Fibromyalgia (FM, Fibromyalgia Syndrome, FMS)

Generalized fatigue or tirednessReduced physical enduranceGeneralized aches and pains of muscles, tendons, and ligamentsMuscle tightening or spasms Pain in specific areas of the body, especially: NeckShouldersChestBack (upper and lower)Hips and thighsInsomnia or poor sleep Sensations of numbness or swelling (although swelling is not actually present)Chronic headaches, including migrainesMorning stiffness, worst on first arising Factors that may trigger or worsen symptoms include: Weather changes, especially cold, damp weatherStress or anxietyOverexertionMedical illnessSurgery DiagnosisThe doctor will ask about your symptoms and medical history, and perform a thorough physical exam. There are no specific tests for this condition. The doctor will look for the following signs: Widespread pain lasting three months or longerTenderness (on physical exam) in at least 11 of 18 specific areas of the body TreatmentThe goal of treatment is to relieve or control the symptoms. Treatments include: Physical and Behavioral Therapies Physical therapy (gradual aerobic exercise and stretching regimen)Application of heat to painful areas Massage, acupuncture, relaxation training may be helpfulTrigger point therapy Biofeedback Cognitive behavioral therapy Lifestyle Changes Eating a healthful dietLearning to cope with physical and mental stress Regular, moderate, low-impact exercise with your doctor's approvalTry gentle exercise that does not strain painful areas, such as:Walking Biking Swimming, preferably in warmer water Regular stretching exercisesMaintaining a regular sleep schedule A team of experts studied fibromyalgia and recommended the following:

Approach that focuses on medication and other treatmentsHeated pool treatments with or without exerciseIndividual exercise programsCognitive behavioral therapy and other forms of counselingOther therapies (eg, massage, relaxation, physical therapy)Tramadol, paracetamol, or other weak opioidsAntidepressants (eg, amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide, pirlindole)Medications for pain relief (eg, tropisetron, pramipexole, pregabalin) PreventionSince the cause is unknown, there are no guidelines for preventing fibromyalgia. RESOURCES: The American Fibromyalgia Syndrome Association, Inc.http://www.afsafund.org/ National Fibromyalgia Partnership, Inc.http://www.fmpartnership.org/ CANADIAN RESOURCES: The Arthritis Societyhttp://www.arthritis.ca/ Fibromyalgia Information and Local Supporthttp://fibromyalgia.ncf.ca/ References: Berkow R. The Merck Manual of Medical Information. New York, NY: Pocket; 2000. Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008?67:536-541. Edema. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/edema/hic_edema.aspx. Updated November 2005. Accessed June 19, 2008.

Fibromyalgia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 2008. Accessed June 19, 2008. Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Fibromyalgia/fibromyalgia_ff.asp. Updated August 2007. Accessed June 19, 2008. Fibromyalgia update. Bandolier website. Available at: http://www.jr2.ox.ac.uk/bandolier/band149/b149-7.html. Myofascial pain syndrome. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/myofascial-pain-syndrome/DS01042. Updated May 2007. Accessed June 19, 2008. Paresthesias. MedHelp website. Available at: http://www.medhelp.org/HealthTopics/Paresthesias.html. Accessed June 19, 2008. Periodic limb movement disorder (PLMD) or nocturnal myoclonus. Eastern Virginia Medical School website. Available at: http://www.evms.edu/sleep/disorders-limb.html. Updated March 2006. Accessed June 19, 2008. Last reviewed May 2008 by John C. Keel, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.