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FIBROMYALGIA SYNDROME (FMS)
WHAT IS FMS?
FMS (fibromyalgia syndrome) is a widespread musculoskeletal
pain and fatigue disorder for which the cause is still unknown. Fibromyalgia means pain in
the muscles, ligaments and tendons-the soft fibrous tissues in the body. FMS used to be
called fibrositis, implying that there was inflammation in the muscles, but research later
proved that inflammation did not exist.
Most patients with FMS say that they ache all over. Their
muscles may feel like they have been pulled or overworked. Sometimes the muscles twitch
and at other times they burn. More women than men are afflicted with FMS. Yet, studies
reveal that the condition is equally severe in both genders and that it shows up in people
of all ages.
To help your family and friends relate to your condition,
have them think back to the last time they had a bad flu. Every muscle in their body
shouted out in pain. In addition, they felt devoid of energy as though someone had
unplugged their power supply. While the severity of symptoms fluctuate from person to
person, FMS may resemble a post-viral state. This similarity is the reason why experts in
the field of FMS and chronic fatigue syndrome (CFS) believe that these two syndromes may
be one and the same. Other conditions that overlap with FMS include Gulf War syndrome and
multiple chemical sensitivities.
HOW IS FMS DIAGNOSED?
For the most part, routine laboratory testing reveals
nothing. However, upon physical examination, patients will be sensitive to pressure in
certain areas of the body, called tender points. To meet the diagnostic criteria, patients
must have widespread pain in all four quadrants of their body for a minimum duration of
three months and at least 11 of the 18 specified tender points (as indicated on brochure
cover). These 18 sites used for diagnosis cluster around the neck, shoulder, chest, hip,
knee and elbow regions. Roughly 75% of CFS-diagnosed patients will meet the FMS criteria.
While many chronic pain syndromes display some symptoms
that overlap with FMS the 1990 multi-center criteria study (published in the Feb. '90
issue of Arthritis and Rheumatism) evaluated a total of 558 patients, of which 265
were classified as controls. These control individuals weren't your typical healthy
"normals." They were age and sex matched patients with neck pain syndrome, low
back pain, local tendonitis, trauma related pain syndromes, rheumatoid arthritis, lupus,
osteoarthritis of the knee or hand, and other painful disorders. These patients all had
some symptoms that mimic FMS but the trained examiners were not foiled-they hand-picked
the FMS patients out of the "chronically ill" melting pot with an accuracy of
88%. FMS is not a wastebasket diagnosis!
What if you have widespread pain, but you only have seven
or eight of the diagnostic tender points? A 1996 consensus report by 35 researchers says
that you may still be diagnosed with FMS as long as you also battle many of the associated
symptoms described below.
SYMPTOMS AND ASSOCIATED SYNDROMES
Pain - The pain of FMS has no boundaries. People describe
the pain as deep muscular aching, throbbing, shooting and stabbing. Intense burning may
also be present, which can feel as though there is acid running through your arteries.
Quite often, the pain and stiffness are worse in the morning and you may hurt more in
muscle groups that are used repetitively.
Fatigue - This symptom can be mild in some patients and yet
incapacitating in others. The fatigue has been described as "brain fatigue" in
which patients feel totally drained of energy. Many patients depict this situation by
saying that they feel as though their arms and legs are tied to concrete blocks, and they
have difficulty concentrating, e.g., brain fog.
Sleep disorder - Most FMS patients have an associated sleep
disorder called the alpha-EEG anomaly. This condition was uncovered in a sleep lab with
the aid of a machine which recorded the brain waves of patients during sleep. Researchers
found that most FMS patients could fall asleep without much trouble, but their deep level
(or stage 4) sleep was constantly interrupted by bursts of awake-like brain activity.
Patients appeared to spend the night with one foot in sleep and the other one out of it.
In most cases, a physician doesn't have to order sleep lab
tests to determine if you have disturbed sleep. If you wake up feeling as though you have
just been run over by a Mack truck-what doctors refer to as unrefreshing sleep-it is
reasonable for your physician to assume that you have a sleep disorder. It should be noted
that most patients diagnosed with CFS have the same alpha EEG sleep pattern and some
FMS-diagnosed patients have been found to have other sleep disorders, such as sleep apnea,
sleep myoclonus (nighttime jerking of the arms and legs), restless leg syndrome, and
bruxism (teeth grinding). The sleep pattern for clinically depressed patients is
distinctly different from that found in FMS or CFS.
Irritable Bowel Syndrome - Constipation, diarrhea, frequent
abdominal pain, abdominal gas, and nausea represent symptoms frequently found in roughly
40 to 70% of FMS patients.
