Monday, March 30, 2009

Fibromyalgia syndrome/Fibromyalgia (FMS)

Is Fibromyalgia a disease?

1. According to Goldenberg DL Fibromyalgia is considered a controversial diagnosis as the disorder is a ‘non-disease’, due in part to a lack of objective laboratory tests or medical imaging studies to confirm the diagnosis.
2. As the criteria accurately diagnosing such an entity (Fibromyalgia) has not yet been thoroughly developed. According to Yunus MB, the recognition that fibromyalgia involves more than just pain has led to the frequent use of the term "fibromyalgia syndrome".

History & meaning:
Historically Fibromyalgia is considered either a musculoskeletal disease or neuropsychiatric condition, evidence from research conducted in the last three decades has revealed abnormalities within the brain CNS regions.
Fibromyalgia (new lat., fibro- fibrous tissue, Gk. myo- muscle, Gk. algos- pain), meaning muscle and connective tissue pain (also referred to as FM or FMS).

S/S: Fibromyalgia is a disorder classified by the presence of chronic widespread pain and a heightened and painful response to gentle touch (tactile allodynia).
Other core features of the disorder include (Not all affected persons experience all the symptoms associated with the greater syndrome.):
1. Debilitating fatigue, sleep disturbance, and joint stiffness.
2. Additional multiple body systems features frequently reported are: difficulty with swallowing, functional bowel and bladder abnormalities, difficulty breathing, diffuse sensations of numbness and tingling (non-dermatomal paresthesia), abnormal motor activity (i.e. nocturnal myoclonus, sleep bruxism), and cognitive dysfunction.
3. An increased prevalence of affective and anxiety-related symptoms is also well known.
Factors worsen fibromyalgia symptoms:

An internet-based survey of 2,596 people with fibromyalgia reported that factors perceived to worsen fibromyalgia symptoms were:

1. Emotional distress (83%),
2. Weather changes (80%),
3. Sleeping problems (79%),
4. Strenuous activity (70%),
5. Mental stress (68%),
6. Worrying (60%),
7. Car travel (57%),
8. Family conflicts (52%),
9. Physical injuries (50%) and
10. Physical inactivity (50%).
11. Other factors included infections, allergies, lack of emotional support, perfectionism, side effects of medications, and chemical exposures.

Differential diagnosis:

According to Reiffenberger DH et al FMS needs to differentiated from 2 other seemingly similar conditions i.e. myofascial pain syndrome (MPS) and chronic fatigue syndrome (CFS).

1. Myofascial Pain Syndrome (or MPS):

Myofascial Pain Syndrome is a term used to describe one of the conditions characterized by chronic pain. It is associated with and caused by "trigger points" (TrPs). The symptoms can range from referred pain through myofascial trigger points to specific pains in other areas of the body.
MPS differs from fibromyalgia by accepted definition, the pain of fibromyalgia is generalized, occurring above and below the waist and on both sides of the body. On the other hand, myofascial pain is more often described as occurring in a more limited area of the body, for example, only around the shoulder and neck, and on only one side of the body.
Neither MPS or FMS (fibromyalgia) is thought to be an inflammatory or degenerative condition, and the best evidence suggests that the problem is one of an altered pain threshold, with more pain reported for a given amount of painful stimuli. This altered pain threshold can be manifest as increased muscle tenderness, especially in the certain areas, e.g., the trapezius muscle. These syndromes tend to occur more often in women than in men, and the pain may be associated with fatigue and sleep disturbances.
The precise cause of MPS is not fully understood and is undergoing research in several medical fields. A fairly new form of therapy called Myofascial Release, using gentle fascia manipulation and massage, is believed by some to be beneficial and pain-relieving.

2. Chronic fatigue syndrome (CFS)

a. Onset: there is ample evidence that majority of CFS cases start suddenly, usually accompanied by a "flu-like illness” which is more likely to occur in winter, while a significant proportion of cases begin within several months of severe adverse stress.
b. Symptoms: The most commonly used diagnostic criteria and definition of CFS is given by

Centers for Disease Control and Prevention (CDC,USA). The CDC definition of CFS requires two criteria be fulfilled:

1. A new onset (not lifelong) of unexplained, persistent fatigue unrelated to exertion and is not substantially relieved by rest, which causes a significant reduction in previous activity levels.
2. Four or more of the following symptoms that last six months or longer:
a. Impaired memory or concentration
b. Post-exertional malaise, where physical or mental exertions bring on "extreme, prolonged exhaustion and sickness"
c. Unrefreshing sleep
d. Muscle pain (myalgia)
e. Pain in multiple joints (arthralgia)
f. Headaches of a new kind or greater severity
g. Sore throat, frequent or recurring
h. Tender lymph nodes (cervical or axillary)
When symptoms are attributable to other conditions, the diagnosis of CFS is excluded. The CDC specifically refers to several illnesses with symptoms resembling those of CFS: "mononucleosis, Lyme disease, lupus, multiple sclerosis, fibromyalgia, primary sleep disorders, severe obesity and major depressive disorders. Medications can also cause side effects that mimic the symptoms of CFS."
3. Activity levels: Patients report critical reductions in levels of physical activity with impairment comparable to other fatiguing medical conditions including multiple sclerosis, late-stage AIDS, lupus, rheumatoid arthritis, heart disease, end-stage renal disease, chronic obstructive pulmonary disease (COPD), and the effects of chemotherapy. The severity of symptoms and disability is the same in both genders with strongly disabling chronic pain, but despite a common diagnosis the functional capacity of individuals with CFS varies greatly. While some lead relatively normal lives, others are totally bed-ridden and unable to care for themselves. Employment rates vary with over half unable to work and nearly two-thirds limited in their work because of their illness.


1. Fibromyalgia syndrome
2. myofascial pain syndrome
3. chronic fatigue syndrome
4. Reiffenberger DH et al; Am Fam Physician. 1996 Apr;53(5):1698-712.

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