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Fibromyalgia syndrome is defined as chronic (more than 3 months) pain associated with a number of other complaints, such as fatigue, problems with sleep, irritable bowel syndrome, headaches, sensation of swelling, particularly in the hands and feet, paresthesias, and anxiety and depression. These complaints are not associated with abnormal laboratory or X-ray findings per se but may occur together with acute illness or as co-complaints in a patient with chronic systemic disease such as rheumatoid arthritis or systemic lupus erythematosus. A set of working criteria has been developed defining FMS as:

Chronic widespread pain experienced and pain in at least 11 of l 8 possible discrete "tender points " on digital palpation. A tender point is a localized area of tenderness to pressure in soft tissue (muscle, bursa, fat-pad, or tendon-insertion into muscle or bone) without radiation as in 'trigger points. The criteria clarify that 'widespread' means symmetrical and above and below the waist. Digital pressure is to be exerted with approximately 4 kg force (rule of thumb: blanching of the palpating finger's nail), and pain at the 'tender points,' not tenderness, fibrositis, fibromialgia, fibrosites, fibromyalgea fibromaylgia


The medical literature appears to be describing fibromyalgia as early as the 18th century, but the first description may actually have been by Hippocrates who, about 400 BC, described pains that were not well defined and were sensitive to changes of the weather. He continued, "the stiffness, tenderness, and fatigue they cause may be likened to that which


Since a number of patients seem to develop symptoms after a flu-like syndrome, some studies have evaluated a viral origin for FMS. Epstein-Barr virus relationship was not found by Buchwald nor by Wallace, and a careful review by Golden-berg did not identify any documented etiology. 12 Acute Lyme disease seems capable of triggering FMS, and increased titer of antibodies to human herpes

Because of the high number of patients complaining of the morning stiffness so common in rheumatoid arthritis (7691%),24-26 as well as the observation of Livedo reticulare (in 64%), Raynaud's phenomenon (in 30-39%), and other


The diagnosis of fibromyalgia is made first and foremost by recognizing the complaints presented through history and physical examination. Key phrases include "pains all over," "always tired," "nobody can figure out what is wrong." Some patients may, however, complain of much more localized pain such as in the low back, one shoulder, or hand/wrist, and


Physical Therapy: A short course of PT with instruction in appropriate stretching and exercises can be helpful. A formalized cardiovascular training program was shown to provide statistical benefit to FMS patients. Application of heat or cold,

Tricyclics: Improvement of sleep pattern and some pain reduction can often be induced by use of 

Exercise: Most patients have experienced the "worn-out" feeling after seemingly normal physical activities. The general consensus is that patients need to exercise to improve, but few studies have been done to prove this contention. McCain and

NSAIDs: Short half-life versions may be helpful in some patients for pain reduction; however, they are often found most effective when concomitant disease, such as arthritis, exists. Many patients will self-medicate by habit or frustration and

Analgesics: Acetaminophen taken at fixed intervals is sometimes helpful. The newer drug Tramadol seems to be worthwhile, but no long-term studies are available in FMS. Narcotics are typically not used in FMS due to the significant risk

Antidepressants: Studies have shown synergism between the use of tricyclics and the selective serotonin reuptake inhibitors (SSRIs). Using amitriptyline and fluoxetine in a

Steroids: In spite of the apparent lower concentration of cortisol in plasma, no effect was found in

Alternative Medicine: As commonly occurs when a diagnosis is controversial and no fast cure is available, a number of medical and non-medical treatments have evolved. These include various dietary 

Disability: Some patients with severe fibromyalgia truly feel incapable of gainful employment, while others with equally severe pains maintain their jobs. Reporting an eight-year follow-up of 1604 FMS patients at six centers, Wolfe et al found