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Fibromyalgia Basics

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What Your Doctor May Not Tell You About Fibromyalgia Fatigue

The First Year, Fibromyalgia, An Essential Guide for the Newly Diagnosed

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Fibromyalgia or fibromyalgia syndrome(FMS) is a chronic pain condition in the fibrous tissues of the body-the muscles, tendons, and ligaments. Fatigue is often part of the condition. So far, there is no known cause or cure. FMS is not considered to be a degenerative disease although for many it feels that way. Chronic pain, fatigue, decreased physical activity, fibro fog (thinking confusion) and emotional stress, can result in significant negative life changes.

Fibromyalgia is a syndrome, not a disease. It was officially recognized by the World Health Organization(WHO) on January 1,1993. The WHO defines fibromyalgia syndrome (FMS) as a painful but not articular (not present in joints), condition predominantly involving muscles, and is the most common cause of widespread muscularskeletal pain. In 1994 the following was added to the definition. '...the presence of unexplained widespread pain or aching, persistent fatigue, generalized morning stiffness, non-refreshing sleep, and multiple tender points. Most patients with these symptoms have 11 or more tender points.

Tender points are places on the body that hurt when pressure is applied. There are 18 primary tender points on the body. They always occur in pairs and are located:

  • where the head and neck meet
  • on the upper line of the shoulder, a little less than halfway from the shoulder to the neck
  • three finger widths, on a diagonal, inward from the last points
  • on the back fairly close to the "dimples" above the buttocks, a little less than halfway in toward the spine
  • below buttocks very close to the outside edge of the thigh, about three finger widths
  • on the neck, just above inner edge of collar bone
  • four finger widths down from the last points
  • on the inner palm side of the lower arm, about three finger widths below elbow crease
  • on the inner side of the knee, in the fat pad
These points can vary slightly from person to person.


People with FMS experience a wide range of symptoms and degrees of discomfort--from little or infrequent pain and fatigue to being severely disabled. The most recognizable symptom is pain. Some sufferers describe FMS as "a chronic migraine in my muscles", "like the discomfort you have in your body when you have the flu", "pervasive low-grade pain and fatigue that never stops" and that "terrible tingly feeling when you wake up and your muscles arenŐt quite awake yet-but all the time".

Women are the largest affected group, but it can affect anyone--all age groups, races, and sexes. There are no tests to identify FMS, only tests that rule out other possible conditions. This is often the most frustrating part, to remain undiagnosed. Patients are often sent to specialist after specialist, sometimes ending up at a psychiatrist and told it is all "in their heads".

FMS is often misdiagnosed because the symptoms can mimic other conditions such as chronic fatigue, lupus, depression, and multiple sclerosis. There are seemingly endless symptoms.

Other common symptoms

FatigueThis symptom can be mild in some patients and incapacitating in others. It affects both physical and mental abilities.

Sleep disorderMany fibromyalgia patients have a sleep disorder that prevents them from reaching the stage 4, restorative sleep. This "feeds" the cycle of fatigue.

Irritable Bowel SyndromeConstipation or diarrhea are reported by most FMS sufferers.

Chronic headachesRecurrent headaches are frequently experienced.

Multiple Chemical Sensitivity SyndromeSensitivities to odors, noises, bright lights, medications and foods are often reported by people with FMS.

Other common symptomsAllergies, temporomandibular joint syndrome (TMJ), painful menstrual periods (dysmenorrhea), mitral valve prolapse, stiffness especially in the morning, numbness and tingling, muscle and leg twitching, bladder problems, the feeling of swollen extremities, skin sensitivities, dry eyes and mouth, visual perception problems, and dizziness or vertigo are common symptoms.

Common treatments include lifestyle changes to help conserve energy and minimize pain, anti-depressant or tricyclic drugs to help regulate sleep patterns, pain medications to control severe pain, a gentle exercise program, massage or similar physical therapies, dietary and environmental changes to keep the immune system in good shape, and relaxation therapy. A therapy using a drug, guaifenesin, has reduced the symptoms for many sufferers.