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Fibromyalgia What is Fibromyalgia? Fibromyalgia, which literally means "pain of fibrous tissue and muscles," is a syndrome that is characterized by all-over muscular pain and fatigue (extreme tiredness). A syndrome is a group of symptoms that appear to be related and tend to occur together. The pain associated with fibromyalgia typically occurs where muscles attach to the bone or ligament, similar to the pain of arthritis. Unlike arthritis, fibromyalgia does not involve the joints, so it does not result in joint deformity or deterioration. In addition to all-over body pain, tenderness occurs in specific locations called "tender points." Tender points are designated areas of the body that hurt when pressure is applied. Tender points appear in the area of the neck, chest, upper and lower back, inside of the arm, buttocks and knee cap. Despite a considerable amount of research on fibromyalgia, there are many unanswered questions concerning the specific cause or causes, diagnosis and most effective treatment. What Causes Fibromyalgia? The precise cause of fibromyalgia is not known. Researchers have many theories as to what may cause or trigger this syndrome. At this time, no single factor has been proven to cause fibromyalgia. It does not appear that it is caused by any physical abnormality; the joints, muscles and nerves of a person with fibromyalgia seem normal. Fibromyalgia may be caused by a combination of factors or triggers, including: Injury or trauma to the nervous system Changes in muscle chemistry Viral infection Hormonal abnormality Neurotransmitter abnormality (neurotransmitters are chemical messengers in the brain) Family history or genetics Chronic sleep disturbance Who Gets Fibromyalgia? It is estimated that between three and six million Americans have fibromyalgia. The typical person with fibromyalgia is female and in her mid-thirties. Women are affected more often than men; approximately two-thirds of people with fibromyalgia are women. Additionally, the symptoms of fibromyalgia appear to be more severe in women than in men. Fibromyalgia usually appears between the ages of 20 – 50, although children and the elderly can also be affected. Signs and Symptoms While the symptoms of fibromyalgia may vary in severity, people are almost always aware of their presence. The symptoms may be the most intense during the first year. The most common symptoms of fibromyalgia are all-over pain and fatigue. Often the pain starts in one area (usually the neck and shoulders), and then spreads to other areas. The muscles that are most often affected are in the neck, spine, shoulders and hips. There are many words that people use to describe the pain, including "exhausting," "burning," "radiating," and "aching." Almost all people with fibromyalgia feel extreme tiredness due to disturbed, unrefreshing sleep. Some people feel that the fatigue is more distressing than the pain. The classic symptoms of fibromyalgia are: All-over pain Fatigue and sleep disturbances Other symptoms may include: Migraine or tension headaches Irritable bowel syndrome Bladder problems due to bladder spasms Mood changes (such as depression or anxiety) Poor concentration and forgetfulness Sensitivity to cold temperatures Numbness and tingling Premenstrual syndrome (PMS) in women The Diagnosis of Fibromyalgia A physician should diagnose fibromyalgia. At this time, there is no specific test that will diagnose fibromyalgia. It may be difficult for a physician to come to a quick diagnosis, as the symptoms of fibromyalgia are similar to many other illnesses. It is important to exclude any of these other illnesses that could be causing the symptoms. The physician will conduct a complete medical and family history, perform a thorough physical exam and draw blood for laboratory analysis. The physician will make the final diagnosis based on symptoms. If a person has pain in eleven of eighteen tender points (found in the neck, chest, upper and lower back, inside of the arm, buttocks and knee cap) that has persisted for more than three months, in addition to other symptoms associated with fibromyalgia, the physician may make the diagnosis of fibromyalgia. How Serious is Fibromyalgia? Complications of Fibromyalgia People respond to fibromyalgia in many ways: some are able to continue functioning well while others are unable to cope with the symptoms. Approximately 30–40% of people will stop working or change jobs, and approximately 50% find some difficulty with, or are unable to perform, normal activities. Regardless of the severity of symptoms, fibromyalgia interferes with the quality of life for most people. Long-Term Outlook Fibromyalgia is a chronic condition, meaning that the symptoms usually do not ever completely disappear. Usually, the symptoms do not get worse and it is not life threatening. It does not cause any permanent damage to joints, bones, muscles, ligaments or tendons. Some people may find that their symptoms lessen. Hopefully, research will improve the understanding of this syndrome so that there are more effective ways to diagnose and treat fibromyalgia. What are the Complementary and Alternative Treatments for Fibromyalgia? Acupuncture Biofeedback Chiropractic Guided Imagery Homeopathy Meditation What are the Conventional Treatments for Fibromyalgia? While there is currently no cure for fibromyalgia, there are many approaches that will provide significant benefit and improve quality of life. Treatment is aimed at diminishing the symptoms, not curing the illness. The management of fibromyalgia includes a combination of approaches including lifestyle modifications (exercise and stress reduction), medication, physical therapy and behavioral cognitive therapy. Thorough education regarding fibromyalgia is important, as this can help people cope with the illness and its impact on daily living. The medications used for fibromyalgia primarily improve sleep and decrease pain. Examples are: Tricyclic antidepressants (TCA) –improve mood and sleep, and diminish muscle pain. Examples are amitriptyline (Elavil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), amoxapine (Asendin), trazodone (Desyrel), and nortriptyline (Pamelor) Serotonin-reuptake inhibitors (SSRI) –increase the serotonin levels in the brain and are primarily used for people who have depression associated with fibromyalgia. Examples are fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and fluvoxamine (Luvox). Other Medications — include cyclobenzaprine (Flexeril) for muscle spasms, acetaminophen (Tylenol) for pain, alprazolam (Xanax) and diphenhydramine (Benadryl) for insomnia and anxiety, and injection of a local anesthetic (Procaine) into tender points for severe pain. Some of the goals of treatment are to: Decrease pain Improve sleep Manage emotional aspects including depression, anxiety and stress Provide coping strategies Improve quality of life Provide thorough education regarding fibromyalgia and its management Self Care How Can the Symptoms of Fibromyalgia Be Diminished? There are several steps that one can take to minimize the symptoms of fibromyalgia: Establish healthy, regular sleep habits. Exercise regularly (good forms of exercise include swimming, walking and stationary biking). Eliminate or reduce stress (use deep breathing, muscle relaxation, meditation, biofeedback, or massage therapy). Learn proper body posture. Maintain a healthy diet that is low in animal fat and high in fiber. Join a support group. Become educated about fibromyalgia; being informed can help one cope with the illness.

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