Fibromyalgia Disease

BASICS

DESCRIPTION

Extremely common pain phenomenon occurring in a defined pattern, reproduced by pressure on "trigger points"

System(s) affected: Musculoskeletal
Genetics: N/A
Incidence/Prevalence in USA: 3 in 100
Predominant age: 18-70
Predominant sex: Female > Male

SIGNS AND SYMPTOMS

Pressure manually applied to specific sites, referred to as "trigger points" reproduce the patient's symptoms:
- Temporalis - above the ear
- Anterior to tragus of ear
- Scalenus capitis
- Sternocleidomastoid
- Low anterior neck
- Pectoralis minor
- Manubriosternal
- Anterior and posterior axillary folds
- Trapezius ridge
- Upper rhomboids
- Lower rhomboids
- Iliac crest
- Mid-buttocks
- Mid-rectus femoris
- Mid-vastus lateralis
- Quadriceps insertion - at the patella
- Humeral epicondyles (many investigators would diagnose fibromyalgia, while some prefer epicondylitis) and negative tenderness at "neutral sites" (e.g., scapula, glabella)
Other signs and symptoms:
- Typically insidious in onset
- Pain is increased in the morning, with weather changes, anxiety, stress
- Pain improved by mild physical activity or vacations (stress-relieving situations)
- Non-restorative sleep, with early morning awakening in an unrefreshed state
- Abnormal non-rapid eye movement (non-REM) stage IV sleep
- Generalized fatigue or tiredness
- Anxiety
- Chronic headache
- Irritable bowel syndrome
- Subjective, non-confirmable complaints of swelling or numbness, not associated with objective neurologic findings
- Depression
- Reduced physical endurance
- Decreased social interaction

CAUSES

Loss of non-REM stage IV sleep
Stress
Trauma

RISK FACTORS

Sleep disturbance
Trauma
Depression
Weather changes

DIAGNOSIS

LABORATORY

Normal Westergren erythrocyte sedimentation rate
Normal creatine phosphokinase and aldolase
Normal TSH, T3 resin uptake and T4
Normal complete blood count, renal and liver function

Drugs that may alter lab results: Steroids
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

None

SPECIAL TESTS

Thermography (controversial)

IMAGING

N/A

DIAGNOSTIC PROCEDURES

The clinical history and physical examination

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Electroprobe, electrical stimulation (but not TENS), ultrasound, hot packs, conditioning, increasing social interactions and general conditioning exercises

SURGICAL MEASURES

N/A

ACTIVITY

Fully active. However, the pain of fibrositis may be so distracting as to reduce attentiveness, predisposing to error and accident.

DIET

No restrictions

PATIENT EDUCATION

Printed material: Rothschild, B.: Diagnosing and treating fibrositis and fibromyalgia. Geriatric Consultant, 9(5/6):26-28, 1990
Your personal guide to living with fibromyalgia. Arthritis Foundation, Atlanta, 1997

FOLLOW UP

PREVENTION/AVOIDANCE

Adequate sleep
General conditioning exercises

POSSIBLE COMPLICATIONS

Chronicity
Fibromyalgia is allegedly a greater source of work loss and dysfunction than rheumatoid arthritis

EXPECTED COURSE AND PROGNOSIS

With resolution of sleep disturbance, may resolve totally
Aggressive physical therapy is critical in those who do not respond
Approximately 5% do not respond to any form of therapeutic intervention. Hypnosis may be attempted in that group.

MISCELLANEOUS

ASSOCIATED CONDITIONS

So common almost any disease can be associated with it

AGE-RELATED FACTORS

Pediatric: Uncommon
Geriatric: Common; polypharmacy may be part of the problem
Others: N/A

PREGNANCY

Limits therapeutic approach to physical therapy modalities

OTHER NOTES

Perhaps the most common cause of neck or back pain in this patient population and most common rheumatologic problem in general

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.