FIBROMYALGIA


About Your Diagnosis
Fibromyalgia (FM) means pain in the muscles, tendons, and ligaments. In FM, there are specific areas of pain in the body called tender points. We do not know the cause of FM. However, research has looked at sleep, levels of chemicals called serotonin and substance P, as well as muscle and growth hormone as possible important factors in the cause of FM.


It is estimated that FM may occur in up to 2% of the population. It is about eight times more common in women than men. Fibromyalgia usually occurs in individuals between the ages of 20 and 50 years, although it is also common in women older than 60 years. Although we do not know the cause of FM, it is not an infectious illness. A physician is able to diagnose FM by obtaining a medical history and performing an examination of the joints and muscles. Most blood tests and x-rays show no abnormalities. However, your doctor may perform blood tests to determine whether your pain and fatigue result from other diseases that may cause similar symptoms, and x-rays may be done to look for any bone or joint abnormalities.


Living With Your Diagnosis
Individuals with FM experience pain and fatigue. Pain is usually worse in the areas of the upper back and neck, and the lower back and hips, although pain can occur around any of the tender points. The fatigue can be severe. Individuals with FM may also have headaches, numbness or tingling in the hands or feet, abdominal bloating, diarrhea or constipation, and forgetfulness. Fibromyalgia may affect your activities at work and at home because of the pain and fatigue. Although there is no cure for FM, individuals with this diagnosis can feel better with appropriate therapies. Treatment focuses on managing the symptoms with medications, exercise, stress management, and fatigue management.


Treatment

The best way to manage FM is through a combination of sleep improvement, exercise, stress management, and medications. Medications can improve the amount and quality of sleep. Individuals with FM often awaken frequently throughout the night and wake up feeling tired. This interrupted sleep pattern prevents them from reaching the deepest form of sleep. A physician may prescribe a medicine to reach this deeper stage of sleep. By improving sleep, the pain will also decrease. The most common medications include amitriptyline, nortriptyline, and cyclobenzaprine. These medications are used in large doses to treat depression, but to manage pain and sleep the medications are used in small doses. The most common side effects from these medications are grogginess upon awakening, dry mouth, constipation, weight gain, and rash.


Appropriate exercises are very helpful in decreasing pain. Stretching and posture exercises should be done every day to maintain good body alignment and prevent pain. Endurance exercises should be done three or four times a week and can include walking, biking, or water therapy. This type of exercise will improve your ability to do activities for a longer length of time. It is important to begin exercise slowly and to increase gradually.


Although stress does not cause FM, it is more difficult to manage daily life when you hurt and are tired. Often individuals with FM have forgotten how to "relax." You should look at your life realistically and explore whether family or financial problems or depression is interfering with your ability to feel better. A counselor can offer services that range from relaxation therapy to family counseling.


The DOs
* Call your doctor if you are experiencing side effects from medications.
* Ask your doctor what over-the-counter pain medications you may take with your prescribed medicines.
* Work with your health professionals. Management of FM may be difficult but not impossible. Communication and follow-up are key factors in feeling better.


The DON'Ts
* Expect medications alone to decrease your pain and fatigue from FM. Feeling better involves improved sleep, exercise, and stress management.
* Take any diet supplement without discussing it first with your physician.
* Stop exercising.


When to Call Your Doctor

* Experience side effects from your medications.
* Continue to wake frequently throughout the night.
* Need a counselor to help with family or financial problems.
* Need additional exercise instruction.
* Need an occupational therapist to help you manage your fatigue.


For More Information

Contact the National Arthritis Foundation in your area. If you do not know the location of the Arthritis Foundation, you may call the national office at 1-800-283-7800 or access information via the Internet at www.arthritis.org. You may also contact the Fibromyalgia Network at 1-800-853-2929.