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| Fibromyalgia |
| Overview |
 | A chronic disorder with widespread muscular pain, fatigue, and tender
points in localized areas of the neck, spine, shoulders, and hips. |
| Main symptoms:
 | Total body pain |
| Multiple tender points on examination |
| Severe fatigue |
| Nonrestorative sleep |
| Postexertional increase in muscle pain |
| Reduced functional ability |
|
| Other symptoms:
| Recurrent headaches |
| Severe fatigue |
| Irritable bowel syndrome |
| Atypical paresthesias |
| Cold sensitivity ( Raynaud's phenomenon) |
| Restless leg syndrome |
| Aerobic deconditioning |
|
| Affects mainly women of childbearing age. |
| Cause unknown, difficult to establish diagnosis because of similarity to
symptoms of multiple other diseases. |
| Probable abnormal central processing of pain sensations (hyperalgesia)
and nonpain sensations (allodynia). |
| American College of Rheumatology diagnostic criteria: pain for at least 3
months in combination with tenderness in at least 11 of the 18 specific tender point
sites. |
| Am
College of Rheumatology: 1990 criteria for the classification of Fibromyalgia |
|
| Electrodiagnostic Studies |
| Zidar and co-workers : needle
EMG in 22 female patients with fibromyalgia and 9 healthy controls. |
| Mean motor unit potential (MUP) parameters for the trapezius and tibialis
anterior muscles in patients did not differ from controls at rest or during maximum
volutary contraction. |
| No evidence of ongoing motor unit activity was detected, not supporting
the theory that muscle pain is caused by constant muscle tension.
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| Fibromyalgia and major depressive disorder
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| Overlapping symptomatology |
| Similar pattern of comorbid disorders |
| High rates of major depressive disorder among relatives of patients with
fibromyalgia. |
| Similar responses to psychological tests and rating scales |
| High lifetime rates of mood disorders. |
|
| Treatment: |
| Aerobic exercise: swimming and walking |
| Physical therapy: Heat and massage.
|
| Spray and stretch: a vapocoolant spray, such as Fluori-Methane over
the muscle with simultaneous passive stretching. |
| Antidepressant: Fluoxetine and amitriptyline
improved the symptoms of pain, global well-being, sleep disturbances, and function. The 2
medications in combination may be better than either 1 alone.
|
| Tramadol (Ultram) may be helpful. |
| Trigger point injections appear to be effective but must be used in
conjunction with a comprehensive treatment program. |
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| Further Reading |
| Treating
Fibromyalgia - AFP Oct 2000 |
| Am
College of Rheumatology: 1990 criteria for the classification of Fibromyalgia |
| Fibromyalgia. Chap 251. Pg. 993-994. Bennett. RM. Rakel: Conn's Current
Therapy 1998, 15th ed., W. B. Saunders. |
| Pain in fibromyalgia. Winfield, JB. Rheumatic Diseases Clin of N Am. 1999 Feb; 25(1); 55-79 |
| The relationship between fibromyalgia and major depressive disorder.
Hudson JI. Rheum Dis Clin North Am. 1996 May; 22(2): 285-303
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| Is there muscle pathology in fibromyalgia syndrome? Simms RW. Rheum Dis
Clin North Am. 1996 May; 22(2): 245-66 . |
| A randomized, double-blind crossover trial of fluoxetine and
amitriptyline in the treatment of fibromyalgia. Goldenberg D. Arthritis Rheum. 1996 Nov;
39(11): 1852-9 |
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