Fibromyalgia: Severe aches and pains that won't quit

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Imagine waking up every day feeling awful--as if you'd just run a marathon or moved too many heavy boxes the day before. Then consider how you'd feel if the pain, fatigue, and stiffness just wouldn't let up. For the estimated three to six million Americans who suffer from a syndrome called fibromyalgia, that kind of chronic discomfort is an all-too-familiar reality.

Taken literally, "fibromyalgia" means pain in the muscles and the fibrous tissues (tendons and ligaments) that connect them. Other symptoms include insomnia; morning stiffness that may last for hours; constant fatigue even after a night's sleep; and recurring headaches. Some patients also experience depression and anxiety (although whether these are a cause or effect of the constant pain is still at issue). Bowel problems like cramps or diarrhea often occur, too. The symptoms frequently come and go in episodes called flares or fibromyalgia storms.

Despite the long list of problems, perhaps the biggest difficulty surrounding fibromyalgia is that it's extremely difficult to diagnose. After all, pain and exhaustion are felt by most of us at one time or another. What's more, the symptoms of fibromyalgia often overlap with those of other disorders, such as lupus. Since fibromyalgia is so difficult to pin down, it's known not as a disease, which is tightly defined, but as a syndrome--a collection of signs and symptoms that appear together.

Fortunately, the condition is being taken more seriously by physicians than it once might have been. In the past, people who reported symptoms connected to fibromyalgia were often doubted by skeptical doctors and disbelieving family members-or worse, written off as psychiatric cases because medical tests couldn't show anything obviously wrong. Now, the medical profession recognizes that fibromyalgia and other chronic pain disorders are real, and some measures have been developed to make diagnosis and treatment a little less tricky.

For instance, although doctors can't "test" for fibromyalgia by drawing blood or taking x-rays, a knowledgeable internist or rheumatologist can perform what's known as a tender point exam. It is conducted by pressing on different sites where fibromyalgia pain is known to lurk and evaluating how much pain occurs in response to the pressure. There are 18 tender points in all, located near the neck, knees, elbows, and hips. If at least 11 of the 18 points are painfully sensitive and the patient has experienced widespread pain for a minimum of three months, a doctor might diagnose fibromyalgia after ruling out other possible reasons for the pain.

Treatment Takes Several Tacks
No surefire cure exists for fibromyalgia, in large part because researchers haven't yet been able to pinpoint a cause. One theory is that sleep disturbance may have something to do with it, since many people with fibromyalgia have abnormal sleep patterns. Stress from physical illness or emotional upset may also act as a trigger. Some believe that the immune system goes out of whack, or that there's a hormonal or chemical imbalance at work. Muscle abnormalities and family tendencies have also been suspected.

Whatever the culprit(s), fibromyalgia patients, most of whom are women, can at least take comfort from the fact that while symptoms flare and subside, they do not worsen with time. Furthermore, there are a number of ways to handle the pain:

Find an understanding doctor who is willing to help manage symptoms as they wax and wane.
Use medications like aspirin and ibuprofen to control pain. Many prescription drugs are also available to relieve the insomnia and depression that often accompany fibromyalgia.
While the initial pain and stiffness may seem torturous at first, engage in regular stretching and gentle exercise, such as walking, swimming, or using a stationary bicycle. That will help increase flexibility and fitness.
Consider heat application, whirlpool, and massage, although studies still haven't fully proven their effectiveness.
Avoid excess caffeine and alcohol, since both can cause insomnia, and stick to a well-balanced diet. Also, beware of those peddling bogus dietary treatments like royal jelly supplements or yeast-avoidance diets. Such therapies have not been proven effective. A diet high in magnesium (found in green leafy vegetables, whole grains, and legumes) has been investigated in several research studies, but the scientific jury is still out on whether fibromyalgia is truly connected to a deficiency in magnesium or any other nutrient.
Fibromyalgia Resources
Fibromyalgia may feel like arthritis because soreness often occurs around the joints, but it's referred to by doctors as a form of rheumatism (pain and stiffness) because it doesn't cause the joint deformities that are hallmarks of arthritis. Still, experts in arthritis as well as in rheumatology arc often knowledgeable about the condition, which is why organizations like the Arthritis Foundation can serve as valuable sources of information. Write, call, or "surf" to:

The Arthritis Foundation, P.O. Box 7669, Atlanta, GA 30357-0669; (800) 283-7800; http://www@arthritis.org.

National Chronic Fatigue Syndrome and Fibromyalgia Association, P.O. Box 18426, Kansas City, MO 64133 (include self-addressed, stamped envelope); (816) 313-2000 (24-hour information line).

National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 1 AMS Circle, Bethesda, MD 20892-3675; (301) 495-4484; (301) 565-2966 (TTY for the hearingimpaired); http://www.nih.gov/niams/.

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