Fibromyalgia syndrome (FMS) is a common condition characterized by chronic widespread pain and stiffness, headaches, reproducible tender points chronic fatigue and exertion intolerance, chronically disrupted non-restorative sleep, cognitive and mood disturbances. FMS symptoms afflict a significant percent of our population, including up to 6% of women. Onset is most common in middle age but can occur in both younger and more elderly people. FMS is not a type of arthritis, nor is it associated with measurable tissue inflammation. At this point it can not be diagnosed with a blood test, x-ray or biopsy. The diagnosis in our clinic is made by identifying the typical risk factors, onset and symptom patterns and documenting tender points on the body, while carefully addressing other underlying illness that might be causing or contributing to the symptoms.  The diagnosis is most commonly made using the ACR (American College of Rheumatology) criteria, which require only chronic widespread pain and at least 11 of 18 tender points.

The cause (or causes) of FMS are unknown, but tendency to the illness may be genetic or familial and in my experience, the onset is almost always "stress" related, as stress is broadly defined, including the range of severe emotional and/or physical stress to simply being chronically overextended. The onset is also often associated with a variety of other co-factors (hormone shifts or deficiencies, mechanical trauma to the head and neck, or chronic spine disorders, surgeries, infections, autoimmune illness, metabolic syndrome or diabetes, mental health disorders and others). Poor coping skills or dysfunctional behaviors are not intrinsic to the onset of fibromyalgia, but they can certainly compound the presentation, severity, duration, and treatment.

The term FMS may encompass a variety of conditions that cause generalized disturbance of the nervous system, especially amplified sensory processing, and are sometimes called central sensitivity syndromes. Patients with FMS seem to develop a lower pain threshold ---although not necessarily a lower pain tolerance--- and amplified pain response that affects not only the muculoskeletal tissues, but also may contribute to headaches, tingling, bowel or bladder pain. It is a process that appears related to abnormal central (brain and spinal cord) processing of sensory information, particularly painful or other noxious stimuli. In addition, there are nonspecific changes in autonomic nervous system functions, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, abnormalities of Substance P and other neurotransmitters in the cerebrospinal fluid, profound alteration of brain waves sleep stages, and brain blood flow abnormalities.

Related conditions include irritable bowel syndrome, gastroesophageal reflux, irritable bladder or interstitial cystitis, endometriosis, tension headaches and migraines, dry eyes and mouth, palpitations, low blood pressure, postural tachycardia and fainting, sleep disorders, allergies, and many others. Illness onset and flares of illness are often associated with both mental and physical stressors. The symptoms can become chronic and very difficult to treat, even after the "stress" is relieved and mood symptoms are well compensated. On the other hand, early intervention can often lead to complete resolution, so one should not hesitate to make the diagnosis in the setting of mild but suggestive symptoms.

Allergic and autoimmune disorders, disruption of the HPA axis, chronic viral infections like hepatitis B or C, malignancies, and neurologic diseases like multiple sclerosis share overlapping symptoms with FMS. Chronic Fatigue Syndrome (CFS) is probably a similar or related disorder, defined more by fatigability, viral and immune symptoms than pain, although significant chronic pain can be present. In some studies, a significant number of patients who receive a diagnosis of either FMS or CFS actually meet the symptom criteria for both.

Treatment of FMS can be both frustrating and challenging. As symptoms warrant, interval assessment for these disorders should be done to identify any illness with more effective treatments than FMS. Otherwise, the treatment of FMS is supportive and symptomatic, except that we now have several drugs approved by the FDA to treat the pain of FMS.  These pain and sleep modulating drugs have improved the symptoms of many FMS patients.

Since the exact cause and pathophysiology are not well understood, the primary approach to treatment of FMS symptoms is to relieve symptoms and improve function.  Any plan that improves pain, restorative sleep and mental health, and includes gentle physical conditioning is likely to improve FMS.