Lucinda Bateman MD

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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 but can occur in both younger and more elderly people. FMS is probably not an 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 is made by identifying the typical risk factors, onset and symptom pattern and documenting tender points on the body, while carefully ruling out other underlying illness that might be causing or contributing to the symptoms.

The cause (or causes) of FMS are unknown, but tendency to the illness may be genetic and onset is almost always "stress" related, as stress is broadly defined. While FMS commonly occurs in the setting of prolonged or severe emotional and/or physical stress, onset if usually associated with a variety of other co-factors (hormone shifts or deficiencies, mechanical trauma to the head and neck, surgeries, infections, autoimmune illness, diabetes, severe mood disorders and others). Poor coping skills or dysfunctional behaviors are not intrinsic to the onset of fibromyalgia, but they can certainly compound the presentation, chronicity and treatment.

The term FMS may encompass a variety of conditions that cause generalized disturbance of the nervous system, especially 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 throughout all the peripheral tissues, including the viscera. It is a process that appears related to abnormal central (brain and spinal cord) processing of sensory information, particularly painful or noxious stimuli. In addition, there are nonspecific changes in autonomic nervous system functions, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, elevation of Substance P 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 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 related disorder, defined more by fatigability, viral and immune symptoms than pain, although significant chronic pain can be present. In some studies, at least 1/3 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.

Since the exact cause and pathophysiology are not well understood, the primary approach to treatment of FMS symptoms is to relieve symptoms. Some suggestions are summarized on the following page: