FIBROMYALGIA: A PATIENT PRIMER

By Benjamin W. Gilliotte, M.D.

INTRODUCTION

Fibromyalgia syndrome, sometimes known as fibrositis, is a common condition, affecting more than ten million persons in the United States alone.

The cause of Fibromyalgia is not known for certain, and that is the reason the word "syndrome" is usually applied in medical terminology. It is probably that heredity predisposes individuals to the condition, but that it does not become manifest until certain aggravating factors come into play later in life.


HISTORY

Although the symptoms of fibromyalgia were apparently described in biblical times in the Book of Job, it only has been in the past fifteen years that research has uncovered significant clues as to the probably causes of fibromyalgia, and only in the past ten years that somewhat effective methods of treatment has been applied and understood.


MANIFESTATIONS

Fibromyalgia is a condition affecting the muscles, the muscle coverings called the fascia, and the nervous system, although is not believed to be primarily a "nervous condition."

A fibromyalgic personality and body type have been described. Of course, not all patients fit these categories. They are said to be often compulsive, well-organized, serious, self-critical individuals who desire to be near-perfect, and become easily frustrated when their perfectionistic desires are not achieved. Their bone and muscle structures are often slight, and their posture is usually poor, with a forward slouch.

The principal symptoms are chronic fatigue, chronic pain, morning stiffness, and unrefreshed sleep. The fatigue is described as a chronic feeling of tiredness and a lack of stamina. The fatigue which is usually noted in the morning, often improves as the day goes on, and then is noted again in the evening. There is also lack of stamina for repetitive upper extremity exercises rather than a weakness of various muscles. The pain is widespread, involving generally the upper and lower back, the back of the neck, the shoulders, and hip areas. The pain is often described as a deep ache, but there is also a burning sensation which is noted. The stiffness usually is worse in the morning, lasting about an hour, improving as activity progresses. Sleep is usually described as not being restful in addition to not being of sufficient duration.

Other symptoms and conditions which may accompany fibromyalgia are: 1) allergies, which affect about half of the patients or their close relatives, 2) weather intolerance, with aggravation being noted when the atmospheric pressure is low, the temperature is low, or the humidity is high, 3) headaches, in the form of muscle aches in the front and back of the head, and sometimes migraine, 4) irritable bowel symptoms such as alternate constipation and diarrhea, and abdominal pain, 5) irritable bladder symptoms such as urinary frequency, 6) coldness of the hands and sometimes the feet similar to what is called Raynaud's phenomenon, 7) paresthesias or a feeling of "pins and needles" of the upper and lower extremities, 8) an association with a cardiac condition called mitral valve-prolapse which is usually benign, and 9) anxiety and depression on occasion.

Fibromyalgia rarely stays at the same symptom degree for long. It may improve only to recur at a later date, again improve, and again recur. It is extremely rare for it to never recur or be cured. However, with proper treatment and life-style alteration on the part of the patient it can often be reasonably controlled.

Bursitis and tendinitis are often associated with fibromyalgia after fibromyalgia has been present for a number of years.

At times there is a known precipitating incident such as an injury or an acute viral illness which appears to induce fibromyalgia. Many other times there is no known injury or illness which precedes the syndrome.

It appears that a tendency toward fibromyalgia is inherited. If one parent has fibromyalgia it is likely that 50% of his or her children will inherit the tendency, but will not develop the condition until something precipitates the condition.


AGGRAVATING FACTORS

Emotional stress, air-conditioning, cold drafts, cold-water swimming, high humidity, low barometric pressure, too much exercise, or too much rest, and keyboard operation all tend to aggravate fibromyalgia.


TREATMENT

First, the patient must become an active participant in the treatment or it will surely fail. All of the known aggravating factors such as those previously listed must be avoided as much as possible.

Second, regular aerobic exercise must be participated in permanently. The purpose is to reach a heart rate of 70 to 80 percent of maximum, about 140 per minute in the average individual. Of course, the personal physician must examine the patient and approve of the exercise. If approved, fast walking, bicycle riding, or swimming are all excellent forms of aerobic exercise. The exercise must be done for at least 30 minutes, with adequate warm-up and cool-down periods, and must be done at least three times a week. This is a life-time prescription as ordered by the physician.

Third, certain anti-depressant medications, in a very low dosage not sufficient for the control of depression, have been found to be beneficial in improving the sleep patterns and decreasing pain. One of these medications is usually prescribed at bedtime. However, medication should be regarded as an aid not a cure for fibromyalgia.

Joining a support group can be of considerable assistance to the patient with fibromyalgia.


OUTLOOK

It should be appreciated that fibromyalgia is not crippling or life-threatening, nor does it later turn into a disease of that type. It can be reasonably controlled if the patient and physician form a working partnership. A positive attitude is essential for the treatment to be effective.

Web page design by Bill Jackson, 1996.

Any comments? Send them to Bill Jackson at cfsdays@yahoo.com

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