Update on Fibromyalgia

There still remains many things we don't know about the condition called fibromyalgia syndrome (FMS). It's not a disease, but rather, a group of symptoms that occur together. Pain is the most distressing symptom but patients can have a wide range of other problems. These may include poor sleep, joint and/or muscle pain, headaches, and fatigue (to name just a few).

In this article, the basic science of FMS is presented. Conditions that can be confused with fibromyalgia are listed. Regional triggers that may induce (bring on) fibromyalgia are also discussed.

FMS is often accompanied by one of many other conditions such as rheumatoid arthritis, thyroid problems, or cancer. Five key issues are the main focus of this review:

  • Which came first, the fibromyalgia or the other conditions that occur at the same time?
  • Is fibromyalgia brought on by stress?
  • Is the pain the cause or the effect of fibromyalgia?
  • What's the best exercise program for this condition?
  • Should medications be used to treat fibromyalgia?

    Early diagnosis and management of FMS has a very good prognosis. Within the first two years, more than half of the patients diagnosed with FMS no longer meet the medical criteria for this condition. The physician must identify the key components for each patient's and develop an individual plan of care.

    Any other condition present must also be treated. Hormone imbalances must be regulated. Psychiatric illnesses should be treated. Psychosocial stressors are identified. Counseling and/or medications can be used to help with anxiety, depression, and the effects of tension.

    Physical therapy can help decrease pain and improve function. Exercise is an important tool in managing muscle pain, fatigue, and sleep disturbances. Exercise also improves muscle endurance and strength.

    Medications can be used at the same time to decrease pain messages from the spinal cord to the brain. The authors review the many drugs available including when to use them, the dosage, and any adverse effects or precautions.

    Patient education and a total management program are needed for good results with fibromyalgia. Patients with special needs should be referred to the appropriate specialist, whether that's a physical therapist, acupuncturist, chiropractor, counselor, psychiatrist, or other professional with specialized skills.



    References: David S. Hallegua, MD, and Daniel J. Wallace, MD. Fighting Fibromyalgia: Five Key Issues. In The Journal of Musculoskeletal Medicine. April 2008. Vol. 25. No. 4. Pp. 172-184.

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