Fibromyalgia  Syndrome

Lucinda Bateman MD

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 sleep, cognitive and mood disturbances.  FMS symptoms afflict a significant percent of our population, perhaps 0.5% of men and up to 6% of women. Onset is most common in middle age. FMS is not really a form of arthritis, nor it is associated with measurable tissue inflammation.   It cannot be diagnosed with a blood test, x-ray or biopsy.  Diagnosis made by identifying the typical symptoms and documenting typical tender areas of the body.

 The causes (or cause) of FMS are unknown, but tendency to the illness maybe genetic and onset is often "stress' related, as stress is broadly defined.  FMS commonly occurs in the setting of prolonged or severe emotional and/or physical stress, combined with a variety of co-factors (hormone shifts or deficiencies. mechanical trauma to the head and neck, surgeries, infections, autoimmune illness, diabetes, and others).

 The term FMS may encompasses a variety of conditions that can cause a generalized disturbance of sensory processing and are sometimes called central sensitivity syndromes.  Patients with FMS develop a lowered pain threshold and amplified pain response throughout all the peripheral tissues, including the viscera.  It is a process that increasingly appears related to abnormal central (brain and spinal cord) processing of sensory information, particularly pain. Related conditions include irritable bowel syndrome, stomach reflux: migraines, dry eyes and mouth, palpitations, low blood pressure and fainting, sleep disorders, 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

 Allergic and autoimmune disorders, disruption of the hypothalamic-pituitary-adrenal (HPA) axis, chronic viral infections, malignancies, and neurologic diseases share overlapping symptoms with FMS. Chronic Fatigue Syndrome (CFS) is probably a related disorder, defined more by fatigability, viral and immune symptoms than pain. As symptoms warrant, interval assessment for these disorders should be done to identify any illness with more effective treatments than EMS.  Otherwise, the treatment of FMS is supportive and symptomatic.

 Treatment of FMS can be both frustrating and challenging.  Since the exact cause and pathophysiology are not well understood, the primary approach to treatment of FMS symptoms is to: