FM/CFS/ME RESOURCES - Fibromyalgia (FM)

 

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FIBROMYALGIA (FM) View the Tender Points of the body

Fibromyalgia (FM), pronounced: fy-bro-my-AL-ja, makes you feel tired and causes muscle pain and "tender points." Tender points are places on the neck, shoulders, back, hips, arms or legs that hurt when touched. People with fibromyalgia may have other symptoms, such as:

  • Widespread musculoskeletal pain
  • Headaches
  • Non restorative sleep
  • Fatigue
  • Psychological distress
  • Specific regions of localized tenderness
  • Morning stiffness
  • Tingling or numbness in hands and feet
  • Headaches, including migraines
  • Irritable bowel syndrome (IBS)
  • Problems with thinking and memory (called "fibro fog")
  • Painful menstrual periods and other pain syndromes

The American Medical Association (AMA) reports that Fibromyalgia is currently the second most common disorder diagnosed by rheumatologists; it affects nearly 20% of their patients. FM is seen worldwide, in all ages and ethnic groups, and in young children through older adults, although for most individuals the symptoms begin in their 20's or 30's.

The community prevalence of FM is reported as 1% in the United Kingdom and up to 5% of the total U.S. population (approximately 3.4% of all women and 0.5% of men). That is, 7 to 10 million Americans have FM. In the US, approximately 90% of those diagnosed are women between the ages of 20 and 50. It occurs in females to males in an approximate ratio of 20 to 1. People with rheumatoid arthritis and other autoimmune diseases are particularly likely to develop FM.


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About FM

Fibromyalgia was once often dismissed by physicians and the public as a psychological disorder or "waste basket" diagnosis because of an absence of objective findings on physical examination and usual laboratory and imaging evaluations. Many physicians still do not accept FM as a distinct illness. However, recent basic and clinical investigation has rapidly clarified the neurophysiologic bases for FM and has led to its new classification as a central sensitivity syndrome (CSS). Fibromyalgia can now be considered a neurosensory disorder characterized, in part, by abnormalities in CNS pain processing. Increased understanding of the biological bases underlying FM is rapidly leading to a new era of specific medications for the condition.

At a clinical level, FM is much more than widespread pain. It overlaps substantially with the following:

The diagnostic label attached to a patient may be determined largely by the first specialist that he or she sees. For example, a rheumatologist might diagnosis FM, whereas a gastroenterologist may diagnose irritable bowel syndrome (IBS). In addition, FM coexists in unusually high frequency with certain illnesses characterized by systemic inflammation, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and chronic hepatitis C infection, among others. In such cases, both disorders must be recognized and treated for optimum therapeutic outcome.

The pain of FM is present in the soft tissues throughout the body. Pain and stiffness concentrate in spots such as the neck and lower back. The tender points don't seem to be inflamed, nor do they display the typical signs of discomfort, such as heat, redness, or swelling. Most tests show nothing out of the ordinary in the anatomy of people with FM. The figure above and to your right indicates the tender points in red. In the image above, the left is the front view, while the image on the right is the back view.

The word Fibromyalgia (FM) 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, neck, shoulders, back, hips, and upper and lower extremities where people with FM feel pain in response to slight pressure.

Although FM 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, FM can cause significant pain and fatigue, and it can interfere with a person's ability to carry on daily activities. Also like arthritis, FM is considered a rheumatic condition.
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What Exactly Does Rheumatic Mean?

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.

While FM is one of the most common diseases affecting the muscles, its cause is currently unknown. The painful tissues involved are not accompanied by tissue inflammation. Therefore, despite potentially disabling body pain, patients with FM do not develop body damage or deformity. FM also does not cause damage to internal body organs. Therefore, FM is different from many other rheumatic conditions (such as rheumatoid arthritis, systemic lupus, and polymyositis). In those diseases, tissue inflammation is the major cause of pain, stiffness and tenderness of the joints, tendons and muscles, and it can lead to joint deformity and damage to the internal organs or muscles.
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Onset

FM as defined by the ACR criteria is more common in females than in males, with a female-to-male ratio of approximately 9:1. Males with FM tend to have lower health perception and more physical limitations than females. Females with FM have greater pain sensitivity and may exhibit greater life interference due to pain.

Some of the mechanisms that may contribute to increased pain sensitivity in women include:

1. Differences in primary afferent input to the CNS, with developmental and menstrual cycle–dependent enhancement.

2. Developmental and phasic gonadal-hormonal modulation of pain regulatory systems, stress-induced analgesia, and opioid receptors.

3. Higher levels of trait and state anxiety.

4. Increased prevalence of depression.

5. Use of maladaptive coping strategies.

6. Increased behavioral activity in response to pain.

Although usually considered a disorder of women aged 20-50 years, FM is observed in pediatric populations, especially in adolescents, and in older persons. FM in children responds to a combination of psychotherapy, exercise, relaxation techniques, and education. Pharmacotherapy is generally not indicated.
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Frequency

United States
Chronic pain and fatigue are extremely prevalent in the general population, especially among women and persons of lower socioeconomic status. The prevalence of regional pain is 20%; widespread pain, 11%; FM according to the American College of Rheumatology (ACR) criteria,27 3-5% in females and 0.5-1.6% in males; and chronic fatigue, approximately 20%. Because the ACR criteria are relatively insensitive, the actual prevalence of FM is higher.

