeminal Neuralgia Assn Page 2
 Click What is Trigeminal Neuragia? Portland,OR Slide Show Click Trigeminal Neuralgia National Conference
Click The Trigeminal Neuralgia National  Association Website A Hard to  Diagnose Medical Disorder. Head Pain.
Click Trigeminal Neuralgia  Brian's Journal Tic Douloureux (TN) FacialPain-Cancer Click Page 1. Trigeminal Neuralgia   Click Page 2 Trigeminal Neuralgia Click Page 3 Trigeminal Neuralgia  Click Page 4  Trigeminal Neuralgia 
  Click MyTrigeminal Neuralgia Stories Directory  Click Brian's TN Story Quck Version  Shirley  Sandi
Wanted Click. Wanted Vinyl Outdoor Building Material Click. Wanted to Buy Classifieds. List your wants here FREE.  
Click Free Internet Classified Advertising
Houston Click Whispering Oaks-Bunker Hill Recycle Team Houston, TX

Recent Changes  Click Earache Pain Click George Bush Photos and Quotes
Major Cities of Interest to this Site.
1 New York City, New York;
2 Los Angeles, California;
3 Chicago, Illinois
 4 Houston, Texas
5 Philadelphia, Pennsylvania
6 Phoenix, Arizona
7 San Antonio, Texas
8 San Diego, California
9 Dallas, Texas
10 San Jose, California9
11 Detroit, Michigan
12 Indianapolis, Indiana
13 Jacksonville, Florida
14 San Francisco, California
15 Columbus, Ohio
16 Austin, Texas
17 Memphis, Tennessee
18 Baltimore, Maryland
19 Fort Worth, Texas
20 Charlotte, North Carolina		 21 El Paso, Texas
22 Washington, District of Columbia
23 Milwaukee, Wisconsin
24 Seattle, Washington
25 Boston, Massachusetts
26 Denver, Colorado
27Louisville,  Kentucky
28 Nashville-Davidson  Tennessee
29 Las Vegas, Nevada
30 Portland, Oregon
31 Oklahoma City, Oklahoma
32 Tucson, Arizona
33 Albuquerque, New Mexico
34 Long Beach, California
35 Atlanta, Georgia
36 Fresno, California
37 Sacramento, California
38 New Orleans, Louisiana
39 Cleveland, Ohio
40 Kansas City, Missouri		 41 Mesa, Arizona
42 Virginia Beach, Virginia
43 San Juan, Puerto Rico
44 Omaha, Nebraska
45 Oakland, California
46 Miami, Florida
47 Tulsa, Oklahoma
48 Honolulu CDP, Hawaii
49 Minneapolis, Minnesota
50 Colorado Springs, Colorado
51 Arlington, Texas
52 Wichita, Kansas
53 St. Louis, Missouri
54 Raleigh, North Carolina
55 Santa Ana, California
56 Anaheim, California
57 Tampa, Florida
58 Pittsburgh, Pennsylvania
59 Cincinnati, Ohio
60 Toledo, Ohio		 61 Aurora, Colorado
62 Bakersfield, California
63 Riverside, California
64 Stockton, California
65 Corpus Christi, Texas
66 Newark, New Jersey
67 Buffalo, New York
68 Saint Paul, Minnesota
69 Anchorage, Alaska
70 Lexington, Kentucky
71 Plano, Texas
72 St. Petersburg, Florida
73 Jersey City, New Jersey
74 Glendale, Arizona
75 Lincoln, Nebraska
76 Chandler, Arizona
77 Henderson, Nevada
78 Greensboro, North Carolina
79 Norfolk, Virginia
80 Birmingham, Alabama		 81 Scottsdale, Arizona
82 Fort Wayne, Indiana
83 Bayamón, Puerto Rico
84 Baton Rouge, Louisiana
85 Madison, Wisconsin
86 Hialeah, Florida
87 Chesapeake, Virginia
88 Garland, Texas
89 Orlando, Florida
90 Rochester, New York
91 Akron, Ohio
92 Chula Vista, California
93 Lubbock, Texas
94 Laredo, Texas
95 Modesto, California
96 Durham, North Carolina
97 Reno, Nevada
98 Fremont, California
99 Montgomery, Alabama
100 Glendale, California

You are at: http://www.NewMedicalDirectories.com/Fibromyalgia/Information.html    ud 01/10/2007 06:55 AM -0600  Bookmark this page now!