Chronic Headaches - Recurrent migraine or tension type
headaches are seen in about 50% of FMS patients and can pose as a major problem in coping
for this patient group.
Temporomandibular Joint Dysfunction Syndrome - This
syndrome, sometimes referred to as TMJ or JMD, causes tremendous jaw-related face and head
pain in one quarter of FMS patients. However, a 1997 published report indicated that close
to 90% of FMS patients have a varying degree of jaw discomfort. Most of the problems
associated with this condition are thought to be related to the muscles and ligaments
surrounding the jaw joint and not necessarily the joint itself.
Multiple Chemical Sensitivities - Studies reveal that FMS
patients are sensitive to odors (perfumes, exhaust fumes, cigarette smoke, etc.), loud
noises, bright lights, and sometimes even the medications that are prescribed for treating
their FMS.
Other common symptoms - Premenstrual syndrome and painful
periods, chest pain, morning stiffness, cognitive or memory impairment, numbness and
tingling sensations, muscle twitching, irritable bladder, the feeling of swollen
extremities, skin sensitivities, dry eyes and mouth, frequent changes in eye prescription,
dizziness, and impaired coordination can occur.
Aggravating factors - Changes in weather, cold or drafty
environments, hormonal fluctuations (premenstrual and menopausal states), stress,
depression, anxiety and over-exertion can all contribute to symptom flare-ups.
WHAT CAUSES FMS?
The cause of FMS remains elusive, but there are many
triggering events thought to precipitate its onset. A few examples would be an infection
(viral or bacterial), an automobile accident or the development of another disorder, such
as rheumatoid arthritis, loons, or hypothyroidism. These triggering events probably don't
cause FMS, but rather, they may awaken an underlying physiological abnormality that's
already present.
What could this abnormality be? Theories pertaining to
alterations in pain-related chemical transmitters (particularly substance P, serotonin,
and norepinephrine), immune system function, sleep physiology, and hormonal control are
under investigation. In addition, modern brain imaging techniques are being used to
explore various aspects of brain function. The body's response to exercise, stress and
simple alterations in position (vertical versus horizontal) are also being evaluated. In
addition, substance P is increased threefold in the spinal fluid of people with FMS, but
it is normal in the blood. Substance P is a major pain transmitter and plays a role in
sleep, digestion, and other body functions. Ironically, many of the drugs prescribed for
FMS/CFS may have a favorable impact on these transmitters as well.
HOW IS FMS TREATED?
Traditional treatments are geared toward improving the
quality of sleep, as well as reducing pain. Because deep level (stage 4) sleep is so
crucial for many body functions, such as tissue repair, antibody production, and perhaps
even the regulation of various neurotransmitters, hormones and immune system chemicals,
the sleep disorders that frequently occur in FMS patients are thought to be a major
contributing factor to the symptoms of this condition. Medicines that boost your body's
level of serotonin and norepinephrineneurotransmitters that modulate sleep, pain and
immune system function-are commonly prescribed. Example drugs commonly used in low doses
are Elavil, Flexeril, Sinequan, Paxil, and Klonopin. Ambien may be used to aid sleep.
Ultram may help with the pain, along with many other drugs that minimize the effects of
substance P, including opioids for severe pain.
In addition to medications, most patients will need to use
other treatment methods as well, such as trigger point injections with lidocaine, physical
therapy, occupational therapy, acupuncture, acupressure, relaxation techniques,
osteopathic manipulation, chiropractic care, therapeutic massage or a gentle exercise
program.
WHAT IS THE PROGNOSIS?
Long term follow-up studies on FMS have shown that it is
chronic, but the symptoms may wax and wane. The impact that FMS can have on daily living
activities, including the ability to work a full-time job, differs among patients.
Overall, studies have shown that FMS can be equally as disabling as rheumatoid arthritis.
SELF-HELP STRATEGIES
Lifestyle modifications may help you conserve energy and
minimize pain. Learn what factors aggravate your symptoms and avoid them, if possible.
Join your local support group and become informed about your condition by subscribing to FIBROMYALGIA
NETWORK newsletter. In this newsletter you will read about research findings,
new treatment options, and tips on coping with FMS and CFS. You may also contact FIBROMYALGIA
NETWORK for a listing of patient contacts and physician referrals. Our phone number
is: (800) 853-2929.
This guide is copyrighted by Fibromyalgia Network, P.O. Box
31750, Tucson, AZ 85751 (800)853-2929. All information in this brochure is provided for
the purposes of assisting FMS and CFS patients in understanding their condition. Patients
should always consult their physician for medical advice and treatment.
*Reprinted from ARTHRITIS AND RHEUMATISM Journal, copyright
1990. Used by permission of the American College of Rheumatology.Visit our Web Site
at:www.FMNetNewscom
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