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.

Fibromyalgia and major depressive disorder

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.

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 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