Dr. Ronald G. Ritchie
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Fibromyalgia (Myofascial Pain Syndrome)

General Information
Fibromyalgia (FM) is a common rheumatic disease with an estimated prevalence of 2.1 to 5.7% of the general population. It has been shown that women are much more likely to develop FM than men (by a ratio of 4 to 1) and that the incidence of FM increases with age, such that it is most common in women who are 50 years of age or older.

Although fibromyalgia is a relatively recent term, this syndrome has been known by several other names over the past years including soft tissue rheumatism, fibrositis, and non-articular rheumatism.

Fibromyalgia diagnosis does not require specialized machinery or laboratory testing. In order to be diagnosed with FM, a person must have experienced widespread pain for a period of three months or longer. This means that a person has to have pain above and below the waist, and on both the left and right side of the body. In addition, a person needs to have 11 of 18 active tender points. Tender points have been identified in specific parts of the body and are considered active when pressure to that area causes an increase in pain. A physician will test this by either using his or her thumb or a device called a dolorimeter to determine if a tender point is active. In addition to widespread pain and 11 of 18 tender points, many individuals with FM also experience a wide variety of other symptoms. Because some of these symptoms are also common in other types of arthritis, your physician may require blood tests, X-rays and other testing to verify your diagnosis.

Some individuals who experience widespread pain without having 11 of 18 tender points, or who have pain which is localized in a specific part of the body, may also have many of the same symptoms as a person with FM. Although not having a formal diagnosis of Fibromyalgia, these individuals should also benefit from treatment.

Signs and Symptoms
As noted, individuals with FM can experience a variety of symptoms and it is for this reason that fibromyalgia is considered a syndrome. Symptoms which may be present include fatigue, stiffness (particularly in the morning), numbness, disturbed sleep, joint or soft tissue swelling, dry eyes, an intolerance to cold, poor memory and concentration, a sensitivity to certain foods, medications and/or allergens, and a feeling of weakness. There are also a number of other conditions which may be present in people with Fibromyalgia including depression, tension and migraine headaches, irritable bowel and bladder, chronic fatigue syndrome (CFS), and Temperomandibular Joint (TMJ) dysfunction.

Many people with FM sleep very lightly, often waking up numerous times during the course of the night, or awakening early in the morning and then having difficulty getting back to sleep. Because of this heightened experience of pain, it is common to become less active as a way of avoiding pain. Decreased activity then leads to muscle deconditioning. What is important here is that the pain related to Fibromyalgia is very real.

Many people with Fibromyalgia can feel like they are on a downward cycle. If you are in pain and not sleeping well, it makes sense that you are going to be very tired or fatigued during the day. Being in pain and having no energy makes it difficult to manage normal activities such as maintaining a job, housekeeping, as well as recreational and other leisure pursuits. This can lead to stress and anxiety as some of these activities begin to fall out of your life. Depression is common as one begins to wonder; “How am I going to be able to make enough money to look after my family”, “I can’t take care of my house and my children as I once could”, “I have lost all the fun activities in my life which used to give me pleasure and enjoyment”. These stresses are made worse by the fact that people with FM look fine. They are not bleeding, disfigured, gaunt or emaciated. Thus, it is often difficult for them to obtain understanding and support from family, friends and employers. Being in pain, feeling fatigued and being depressed makes it difficult to remain active; especially when many of these activities seem to make the pain worse.

What happens to cause fibromyalgia?
Researchers are not sure of the cause of this syndrome; however, a number of factors possibly responsible have been suggested. For many individuals, FM develops gradually without any known cause whatsoever. Others attribute the onset of this syndrome to a variety of causes including mechanical problems in the neck and low back, motor vehicle accidents, work-related injuries, viral illnesses, surgery, infections, emotional traumas, or physical or emotional stress. Simply stated, the causes are varied and have as much to do with the unique physiology and genetics of the individual as with the external provocative insults that are associated with the onset of FM.