FM experts estimate that about 10 million Americans and approximately 3-6% of the population worldwide suffer with FM. While it is most common in women, the illness strikes men, women, and children of all ages and ethnic backgrounds. For those with severe symptoms, FM can be extremely debilitating and interfere with even routine daily activities.
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Mortality

FM is a chronic relapsing condition. In academic medical centers, long-term follow-up care of patients with FM reportedly averages 10 outpatient visits per year and 1 hospitalization every 3 years. Chronic pain and fatigue in FM increases the risk for metabolic syndrome.

A subset of patients with FM consider themselves to be more ill and more impaired, reporting markedly abnormal scores for pain, functional disability, fatigue, sleep disturbance, and psychologic status. They have significantly higher levels of comorbid illness and healthcare utilization and costs than matched controls. The annual economic burden of FM in 2005 was $10,199 (US dollars) per patient per year, nearly double that of matched controls.
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Years Spent Searching For Help

If you've been from one doctor to another looking for a correct diagnosis, you're not alone. It takes many years for most FM patients to receive an accurate diagnosis. Many times this is because FM mimics other illnesses. Often times it's because many physicians don't understand FM, or don't believe it to be a real illness.
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Prognosis

Fibromyalgia can be mild or disabling, and the emotional toll can be substantial. People with fibromyalgia experience greater psychological distress and a greater impact on quality of life than those with other conditions, such as chronic low back pain. About half of all patients have difficulty with routine daily activities, or are unable to perform them. An estimated 30 - 40% of patients have had to quit work or change jobs. Patients with either CFS or fibromyalgia are more likely to lose jobs, possessions, and support from friends and family than are people suffering from other conditions that cause fatigue.

While there is currently no cure for fibromyalgia, better ways to diagnose and treat the chronic pain disorder continue to be developed. Since June 2007, the U.S. Food and Drug Administration has approved three medications for the treatment of fibromyalgia and other FM medications are currently in development. Research efforts have expanded as well. In 1990 there were approximately 200 published research papers on fibromyalgia studies. Today there are more than 4,000 published reports.

While many strides have been made in the last decade, fibromyalgia remains a challenging condition. However, clinical studies have demonstrated that fibromyalgia patients can reduce their symptoms through a variety of treatment options. Working in conjunction with knowledgeable healthcare professions, motivated and informed patients can experience significant improvement in their symptoms and quality of life. Developing an individualize self-management plan, from identifying effective treatments approaches to making necessary lifestyle changes, will further improve one's health.
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Risk of Negative Behaviors

The pain, emotional consequences, or sleep disturbances that come with fibromyalgia may lead to self-medication and overuse of sleeping pills, alcohol, drugs, or caffeine.
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Long-term Outlook

Outlook in Adults. Some studies show that fibromyalgia symptoms remain stable over the long term, while others report a better outlook, with 25 - 35% of patients reporting improvement in pain symptoms over time. Studies suggest that regular exercise improves the outlook. Those with a significant life crisis, or who are on disability, have a poorer outcome, as determined by improvements in the patients' ability to work, their own feelings about their condition, pain sensation, and levels of disturbed sleep, fatigue, and depression. Although the disease is lifelong, it is not fatal.

Outlook in Children. Children with fibromyalgia tend to have a better outlook than adults with the disorder. Several studies have reported that more than half of children with fibromyalgia recover in 2 - 3 years.

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Sources:

  • Health Library, Fibromyalgia, Highlights, Prognosis, Norton Healthcare, http://www.nortonhealthcare.org.

  • Fibromyalgia, Prognosis, National Fibromyalgia Association, http://www.fmaware.org.

  • Healthguide, Fibromyalgia, Prognosis, New York Times, http://health.nytimes.com.

  • Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum. Jun 2007;36(6):339-56.

  • The National Center on Physical Activity and Disability, Disability/Condition: Fibromyalgia and Exercise, Prevalence, October 18, 2009.

  • Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum. May 2002;46(5):1333-43.

  • Wood PB. Treating comorbidities in fibromyalgia. Pain Pract. 2008;18(1):pp 42-53.

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  • Buskila D, Press J, Abu-Shakra M. Fibromyalgia in systemic lupus erythematosus: prevalence and clinical implications. Clin Rev Allergy Immunol, Aug 2003;25(1):25-8.

  • Thompson ME, Barkhuizen A. Fibromyalgia, hepatitis C infection, and the cytokine connection, Curr Pain Headache Rep. Oct 2003;7(5):342-7.

  • A Patient's Guide to Fibromyalgia, eOrthopod.com.

  • (National Women's Health Information Center, OWH, HHS).

  • A Physician's Guide to Fibromyalgia Syndrome (Missouri Arthritis Rehabilitation Research and Training Center).

  • Winfield JB. Psychological determinants of fibromyalgia and related syndromes, Curr Rev Pain, 2000;4(4):276-86.

  • Thorsten Giesecke, M.D., research fellow, University of Michigan, Ann Arbor, Mich.; Roger H. Murphree, chiropractor, Birmingham, Ala.; Jacob Teitelbaum, M.D., director, Center for Effective CFIDS/Fibromyalgia Therapies, Annapolis, Md.; National Institute of Arthritis and Musculoskeletal and Skin Diseases; October 2003 Arthritis & Rheumatism.

  • John A Pederson, New Research on Fibromyalgia, page 200, 1600212670 : 9781600212673, Gazelle Book Services Limited, White Cross Mills, Hightown, LANCASTER LA1 4XS, United Kingdom.

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  • Fibromyalgia, U.S. National Library of Medicine, National Institutes of Health, MedlinePlus, http://www.nlm.nih.gov.

  • Hoffman DL, Dukes EM. The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12. Int J Clin Pract. Jan 2008;62(1):115-26.
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