Fibromyalgia, affecting some 5-10 percent of the population, is characterized by tight, tender muscles, usually sore points in the neck, shoulders, chest, back, knees and hips. Insomnia and depression often are associated with the condition. While it is benign and non-progressive, fibromyalgia is chronic. No specific cause is known, although it sometimes appears following trauma. Chronic pain affects some 80 million Americans and, following cancer and heart disease, is the third leading cause of physical impairment in the United States.

Diagnosis

Diagnosis of fibromyalgia often involves ruling out other illnesses. To meet ACR (American College of Rheumatology) 1990 diagnostic criteria for fibromyalgia, digital palpation with an approximate force of 4 kgs. must produce a report of pain in at least 11 of these 18 tender points. Other areas can be tender as well. The tenderness should be focal rather than diffuse. Tender points must be present on both sides of the body, above and below the waist and in the midline. Widespread pain must have been present for at least 3 months. Some accept a diagnosis of fibromyalgia with fewer than 11 tender points if several associated symptoms are also present

The treatment for FMS is multifold.

Education

Patients must understand that the diagnosis is fibromyalgia, rather than a euphemism or synonym. Fibromyalgia is a chronic pain disorder and that it is not a progressive condition, an immunologic disorder, or an inflammation. Consequently, anti-inflammatory remedies (specifically NSAIDs) have little long-term benefit in the management of fibromyalgia. The Arthritis Foundation has the most factual information on fibromyalgia education. Reliable studies have not demonstrated that chiropractic manipulation, acupuncture, hypnotherapy, or nutritional supplements help most people.

Sleep Hygiene

Clearly most people with chronic pain (regardless of the cause) have difficulty attaining restorative sleep, and FMS patients are no exception. Soporifics (Sleep inducers) that improve the quality of sleep are often helpful for pain tolerance and improving overall well-being.

Medications

Nonhabituating medications such as tricyclic antidepressants or some mild benzodiazepines for some resistant cases can be useful.

Exercise

Exercise has been found repeatedly to help improve overall tolerance to pain and reduce the symptoms of FMS. Generally this needs to be a conditioning form of exercise with some increase in target heart rate, such as low-impact aerobics (eg, swimming, bicycling, etc.).