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Home :: Fibromyalgia Syndrome

Fibromyalgia Syndrome

A diffuse pain syndrome, fibromyalgia syndrome (FMS, previously called "fibrositis") is one of the most common causes of chronic musculoskeletal pain; it's observed in up to 15% of patients seen in a general rheumatology practice and 5% of general medicine clinic patients. Symptoms of FMS include diffuse musculoskeletal pain,daily fatigue, and sleep disturbances. Multiple tender points in specific areas on examination is the characteristic feature. Women are affected much more often than men, and although FMS can affect all age-groups, its peak incidence is between ages 20 and 60. It may occur as a primary disorder or in association with an underlying disease such as systemic lupus erythematosus, rheumatoid arthritis, osteoarthritis, and sleep apnea syndromes.

FMS has also been reported in children, who tend to have more diffuse pain and sleep disturbances than adult patients. Children may have fewer tender points, and many improve over 2 to 3 years.

Causes

The cause of FMS is unknown, but there are many theories regarding its pathophysiology. Although the pain is located primarily in muscle areas, no distinct abnormalities have been documented on microscopic evaluation of biopsies of tender points when compared with normal muscle. Other theories suggest decreased blood flow to muscle tissue (due to poor muscle aerobic conditioning versus other physiologic abnormalities); decreased blood flow in the thalamus and caudate nucleus, leading to a lowering of the pain threshold; endocrine dysfunction, such as abnormal pituitary-adrenal axis responses; and abnormal levels of the neurotransmitter serotonin in brain centers, which affect pain and sleep. Abnormal functioning of other pain-processing pathways may also be involved. Considerable overlap of symptoms with other pain syndromes, such as chronic fatigue syndrome, raises the question of an association with an infection, such as with parvovirus B19. Human immunodeficiency virus infection and Lyme disease have also been associated with FMS.

It's possible that the development of FMS is multifactorial and is influenced by stress (physical and mental), physical conditioning, and quality of sleep as well as by neuroendocrine, psychiatric and, possibly, hormonal factors (due to the female predominance).

Signs and symptoms

The main fibromyalgia symptoms are the presence of multiple tender points, fatigue and extensive, chronic pain in the tissues of the muscles, tendons (which connect muscle to bone) and ligaments (which connect bones, muscles and tendons).

Additional symptoms may include: Irritable bowel and bladder, headaches, facial pain and migraines, restless legs syndrome, impaired memory and concentration, skin sensitivities and rashes, dry eyes dry mouth, anxiety, depression, impaired coordination, dizziness, vision problems, heightened sensitivity to odors, noise, light, touch and weather change. All fibromyalgia symptoms can be made worse by stress.

Diagnosis

A number of tests may be done to rule out other disorders. An examination reveals multiple tender areas on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, or knees.

Sometimes, laboratory and x-ray tests are done to help confirm the diagnosis. The tests will also rule out other conditions that may have similar symptoms.

Other underlying ailments, such as chronic fatigue syndrome, irritable bowel syndrome, and rheumatoid arthritis, can also be present. New patients should be checked for these underlying conditions as well as fibromyalgia.

Treatment

The most important aspect in FMS management is patient education. Patients must understand that although FMS pain can be severe and is often chronic, this syndrome is common and does not lead to deforming or life-threatening complications.

A regular, low-impact aerobic exercise program can be effective in improving muscle conditioning, energy levels, and an overall sense of well-being. The FMS patient should stretch before and after exercising to minimize injury. Any exercise program, such as walking, bicycling, and swimming, should be started at a low intensity with a slow, gradual increase as tolerated. The patient may also benefit from physical therapy, the injection of tender points with steroids or lidocaine, massage therapy, and ultrasound treatments for particularly problematic areas. A few studies have shown that acupuncture and phototherapy are also beneficial.

Drug therapy is typically used to improve the patient's quality of sleep and for pain control. A bedtime dose of a tricyclic antidepressant, such as amitriptyline, nortriptyline, or cyclobenzaprine, may improve sleep but produce anticholinergic adverse effects and daytime drowsiness. Hypnotic agents, such as many benzodiazepines, are less useful overall because they generally do not prevent the frequent awakenings through the night in these patients. The combination of a tricyclic antidepressant at bedtime with a serotonin uptake inhibitor, such as fluoxetine, during the day may also be useful.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are typically not effective against FMS pain, although NSAIDs may be used if tendinitis or arthritis coexists with this disorder. Narcotics should be used only with extreme caution to control pain, preferably under the guidance of a pain clinic.

Prevention

There is no proven prevention for this disorder. However, over the years, the treatment and management of the disease has improved.



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