But that view is changing rapidly. Not only is fibromyalgia
accepted as a diagnosable illness, it is also a syndrome that
researchers are finding more complicated as new information
As recently as a year ago, many physicians still associated
some of fibromyalgia's symptoms with emotional problems, but
that's no longer the case.
A simple description of fibromyalgia is that it is a chronic
syndrome characterized by widespread muscle pain and fatigue.
For still unknown reasons, people with fibromyalgia have
increased sensitivity to pain that occurs in areas called
their "tender points." Common ones are the front of the knees,
the elbows, the hip joints, the neck and spine. People may
also experience sleep disturbances, morning stiffness, irritable
bowel syndrome, anxiety and other symptoms.
According to the American College of Rheumatology, fibromyalgia
affects 3 million to 6 million Americans, 80 percent to 90
percent of whom are women. The condition is most often diagnosed
during middle age, but at least one of its symptoms appears
earlier in life.
But is there a psychological tie-in strong enough to differentiate
fibromyalgia from other similar diseases and conditions? Apparently
"Fibromyalgia patients are such a diverse group of patients,
they cannot all be the same," said Dr. Thorsten Giesecke,
a University of Michigan research fellow.
Giesecke and his colleagues evaluated 97 fibromyalgia patients,
including 85 women and 12 men. The patients underwent a two-day
series of tests, answering questions about their coping strategies
and personality traits -- particularly their emotional well-being.
They were also tested for sensitivity to pressure and pain.
"It's generally been thought that fibromyalgia patients
who have higher distress have higher pain sensitivities,"
In other words, it was believed that those with fibromyalgia
who were prone to emotional difficulties such as depression
and anxiety were more likely to experience greater physical
But his study didn't bear that out. In fact, patients in
one of the three groups in the study who had the highest pain
levels had the lowest anxiety.
The term fibromyalgia comes from the Latin word for fibrous
tissue (fibro) and the Greek ones for muscle (myo) and pain
(algia). Tender points are specific locations on the body
-- 18 points on the neck, shoulders, back, hips and upper
and lower extremities -- where individuals with fibromyalgia
feel pain in response to relatively slight pressure.
The U.S. government's National Institute of Arthritis and
Musculoskeletal and Skin Diseases says fibromyalgia patients
often experience combinations of many other chronic and frustrating
- sleep disturbances,
- morning stiffness,
- irritable bowel syndrome,
- painful menstrual periods,
- numbness or tingling of the extremities,
- restless leg syndrome,
- temperature sensitivity,
- cognitive and memory problems, sometimes referred to as
Latest research indicates that fibromyalgia is the result
of internal biochemical imbalances that cause physical symptoms
such as pain, weakness and mental impairment. Because it is
a syndrome -- a collection of signs and symptoms -- rather
than a disease, fibromyalgia can't be diagnosed by an invariable
set of specific symptoms or reproducible laboratory findings.
Even with the findings about relatively small psychological
influence, practical experience seems to indicate that stress
may play a role. Roger H. Murphree, a Birmingham, Ala., chiropractor
who specializes in treating patients with fibromyalgia and
chronic fatigue syndrome, said he has seen a link between
stress and the intensity of fibromyalgia.
"Most of us live in a world of stress," Murphree said. "Something
has to give, and it's usually sleep. Meanwhile, we subsist
on junk food, caffeine, alcohol and prescription medications.
Such a lifestyle isn't good for anyone. But for an unlucky
few, the toll is severe."
Dr. Jacob Teitelbaum, whose practice in Annapolis, Md.,
led him to do research into fibromyalgia and the closely related
chronic fatigue syndrome, concluded that the body's endocrine
system could hold the clue to treatment. It's a matter of
how the body's energy is marshaled, he said.
"Fibromyalgia is like the body blowing a fuse," he explained.
"The hypothalamus serves as humans' internal fuse box. When
the demands of living build up, stress increases and the hypothalamus
shuts down. Because the circuit is overtaxed and the fuse
is blown, the body simply can't generate enough energy."
"That causes muscles to cease functioning in a shortened
position, resulting in pain all over the body and a general
feeling of fatigue or weariness," Teitelbaum said.
Murphree's experience with hundreds of patients confirms
Teitelbaum's analogy. Most, he said, are either "Type A" perfectionists
or "Type B" caregivers.
"Type A fibromyalgia patients work and work and work until
they burn out," said Murphree. "Type B patients give and give
and give -- nurturing their spouses, children, family and
friends -- until they break down. Anyone whose lifestyle includes
very little downtime is at risk."
Teitelbaum recommends a four-pronged approach to repair
the "blown fuse" and turn the body's current back on:
- Restoration of sleep -- at a minimum, eight to nine hours
every night, using appropriate medications, as needed;
- Restoration of a normal hormone balance, including thyroid,
adrenal and reproductive hormones;
- Appropriate treatment for infections that may be present
as a consequence of the body's depleted immune function;
- Nutritional support, particularly with B complex vitamins,
magnesium, zinc and malic acid.
Teitelbaum uses the acronym SHIN to summarize his
treatment regimen. "S is for sleep, H for hormone balance,
I for infection control, and N for nutrition," he explained.
"The important thing is that all four should be implemented
in concert with one another for maximum therapeutic effect."
articles on Fibromyalgia
Institute of Arthritis and Musculoskeletal and Skin Diseases
offers more information on fibromyalgia.